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).

When to Call for Vaginal Bleeding - Abnormal

Care Advice

Menstrual Periods

What You Should Know about Abnormal Vaginal Bleeding:

• This is vaginal bleeding which is not normal for you. It may be heavier or lighter than your normal period, or at an unusual time. You may or may not also have pain or vaginal discharge.
• Talk to your doctor if you are bleeding more than normal. This means using 2 or more tampons or pads than you normally use per day. Periods that last 3 or more days longer than normal should also be discussed.
• The bleeding can occur:
• at the time of your period as heavy bleeding or clots
• in between your periods
• after sex
• while you are still having periods
• while you are going through the menopause (peri-menopause)
• after the menopause (more than 12 months after your last period)
• while using birth control
• Here is some care advice that should help.

Iron and Anemia:

• Heavy periods can cause anemia. This is caused from not enough iron. It is one of the most common causes of anemia in women.
• Women with heavy periods should eat foods rich in iron. They can also take a daily vitamin pill with iron.

Mild Spotting Causes - Normal:

• There are common causes spotting outside of normal periods.
• Spotting can happen after a doctor's exam.
• It can also happen the first time you have sex.
• Some women spot when they ovulate (often on about day 14.) This spotting can be normal.
• Bleeding from these causes should not last longer than 2 days.

Pregnancy Test, When in Doubt:

• If there is a chance that you might be pregnant, use a urine pregnancy test.
• You can buy a pregnancy test at the drugstore.
• It works best if you test your first urine in the morning.
• Follow all package instructions.

Call Your Doctor If:

• Pregnancy test is positive
• You have trouble with the at-home pregnancy test
• Bleeding becomes worse
• Spotting lasts more than 2 days or happens again
• You think you need to be seen
• Your symptoms get worse

Irregular Bleeding On Birth Control Meds

What You Should Know:

• Mild bleeding or spotting is common with types of hormonal birth control.
• This is often true the first few months after you start birth control.
• It often will get better as your body adjusts to the hormones.
• Here is some care advice that should help.

Spotting Between Periods and Taking Birth Control Pills:

• This is common.
• You may have breakthrough bleeding or spotting with most of these pills.
• It is likely to happen during the first three pill pack cycles.
• Missing a pill may cause breakthrough bleeding or spotting.

Irregular Bleeding and Using Birth Control Implant or Shot:

• This is common for the first several months.
• Irregular bleeding may be heavier or lighter than normal.
• It may also be more or less frequent bleeding than your normal period.
• Bleeding and spotting usually decrease over time.

Irregular Bleeding and Using the Birth Control Patch:

• This is common.
• You may have breakthrough bleeding or spotting with these patches.
• This is likely to happen during the first 3 cycles (months).

Irregular Bleeding and Using the Vaginal Ring (NuvaRing):

• This is not common.
• Most women don't have breakthrough bleeding or spotting with NuvaRing.
• But, it can happen during the first 1-2 months of use (first 2 cycles).

Keep a Record of Bleeding:

• Keep a record of the days you have any bleeding or spotting.

Call Your Doctor If:

• Irregular bleeding happens more than 2 cycles (2 months)
• Bleeding becomes worse
• You think you need to be seen
• Your symptoms get worse

Taking Birth Control Pills and Missed Doses

What You Should Know About Missed or Late Doses of Birth Control Pills:

• Almost everyone misses a dose of their birth control pill at one time or another.
• Try to remember to take them the same time every day. Many women take them with a meal. Some women use an alarm or phone reminder to remind themselves.
• Missing a pill is also a common cause of breakthrough bleeding or spotting. This is normal.
• Here is some care advice that should help.

Missed Placebo Pills:

• Follow these directions if you missed 1 or more placebo pills (reminder pills).
• Throw away the missed pill or pills.
• Keep taking the rest of the pills on the usual day.
• You are not at higher risk for pregnancy.
• You do not need to use a back-up form of birth control.
• Example: missed pill(s) during days 22-28 of a 28-day of combination pill pack.

Late Taking 1 Active Pill (less than 24 hours since a pill should have been taken):

• Follow these directions if you are late taking an active hormone pills (not placebo pills).
• Take the late pill as soon as you can.
• Take the next pill at the normal time. This means you may need to take 2 pills at one time. This may also mean taking 2 pills on the same day.
• Taking 2 pills may make you feel a little nauseated, but this is normal. It should pass in a day.
• There is little or no risk of getting pregnant with 1 late pill. Exception: progestin-only pills. See that Advice below.
• You do not need to use a back-up method of birth control.

Missed 1 Active Pill (24-48 hours since a pill should have been taken):

• Follow these directions if you missed 1 active hormone pill (not placebo pills).
• Take the missed pill as soon as you can. Take the next pill at the normal time. This means you may need to take 2 pills at one time. This may also mean taking 2 pills on the same day.
• Taking 2 pills may make you feel a little nauseated, but this is normal. It should pass in a day.
• There is little or no risk of getting pregnant with 1 missed pill. Exception: progestin-only pills. See that advice below.
• You do not need to use a back-up method of birth control.

Missed 2 Active Pills (2 or more):

• Follow these directions if you missed 2 or more active hormone pills (not placebo pills).
• Take one of the missed pills (most recently missed) as soon as possible.
• Throw away other missed pills. Take the next pill at the normal time. This means you may need to take 2 pills at one time. This may also mean taking 2 pills on the same day.
• Taking 2 pills may make you feel a little nauseated, but this is normal. It should pass in a day.
• Call your doctor for further instructions during office hours.
• Use a back-up birth control method until you speak with your doctor. You can also avoid having sex until you talk with your doctor. Ask your doctor how long you need to use back-up birth control.
• Consider emergency contraception, if it is available to you, if you've had unprotected sex in the past 5 days.

Progestin-Only Pills - Missing Doses or Taking Dosages Late:

• These pills need to be taken at the same time daily to work the best. This is very important. Reason: pregnancy is possible if you take your dosage more than 3 hours past the normal time.
• Follow these directions if you miss a pill or take a pill more than 3 hours late.
• Take the missed or late pill as soon as you can. Keep taking the rest of your pills at your normal time every day. This means you may need to take 2 at one time. This may also mean taking 2 pills on the same day.
• Use a backup method (such as condom and foam) after taking the late pill. You will need to do this for 48 hours.
• If you had sex before you realized you missed pills, consider emergency contraception if it is available to you.

Lost 1 Pill:

• Take the next pill in the pack today.
• As a result, you will finish the birth control pill pack one day sooner.
• Start your next pill pack one day earlier. Reason: most pregnancies on the pill (with regular use) happen with late starts of the pill pack. Even just 1 or 2 days late as you may ovulate early.

Emergency Contraceptive Pills (ECP) - When to Consider:

• Emergency contraception pills (ECPs) can be used by women who are worried they might become pregnant.
• Due to recent legal and political actions, ECPs are not available to women in every state. Ask your doctor or pharmacist if they are available to you.
• ECPs should be taken as soon as possible within 5 days after unprotected sex.
• The sooner ECPs are taken, the better they work.

Pregnancy Test, When in Doubt:

• If there is a chance that you are pregnant, use a urine pregnancy test.
• You can buy a pregnancy test at any drugstore.
• It works best if you test your first urine in the morning.
• Follow all package directions.

Call Your Doctor If:

• Pregnancy test is positive
• You have more than mild bleeding or spotting
• You think you need to be seen

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.




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