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Abnormal Menstrual Bleeding

Menstrual bleeding can be defined as too much with any of the below:

• More than 7 days of bleeding
• More than 6 soaked pads or tampons per day
• Periods happen more often than every 21 days
• Any bleeding or spotting between regular periods
• If you feel your bleeding is more than normal, you should be seen.

Causes of Abnormal Vaginal Bleeding

• Vaginal bleeding is abnormal if it occurs between regular periods. Heavy bleeding is also not normal. Abnormal bleeding that is severe or lasts more than 7 days should be seen. Bleeding along with signs of severe anemia (pale skin, weakness) should also be seen.
• Sexually Transmitted Infections (STIs) may cause spotting or blood-tinged discharge. If you think you have a sexually transmitted infection, see a doctor. You and your sexual partners should be treated to avoid spread to others and problems from the infection. It could affect your fertility.
• Birth Control. Some birth control meds can cause spotting or abnormal bleeding. This most often occurs for the first few months on the birth control med.
• Pregnancy. Vaginal bleeding can be a sign of pregnancy. Many women have some bleeding in early pregnancy and go on to have a normal pregnancy and delivery. It can also be more serious problem, so if you are or could be pregnant and you have bleeding or spotting, you should let your doctor know. If you are not sure you are pregnant, do a pregnancy test.
• Cervical Polyps. Polyps are small growths that can occur on the cervix. They may cause a vaginal discharge or vaginal bleeding or spotting between periods or after sex. They are rarely cancerous and can easily be removed.
• Cervical Ectopy or Erosion. Some of the softer lining that is inside the womb, spreads to the cervix. It is not a serious problem. It may not need any treatment, but can cause a vaginal discharge or vaginal bleeding or spotting after sex or between periods.
• Hormone Changes can be caused from stress or hormone treatment (birth control pill, contraceptive implants or coils). This may cause abnormal bleeding or spotting between periods. It is normal to have spotting at first with some types of implants and coils.
• Cervical Cancer. Bleeding after sex can be a sign of cervical cancer. Get this checked right away. If caught early, cervical cancer can be treated. Get regular Pap smear tests. They can detect cervical cancer at an early stage (even before you develop symptoms). They can also detect changes in the cervix which could lead to cancer later on.
• Uterine Cancer. Symptoms of pain and heavy vaginal bleeding which are not common for you should be checked by your doctor. The symptoms may happen at the time of your period, at a different time in your cycle or after your periods have finished (menopause).
• Pelvic Inflammatory Disease can cause pain and abnormal bleeding at the time of your period or in between periods.
• Fibroids are non-cancerous growths that occur in the wall of the womb. They can grow to be very large and can cause heavy periods and pain. They may need to be removed by surgery.
• Endometriosis is an issue in which womb lining tissue grows outside the womb (on the ovaries, fallopian tubes or even in the abdomen). It is not cancerous, but can cause pain and abnormal bleeding.
• Peri-menopausal Abnormal Bleeding.  During menopause your periods may become lighter and less regular than what has been normal for you. Over time, they will stop. During this time, it is hard  to know what is normal and what is abnormal. If you are worried or think your bleeding is abnormal, talk with your doctor.
• Post-menopausal Bleeding (serious).  This is bleeding happens at least 12 months after your last period. You should always see your doctor if this happens to you. It could simply be that the lining of your vagina has become frail and dry as your hormone levels fall. This can cause bleeding and/or a vaginal discharge, since infection is more likely. It can usually be diagnosed with a vaginal exam. It is easily treated with hormone creams. A more serious cause of post-menopausal bleeding, which must be ruled out is uterine cancer or cancer of the lining of the uterus. Your doctor will order tests to rule this out. If caught early, it is possible to treat it.

Vaginal Bleeding Severity:

• Spotting: pinkish/brownish mucus discharge, less than 1 pad total per day
• Mild: less than 1 pad per hour; like common menstrual bleeding
• Moderate: 1-2 pads per hour; small blood clots (size of a pea, grape, small coin)
• Severe: soaking more than 2 pads per hour. Bleeding may overflow the pads. Can also have large blood clots (size of a golf ball or large coin).