Abnormal Non-menstrual Vaginal Bleeding

• Vaginal bleeding that occurs outside the normal menstrual period may indicate health problems, such as sexually transmitted diseases, cervicitis, vaginitis, or an ectopic pregnancy. It can also be an indicator of other more serious diseases, including cancers of the reproductive system.
• If vaginal bleeding is exceptionally heavy or lasts longer than 7 days, or if it is accompanied by severe lower abdominal or pelvic pain, dizziness, fever, or abnormal paleness, you should see a doctor to diagnose the cause and receive treatment.
• Abnormal vaginal bleeding may resolve on its own. However, some vaginal bleeding, if left untreated, can become so severe that it can no longer be treated or may even become life-threatening.

Women of reproductive age usually have their period every 21-35 days. Menstrual flow in each cycle generally lasts no more than 7-8 days, depending on  the person’s body, along with other factors such as age, stress, diet, exercise, and genetics. Menstruation lasts until about 45-55 years of age or whenever menopause begins.  
Vaginal bleeding that occurs at times other than during the monthly period may indicate health problems, such as sexually transmitted diseases, cervicitis, vaginitis, or an ectopic pregnancy. However, it can also be an indicator of other more serious diseases, including cancers of the reproductive system. As such, if you experience any vaginal bleeding outside of your normal menstrual cycle, you should see a doctor to diagnose the exact cause and receive proper treatment.

• Normal Vaginal Bleeding or menstruation. In each menstrual cycle, the ovaries produce eggs for fertilization by sperm. If no eggs become fertilized, the lining of the uterus (endometrium) breaks down and is shed during menstruation. The length of the menstrual cycle varies from woman to woman.
• Abnormal Vaginal Bleeding is bleeding that occurs between periods, such as bleeding or spotting during pregnancy, postmenopausal bleeding, prepubertal bleeding (vaginal bleeding before the age of 9), etc. Abnormal vaginal bleeding may be due to a variety of causes.

Abnormal vaginal bleeding can occur for a variety of reasons, but if vaginal bleeding occurs along with any of the following symptoms, you should see a doctor for diagnosis of the cause and to receive treatment.

• Heavy vaginal bleeding or bleeding that lasts longer than 7 days and is so heavy that it requires changing sanitary napkins every 2 hours or effect your normal activity in daily life 
• Severe lower abdominal or pelvic pain
• Light-headedness or dizziness as if you are going to faint
• Fever
• Symptoms worsening or increasing in frequency
• Looking abnormally pale

• Hormonal contraceptives such as the pill, patch, or injection may cause abnormal vaginal bleeding as a side effect during the first 3 months of use. This is because excess hormones can cause changes in the endometrium.
• Certain sexually transmitted diseases, such as chlamydia
• Cervical or endometrial infections
• Blood clotting disorders
• Other health conditions, such as hypothyroidism, liver disease, or chronic kidney disease
• Uterine fibroids, which are non-cancerous growths that develop in the lining or muscle of the uterus
• Polycystic Ovary Syndrome (PCOS), which occurs when the ovaries become enlarged and contain fluid-filled sacs (follicles) that surround the eggs
• When the body produces excess testosterone or androgen, sometimes causing an absence of menstrual periods
• Cancers of the reproductive system, including uterine cancer, which are more common in postmenopausal women
• Pregnancy complications, such as an ectopic pregnancy, placenta previa, placental abruption, or miscarriage
• Other causes, including overly intense exercise, insertion of a foreign object into the vagina, significant weight gain or loss, a tear or wound in the vagina, etc.

If you are experiencing abnormal vaginal bleeding, you should see a doctor for diagnosis. The doctor will review your medical history, ask about your menstrual cycle, and may arrange some additional exams as follows:

• A pelvic or internal exam to check for abnormalities of the uterus and ovaries
• Cervical cancer screening by collecting a sample from the cervix to test for infection from sexually transmitted diseases and cervical cancer
• A pregnancy test to check for an ectopic pregnancy, placenta previa, placental abruption, or miscarriage
• A blood test to check the integrity of blood cells in the case of excessive bleeding which can lead to anemia
• A blood test to check for abnormalities in various bodily functions, including the thyroid, liver, kidneys, and sex hormones

Treatment for abnormal vaginal bleeding depends on the cause and the severity of the condition, as follows:

• Hormonal adjustment may be made with medication or injections in the case of patients with a hormonal imbalance.
• If uterine fibroids, or endometrial polyps are detected, surgery may be needed
• Antibiotics may be used to reduce infection.
• In the case of ineffective drug treatment, curettage of the uterus may be performed in order to control excessive bleeding and detect any further abnormalities of the uterine lining.
• If the doctor is unable to determine the exact cause, patients will be given birth control pills to help adjust the menstrual cycle and reduce bleeding.

If it is found that abnormal vaginal bleeding is caused by cancer of the reproductive system, such as cervical cancer, endometrial cancer, ovarian cancer, or vaginal cancer, your doctor will consider treatments as follows:

• Surgery, of which there are many types, including surgery for only the part of the body where the cancer cells are found, or the surgical removal of internal pelvic organs such as the bladder, ovaries, uterus, and vagina if cancer cells have spread or there is risk of cancer recurrence.
• Chemotherapy to kill cancer cells, suitable for patients with advanced cancer or who are at risk of recurrent cancer. This is mostly postoperative chemotherapy.
• Immunotherapy, which boosts the immune system to help fight cancer. This method is used in cases where other treatments have been ineffective.
• Targeted therapy uses drugs to target and destroy cancer cells. It is highly efficient and may cause fewer side effects than chemotherapy.

Some abnormal vaginal bleeding can resolve on its own. However, if vaginal bleeding is affecting your health, proper medical treatment is required to prevent recurrence and the development of more severe conditions that may be incurable and could, eventually, cause life-threatening complications