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Vaginal bleeding: What's normal, what's not?
From MayoClinic.com
Special to CNN.com

Women expect vaginal bleeding as the uterus sheds its lining during menstruation. What's considered normal vaginal bleeding varies from woman to woman. One woman may have a period every 21 days, bleed for a few days and lose only a few teaspoonfuls of blood. Another woman may have her period only every 35 days, bleed for more than a week and lose several teaspoonfuls of blood. Both are within normal ranges of vaginal bleeding in the average premenopausal woman.

But unexpected vaginal bleeding could indicate a problem of the vagina, cervix or uterus, especially if you're postmenopausal. When might vaginal bleeding be a cause for concern? Andrew Good, M.D., an obstetrician and gynecologist at Mayo Clinic, Rochester, Minn., provides answers to your questions about irregular vaginal bleeding.

What's considered irregular or abnormal vaginal bleeding?

Irregular vaginal bleeding may include spotting of small amounts of blood between periods — often seen on toilet tissue after wiping — or heavy periods in which you soak a pad an hour for several hours. Any vaginal bleeding for weeks at a time also is considered irregular.

Should you be concerned if you experience irregular vaginal bleeding?

It depends on your age and the circumstances. If you're premenopausal, light spotting a couple of days before your period is common and not worrisome. And if you're starting on birth control pills, you may experience occasional spotting the first few months.

If you're menopausal or postmenopausal and are on hormone therapy on a cyclic regimen — taking oral estrogen daily plus oral progestin for 10 to 12 days a month — you may experience some bleeding resembling a period for a few days out of the month. This is known as withdrawal bleeding. If you have any vaginal bleeding other than the expected withdrawal bleeding, contact your doctor.

If you're menopausal or postmenopausal and are on hormone therapy on a continuous combined regimen of estrogen and progesterone — taking a low-dose combination of estrogen and progestin daily — light, irregular bleeding is common for the first six months of combined hormone therapy. If bleeding persists longer or heavy bleeding begins, see your doctor.

If you're menopausal or postmenopausal and aren't on hormone therapy, any vaginal bleeding means you need to see your doctor. In girls who haven't gone through puberty, any vaginal bleeding is cause for concern. Newborn girls may experience some vaginal bleeding for a few days — any vaginal bleeding beyond that should be investigated.

In general, if you're experiencing unexpected vaginal bleeding, consult your doctor.

What gynecologic conditions are associated with irregular vaginal bleeding?

Irregular vaginal bleeding could indicate one of the following diseases or conditions:

  • Menstrual dysfunction
  • Fluctuating hormone levels
  • Vaginal infection
  • Tumors, polyps or fibroids of the vagina, cervix, uterus or fallopian tubes
  • Cervical disorders — such as cervical ectropion, a condition common among younger women, especially young women taking birth control pills — in which the cervical tissue becomes more susceptible to abrasion, often associated with bleeding after sexual intercourse
  • Cancer of the uterus, cervix, vagina or vulva
  • Some sexually transmitted diseases, such as chlamydia, gonorrhea or genital warts
  • Vaginal injury from trauma or sexual abuse
  • Early pregnancy-associated bleeding or an ectopic pregnancy, in which the fertilized egg becomes implanted outside the uterus
  • Complications from pregnancy, such as miscarriage

Should you be concerned about irregular vaginal bleeding if you've had a hysterectomy?

Yes. During a total hysterectomy, your uterus and cervix are surgically removed. In their absence, vaginal bleeding is likely the sign of a vaginal condition that needs medical evaluation. In some hysterectomies, the cervix isn't removed. Irregular vaginal bleeding could then be related to either the cervix or the vagina and needs medical evaluation.

Does irregular vaginal bleeding mean you have cancer?

In most cases, irregular vaginal bleeding is due to a noncancerous (benign) condition. In premenopausal women, irregular vaginal bleeding is often the result of hormonal fluctuations and not a malignancy. In older women, particularly postmenopausal women, vaginal bleeding may be associated with a gynecologic cancer, but the bleeding could instead be due to a noncancerous condition. Certain risk factors exist for uterine, cervical and vaginal cancers. Talk with your doctor about whether you're at increased risk of these cancers.

What should you do if you experience irregular vaginal bleeding?

If you experience irregular vaginal bleeding, schedule an appointment with your physician and be certain to record when the bleeding occurs during the month. Also, try to determine if the bleeding is vaginal or anal. Don't be frightened — most irregular vaginal bleeding has a benign cause. If you're having heavy vaginal bleeding — saturating a pad an hour for more than a couple of hours — seek prompt medical attention.

If you're taking birth control pills or are on hormone therapy, talk with your doctor and follow the instructions he or she gives you. This may be as simple as taking additional pills, but you may need to change medicines completely.

If you're pregnant and experience vaginal bleeding, contact your doctor immediately.

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  • August 17, 2006

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