Many women experience bleeding or spotting between periods. Vaginal bleeding is considered to be abnormal if it occurs:
* When you are not expecting your menstrual period.
* When your menstrual flow is lighter or heavier than what is normal for you.
* At a time in life when it is not expected, such as:
o Before age 10.
o After menopause.
There are many possible causes for abnormal vaginal bleeding. By itself, it does not necessarily indicate a serious condition.
* Because bleeding can indicate a problem with pregnancy, possible pregnancy should always be considered in a woman of childbearing age.
o Spotting to minimal bleeding may be normal but needs to be evaluated by your health professional.
o Heavy vaginal bleeding or bleeding that occurs after 12 weeks may mean a serious problem, including an infection, tubal pregnancy, or miscarriage.
* Ovulation can cause midcycle bleeding.
* Birth control (birth control pills, hormonal methods) sometimes causes abnormal vaginal bleeding. You may have minor bleeding between periods during the first few months if you have recently started using birth control pills. You also may have bleeding if you do not take your pills at a regular time each day.
* An intrauterine device (IUD) also may increase your chances of spotting. For more information on the IUD, see the topic Birth Control in Related Information.
* Women who are breast-feeding often have irregular vaginal spotting or bleeding.
* Extreme emotional stress and excessive exercise can cause abnormal bleeding, although excessive exercise more frequently causes an absence of menstruation (amenorrhea).
* If you are age 40 or older, abnormal vaginal bleeding may mean the beginning of menopause. In a woman who has not had a menstrual period for 12 months, vaginal bleeding is always abnormal and should be discussed with a health professional.
* Hormonal imbalances also can cause abnormal bleeding.
In all of these situations, if the bleeding is not heavy and occurs only occasionally, there is probably no cause for concern.
Other, less common causes of abnormal vaginal bleeding that may be more serious include the following:
* Infection of the pelvic organs(vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted diseases (STDs) are often the cause of infections. See the topic Exposure to Sexually Transmitted Diseases in Related Information.
* In a young girl who has not started to menstruate, vaginal bleeding can indicate sexual abuse. The cause of bleeding needs to be determined by a health professional to rule out this possibility.
* Cervical polyps or cancer of the cervix may cause bleeding after intercourse.
* Heavy bleeding during the first few weeks after delivery (postpartum) or after a therapeutic abortion may indicate:
o Products of conception are still in the uterus.
o The uterus has not contracted to the prepregnancy size.