Vaginal Bleeding - Abnormal

Symptoms

DEFINITION

Menstrual bleeding is abnormal and excessive when any of the following occur:

• More than 7 days (1 week) of bleeding
• More than 6 well-soaked pads or tampons per day
• Periods occur more frequently than every 21 days
• Any bleeding or spotting between regular periods

On a practical level, however, if a woman feels that the amount of bleeding is excessive or heavier than her normal periods, she should discuss this with her doctor. An increase of two or more tampons or pads per day or an increase in duration of 3 or more days is significant

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General Information

• The first day of menstrual bleeding is considered the first day of a new menstrual cycle.
• Menstrual bleeding typically lasts 3-7 days. The heaviest flow usually occurs during the first 1-3 days.
• Ovulation generally occurs around day 14 of the cycle.
• The length of the menstrual cycle varies from woman to woman. The range is from 24 to 35 days. The average is 28 days.
• Excessive vaginal bleeding is the most common cause of iron deficiency anemia in women of childbearing age.

Caution - Pregnancy

• The possibility of pregnancy must be considered in all women in their childbearing years who have vaginal bleeding.
• In early pregnancy, vaginal bleeding can be a sign of serious problems like miscarriage or pregnancy in the tubes.

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See More Appropriate Topic (instead of this one) If

• MENSTRUAL PERIOD, MISSED OR LATE
• Questions about EMERGENCY CONTRACEPTION

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Passed out (fainted)
• Very weak (can't stand)

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Severe vaginal bleeding (i.e., soaking 2 pads or tampons per hour for 2 or more hours)
• Moderate vaginal bleeding (i.e., soaking 1 pad or tampon per hour for 6 or more hours)
• Severe abdominal pain
• Constant abdominal pain for more than 2 hours
• Pregnant or could be pregnant (e.g., missed last period)
• Passed tissue (e.g., gray-white)
• Pale skin (pallor) of new onset or worsening

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Spotting after a procedure (e.g., biopsy) or pelvic examination (e.g., pap smear) that persists for more than 3 days

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Menstrual bleeding lasts longer than 7 days
• Menstrual cycle is shorter than 21 days or longer than 35 days
• Menstrual bleeding with 6 or more soaked pads or tampons per day
• Missed menstrual period has occurred 2 or more times in the last year and the cause is not known
• Bleeding or spotting occurs between regular periods
• Irregular bleeding occurs more than two cycles (2 months) and using birth control medicine (pills, patch, Depo-Provera, Norplant, vaginal ring)

Self Care at Home If

• Normal menstrual period
• Mild vaginal bleeding and you don't think you need to be seen

Care at Home

HOME CARE ADVICE 

MILD VAGINAL BLEEDING

1. Pregnancy test, when in doubt:
   • If there is any possibility of pregnancy, obtain and use a urine pregnancy test from the local drug store.
   • Follow the instructions included in the package.
2. Spotting after a Procedure or Pelvic Exam: The cervix bleeds easily and even an internal exam, Pap smear, or biopsy of the cervix can cause some spotting. This spotting should subside within 24-72 hours.
3. Spotting After First Intercourse: Mild bleeding or spotting with first intercourse is common. It should stop within 48 hours and not recur.
4. Iron and Anemia: Heavy periods are the most common cause of iron deficiency anemia in women of childbearing age. Women with heavy periods should eat a diet rich in iron or take a daily multivitamin pill with iron.
5. Call Your Doctor If:
   • Pregnancy test is positive
   • You have difficulties with the home pregnancy test
   • Bleeding becomes worse
   • You become worse

Irregular Vaginal Bleeding while Using Birth Control Medicine

1. Spotting Between Periods and Taking Birth Control Pills: Breakthrough bleeding or spotting is common with most current birth control pills, especially during the first three pill pack cycles.
2. Spotting Between Periods and You Forgot to Take a Birth Control Pill:
   • Missing a pill may cause breakthrough bleeding or spotting.
   • If you ever forget to take more than one pill during a month, then you should use a "back-up" contraceptive method (e.g., condom) until you start the next pill pack.
3. Irregular bleeding and You are Using Norplant or Depo-Provera: Irregular bleeding is a common side effect. It may include heavier, lighter, more frequent or less frequent bleeding than your normal periods.
4. Irregular bleeding and You are using the Birth Control Patch: Breakthrough bleeding or spotting is common with current birth control patches, especially during the first 3 cycles (months).
5. Irregular Bleeding and You are Using the Vaginal Contraceptive Ring (i.e., NuvaRing): Breakthrough bleeding or spotting is not common with the vaginal contraceptive ring (i.e., NuvaRing). However, it can occur especially during the first 1 or 2 months of use (first 2 cycles).
6. Diary: Keep a record of the days you have any bleeding or spotting.
7. Call Your Doctor If:
   • Irregular bleeding occurs more than two cycles (2 months)
   • Bleeding becomes worse
   • You become worse

Taking Birth Control Pills and Missed One or More Pills

1. Birth Control Pills - MISSED 1:
   • If you forget to take a pill, take it as soon as you remember. Then take the next one on schedule. This may mean you take 2 pills in one day.
   • If you ever forget to take more than 1 pill for a month, then you should use a "back-up" contraceptive method (condom and foam) until you start the next pill pack.
2. Birth Control Pills - MISSED 2:
   • If you forget to take 2 pills, then take 2 pills the next two days. Then take the next one on schedule.
   • Never take more than 2 pills in one day (Reason: nausea and vomiting are side effects of too much hormone from the pills).
   • You must use a "back-up" contraceptive method (condom and foam) until you start the next pill pack.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

First Aid - Shock

• Lie down with the feet elevated (Reason: counteract shock).

Note: In this illustration the individual in shock is laying down and his feet have been placed up on a stack of blankets.