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When Should Abnormal Uterine Bleeding Be a Cause for Concern?

When Should Abnormal Uterine Bleeding Be a Cause for Concern?

woman holding heating pad to pelvis

Abnormal vaginal bleeding can be alarming at any stage of life. Some vaginal bleeding is no cause for concern. However, there are several serious, and even life threatening, complications linked to uterine bleeding during your period or pregnancy.

So, how can you tell the difference, and when is time to see your doctor? We’re covering the many causes of abnormal bleeding during your period or pregnancy so you can seek appropriate treatment when necessary. 

Abnormal Vaginal Bleeding During Your Period

Obviously, vaginal bleeding is a normal part of the menstrual cycle. So, what is considered abnormal bleeding during your period? On average, women pass 40 milliliters of blood during a menstrual period over the course of four to seven days. If you have heavy or prolonged periods and bleeding between periods, this could be considered abnormal. 

Symptoms of abnormal vaginal bleeding during your period include:

  • Bleeding for more than eight days
  • Heavy blood loss during your period, such as soaking through one or more sanitary pads or tampons every hour for several hours in a row 
  • Needing to change your pad or tampon during the night
  • Have to restrict your daily activities due to heavy bleeding
  • Bleeding or spotting between periods
  • Severe cramping and fatigue
  • Vaginal bleeding after menopause

There are a variety of causes for abnormal bleeding during your period, including: 

  • Uterine polyps or fibroids: Uterine polyps are small growths attached to the inner wall of the uterus that are caused by an overgrowth of cells. Fibroids are noncancerous growths in the uterus that typically develop during childbearing years. Both can cause pain and heavy bleeding during your period. 
  • Hormonal imbalances: A hormonal imbalance (typically an excess of estrogen and not enough progesterone) is a common cause of abnormally heavy bleeding. This is most common in teenage girls and women nearing menopause.
  • Endometriosis: Endometriosis is a painful disorder in which tissue similar to the tissue that normally lines the inside of the uterus begins to grow outside the uterus. This condition can cause painful bleeding, cramps, and painful intercourse.
  • Medications: Some anti-inflammatory drugs, anticoagulants (blood thinners), hormone medications, or steroids can affect menstrual bleeding. 
  • Infection: Abnormal bleeding combined with a fever may indicate a pelvic infection. This is most common during menstruation, but can occur at any time during your menstrual cycle. Symptoms typically include pelvic pain (especially during intercourse), bad-smelling vaginal discharge, bleeding between periods, and a fever. 
  • Some forms of contraception: Some women may experience irregular periods or miss periods for up to six months after stopping birth control pills. Intrauterine devices (IUDs) can also cause period irregularities (lighter or heavier flows) or cause your period to stop completely after some time. Birth control pills that only contain progestin (no estrogen) can also commonly cause bleeding between periods.

Upon diagnosis, your doctor will be able to recommend the best course of treatment for you. Treatment options for abnormal menstrual bleeding include:

  • Medication, such as prostaglandin inhibitors, hormone replacement therapy, or antibiotics
  • Dilatation and curettage, which involves scraping the cervix and lining of the uterus
  • Changing your method of contraception 
  • Surgery to remove tumors, polyps, or fibroids 
  • Treating any underlying disorders, such as hypothyroidism or a bleeding disorder
  • Surgical hysterectomy to remove your uterus, which is generally only considered for treatment of serious diseases, such as cancer

Abnormal Uterine Bleeding During Pregnancy

During your first trimester of pregnancy, you may experience some vaginal bleeding. This is fairly common. However, it’s important to be aware of potential complications and warning signs that could signal more serious issues.

First Trimester Uterine Bleeding Causes

  • Implantation bleeding is a normal part of early pregnancy. You may experience light spotting within the first six to 12 days after you conceive. Implantation bleeding is typically light and lasts up to a few days.
  • Miscarriages are most common during the first 12 weeks of pregnancy. They can cause vaginal bleeding, along with strong cramps and tissue passing through the vagina.
  • Ectopic pregnancy occurs when the embryo implants outside the uterus, usually in the fallopian tube. Ectopic pregnancies can be life threatening if not treated quickly, as the fallopian tube can burst. Other symptoms of ectopic pregnancy include strong cramps and lightheadedness.
  • Molar pregnancy occurs when abnormal tissue grows inside the uterus instead of a baby. The tissue can be cancerous and spread to other parts of the body. Symptoms include uterine bleeding, nausea, vomiting, and a rapid enlargement of the uterus.
  • Cervical changes occur during pregnancy as extra blood flows to the cervix. Because of this, sex or a pap smear trigger bleeding. This is not a cause for concern.
  • Infections of the cervix and vagina, including sexually transmitted infections, can cause vaginal bleeding.

Second and Third Trimester Uterine Bleeding Causes

Uterine bleeding during the second and third trimesters can indicate serious complications that require immediate medical attention. If you experience vaginal bleeding after your first trimester, you should contact your doctor. Causes of abnormal bleeding during your second or third trimester could include: 

  • Placenta previa occurs when the placenta sits low in the uterus and partially or completely covers the opening of the birth canal. This is an emergency that requires immediate medical attention.
  • Placental abruption occurs when the placenta detaches from the uterine wall before or during labor, causing blood to pool between the placenta and uterus. Other symptoms include abdominal pain, clots from the vagina, a tender uterus, and back pain.
  • Uterine rupture is rare, but can occur when the scar from a previous C-section tears open during pregnancy. This can be life threatening and requires emergency C-section. Other symptoms include pain and tenderness in the abdomen.
  • Preterm labor occurs when the body goes into labor before 37 weeks of pregnancy. Days, or even weeks, prior to labor, the mucus plug passes out of the vagina, often leaving bloody discharge. However, if you experience ongoing bleeding accompanied by  contractions, vaginal discharge, and pressure in your abdominal and low back prior to your 37th week of labor, contact your doctor.

When to Contact Your Doctor

If you are experiencing abnormal bleeding during the second or third trimesters of pregnancy, contact your doctor immediately, as some pregnancy complications can be life threatening and require medical intervention. If you experience ongoing bleeding or concerning symptoms during early pregnancy or your menstrual cycle, contact your doctor to determine whether your systems may be linked to other complications or require treatment. 

At Walnut Hill, our team of doctors and nurses provide the best care through every stage of your life, from contraception and menstrual issues to pregnancy and childbirth. Contact us today to schedule an appointment.