Vaginal bleeding - irregular

Irregular vaginal bleeding is any bleeding from a woman’s vaginal area that is not part of a regular menstrual period. The range of possible causes includes infection and hormonal changes. If you have ongoing bleeding problems, see your doctor for a full assessment to make sure there is no underlying disorder causing them.

The menstrual cycle#

During each monthly cycle, the lining of the womb (uterus) thickens in readiness for pregnancy. When pregnancy does not occur, this lining is shed as a period. The loss is about half blood, which can vary in color from bright red to dark brown. On average around 40 ml (about two tablespoons) of fluid is lost, which the body quickly replaces. After each period, the whole cycle starts again.

Periods differ from woman to woman and from month to month. A period can last from three to 10 days and occur every three to six weeks. This pattern can vary with age, stress, diet, exercise and inherited factors, and the flow can also vary.

It is common to feel some cramping pain with a period. This is felt just below the navel and may spread into the legs or lower back. It can feel like a dull ache or a sharp twinge. During a period it is also common to feel bloated and heavy, get more pimples, feel tense and emotional, and have sore breasts and greasier hair.

Causes of irregular bleeding#

In many women, the cause of irregular bleeding is not found. For others, the cause depends on their age and the site of the bleeding. Once pregnancy has been ruled out, some of the known causes include:

• hormonal changes
• contraception such as the pill, an injection or an IUD (intrauterine device)
• infection in the vagina or uterus
• fibroids or polyps inside the uterus
• trauma to the vagina
• some medications, such as anticoagulants or anti-epilepsy drugs
• underlying health problems, such as bleeding or thyroid disorders
• cancer in the lining of the uterus, the cervix or the vagina

Diagnosis#

For some women, a medical history and physical examination are enough for the doctor to diagnose the cause of the irregular bleeding. For others, a range of tests may be offered, including:

• cervical smear and swabs
• a pregnancy test
• blood tests
• ultrasound
• dilation and curettage (D&C), which involves gently widening the cervix and scraping away the uterine lining

Treatment#

Treatment depends on the cause but may include:

• treatment for any underlying health problem
• anti-inflammatory drugs
• antibiotics
• a change of contraception
• hormone therapy
• anti-bleeding agents such as tranexamic acid
• surgery to remove fibroids, polyps or cancers

Taking care of yourself at home#

If you have irregular bleeding, some general home care suggestions include:

• keep a diary of your symptoms to show your doctor
• get plenty of sleep
• eat a well-balanced diet
• do some gentle exercise

If you have pain with your bleeding, suggestions include:

• rest
• curl your knees up to your chest and lie on your side
• place a warm pack, such as a hot water bottle or wheat bag, over your abdomen
• take a warm bath
• wear loose clothing
• rub or massage where it hurts
• take painkillers such as paracetamol (acetaminophen), but avoid aspirin
• try relaxation techniques
• consider increasing your intake of magnesium or vitamin B1

Key points#

• Irregular vaginal bleeding is any bleeding that is not part of a regular period, and its causes include infection and hormonal changes.
• In many women the cause is not found; for others it depends on their age and the site of the bleeding.
• Always have ongoing bleeding problems assessed by a doctor to rule out an underlying disorder.
• Treatment depends on the cause and may range from treating an underlying health problem to medication, a change of contraception or surgery.

Where to get help#