Abnormal vaginal bleeding

The usual cause of vaginal bleeding is menstruation (the monthly period). However, any vaginal bleeding that is not normal menstrual bleeding or mid- cycle spotting (which often occurs during the first few months of taking the oral contraceptive pill) may be abnormal and must be investigated. This is because it may be a sign of a problem within the vagina, uterus (womb) or ovaries. This includes irregular or excessively heavy menstrual bleeding, and any vaginal bleeding in a woman who has passed the menopause.

In teenage girls, the first few periods can be irregular and of varying degrees of heaviness, and this is not abnormal. Around the time of the menopause, menstrual bleeding often becomes irregular, and again this is not abnormal.

HRT (hormone replacement therapy) may also cause harmless bleeding in postmenopausal women who have stopped having periods.

What causes abnormal vaginal bleeding and who is at risk? Abnormal vaginal bleeding may occur between the normal menstrual bleeds (intermenstrual bleeding) or it may take the form of unusually heavy menstrual bleeding (menorrhagia). In postmenopausal women, it may develop after a number of years without any vaginal bleeding. It can be caused by a number of things, including:

* hormone imbalances,
* injury to the vagina or vulva,
* sexual abuse,
* infection in the uterus,
* polyps and fibroids (benign growths) in the uterus,
* cancer of the cervix,
* cancer of the uterus,
* some cancers of the ovaries,
* complications of an early (possibly
* unknown) pregnancy, for example,
* ectopic pregnancy or threatened miscarriage.

Hormonal imbalances are by far the most common cause, and the problem usually occurs during the reproductive years.

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