Vaginal Bleeding - Abnormal

Is this your symptom?

  • Abnormal vaginal bleeding
  • Heavy menstrual bleeding
  • Light bleeding or spotting in between normal periods

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

When to Call for Vaginal Bleeding - Abnormal

Call 911 Now

  • Passed out (fainted) or too week to stand with large blood loss
  • You think you have a life-threatening emergency

Go to ER Now

  • Severe abdominal pain
  • Constant stomach pain lasts more than 2 hours
  • Passed tissue (gray-white)

Call Doctor or Seek Care Now

  • Very heavy bleeding, such as:
    • soaking 2 pads or tampons per hour for more than 2 hours OR
    • soaking 1 pad or tampon per hour for more than 6 hours
  • Pregnant or could be pregnant
  • Fever or chills; feeling hot, or shivery
  • Skin bruises or nosebleed, not caused by an injury
  • Very pale skin that is a new symptom
  • You gave birth in the last 8 weeks
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Bleeding is heavy (6 or more soaked pads or tampons per day)
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Bleeding lasts for more than 7 days
  • Bleeding between your periods or after sex
  • Bleeding after you have gone through menopause
  • Menstrual cycle is less than 21 days or more than 35 days
  • You have other questions or concerns

Self Care at Home

  • Normal period
  • Mild vaginal bleeding or spotting

Call 911 Now

  • Passed out (fainted) or too week to stand with large blood loss
  • You think you have a life-threatening emergency

Go to ER Now

  • Severe abdominal pain
  • Constant stomach pain lasts more than 2 hours
  • Passed tissue (gray-white)

Call Doctor or Seek Care Now

  • Very heavy bleeding, such as:
    • soaking 2 pads or tampons per hour for more than 2 hours OR
    • soaking 1 pad or tampon per hour for more than 6 hours
  • Pregnant or could be pregnant
  • Fever or chills; feeling hot, or shivery
  • Skin bruises or nosebleed, not caused by an injury
  • Very pale skin that is a new symptom
  • You gave birth in the last 8 weeks
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Bleeding is heavy (6 or more soaked pads or tampons per day)
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Bleeding lasts for more than 7 days
  • Bleeding between your periods or after sex
  • Bleeding after you have gone through menopause
  • Menstrual cycle is less than 21 days or more than 35 days
  • You have other questions or concerns

Self Care at Home

  • Normal period
  • Mild vaginal bleeding or spotting

Care Advice for Stomach Pain

What You Should Know About Stomach Pain:

  • Mild stomach pain can be caused by something simple. It could be from gas pains or eating too much.
  • Sometimes, stomach pain signals the start of a viral infection. This will lead to vomiting or loose stools.
  • Watching your child for 2 hours will help tell you the cause.
  • Here is some care advice that should help.

Lie Down:

  • Have your child lie down and rest until feeling better.

Clear Fluids:

  • Offer clear fluids only (such as water, flat soft drinks or half-strength Gatorade).
  • For mild pain, offer a regular diet.

Prepare for Vomiting:

  • Keep a vomiting pan handy.
  • Younger children often talk about stomach pain when they have nausea. Nausea is the sick stomach feeling that comes before they throw up.

Pass a Stool:

  • Have your child sit on the toilet and try to pass a stool.
  • This may help if the pain is from constipation or diarrhea.
  • Note: for constipation, moving a warm wet cotton ball on the anus may help.

Do Not Give Medicines:

  • Any drug (like ibuprofen) could upset the stomach and make the pain worse.
  • Do not give any pain medicines or laxatives for stomach cramps.
  • For fever higher than 102° F (39° C), acetaminophen (such as Tylenol) can be given.

What to Expect:

  • With harmless causes, the pain is most often better or gone in 2 hours.
  • With stomach flu, belly cramps may happen before each bout of vomiting or diarrhea. These cramps may come and go for a few days.
  • With serious causes (such as appendicitis), the pain worsens and becomes constant.

Call Your Doctor If:

  • Pain becomes severe
  • Constant pain lasts more than 2 hours
  • Mild pain that comes and goes lasts more than 24 hours
  • You think your child needs to be seen
  • Your child becomes worse

Extra Help - Worried Stomach:

  • Help your child talk about events that trigger the stomach pain. Talk to your child about how to cope with these the next time around.
  • Help your child worry less about things she can't control.
  • To treat the pain, help your child get very relaxed. Lying down in a quiet place and taking slow deep breaths may help. Make the belly go up and down with each breath. Then try to relax all the muscles in the body. Think about something pleasant. Listening to audios that teach how to relax might also help.
  • Make sure your child gets enough sleep.
  • Make sure that your child doesn't miss any school because of stomach pains. Stressed children tend to want to stay home when the going gets rough.
  • Caution: your child should see her doctor for an exam. Do this before concluding frequent stomach pains are from worrying too much.

Copyright 2025 Schmitt Decision Logic LLC. Date Updated: Mar 31 2025 12:53 Version 0.1

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