Causes of Abnormal Vaginal Bleeding

Abnormal vaginal bleeding is frequently due to a gynecologic condition, but can also be the result of other medical problems or even a medication you are taking. If you have reached menopause, 12 consecutive months without a period, any subsequent vaginal bleeding may be a cause for concern and should be evaluated.

There are many possible causes of abnormal vaginal bleeding:

Evaluation of Abnormal Vaginal Bleeding
Uterine/endometrial Biopsy Procedures
Office Hysteroscopy Procedures


Uterine reasons

  • Uterine polyp (almost always benign)
  • Uterine fibroids
  • Adenomyosis
  • Cancer or precancer (strongly linked to overweight/obesity)
  • Endometritis or infection of the uterus
  • Pelvic Inflammatory Disease/PID (infection of the uterus and pelvic organs, usually related to a sexually transmitted disease)

Cervical reasons

  • Benign inflammation
  • Cancer or precancer
  • Infection with Gonorrhea, Chlamydia, Trichomonas, or HPV
  • Cervical polyp (almost always benign)
  • Cervical ectropion (benign condition where the inner lining of the cervix protrudes through the cervical opening and grows on the vaginal part of the cervix)

Vaginal reasons

  • Atrophy (thinning of vaginal walls, usually related to menopause)
  • Vaginal infections such as yeast and Trichomonas
  • Vaginal cancer or precancer (rare and usually related to DES exposure)

Hormone/Endocrine Factors

  • Hypothyroid (overactive thyroid)
  • Hyperthyroid (underactive thyroid)
  • Polycystic Ovarian Syndrome (PCOS)
  • Hormonal Fluctuations due to Perimenopause
  • Stopping, changing, or missed birth control pills or menopausal hormone therapy (withdrawal bleeding)
  • Medical conditions such as Celiac disease, kidney or liver disease

Other causes

  • Miscarriage or ectopic pregnancy
  • Pregnancy
  • Sexual intercourse
  • Von Willebrand disease (and other blood clotting disorders)
  • Forgotten (retained) tampon
  • Intrauterine device (IUD)
  • Trauma
  • Sexual abuse
  • Medications

Polycystic Ovary Syndrome (PCOS)

PCOS is a hormonal disorder common among young women. Symptoms can be irregular and/or prolonged menstrual periods, excess male hormone (androgen) levels resulting in acne, male pattern excessive hair growth, as well as hair loss and male pattern baldness. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly ovulate, which may result in infertility. Women who have PCOS are resistant insulin, an important hormone that regulates the use of sugar in the body. This results in too much insulin, which causes inflammation and over time can lead to heart disease. Excess insulin can also lead to weight gain and obesity.

The exact cause of PCOS is unknown but is frequently linked with being overweight or obese. There may also be a hereditary component. Early diagnosis and treatment along with weight loss may reduce the risk of complications. Possible risks and complications include high blood pressure, high cholesterol, type 2 diabetes, sleep apnea, depression, anxiety, eating disorders, heart disease, infertility, miscarriage, as well as complications in pregnancy such as diabetes, high blood pressure, preeclampsia, cesarean section, and premature birth.

Diagnosis of PCOS?

A diagnosis of PCOS is made when you experience at least two of these signs:
Irregular periods – Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 38 days between periods, abnormally heavy periods, or periods lasting more than 8 days.

Excess androgen – High levels of the male hormone may result in excess facial and body hair (hirsutism), acne and male-pattern baldness.

Polycystic ovaries – Over time, ovaries can enlarge and develop many follicles that surround the eggs due to disruption of ovulation and can result in infertility.


Polyps are an overgrowth of cells in the lining of the uterus or cervix They are usually noncancerous (benign), although rarely some can become cancerous. They usually are within your uterus, but occasionally protrude through the opening of the uterus (cervix) into your vagina. They can also form within the cervix. They most commonly occur in women over the age of 40, although younger women can also get them. Symptoms include irregular or heavy menstrual bleeding, bleeding with intercourse, infertility, and bleeding after menopause. Risk factors for developing polyps include menopause, high blood pressure, obesity, or Tamoxifen, a drug therapy for breast cancer. Determining if you have a polyp can be done with an exam, ultrasound, or hysteroscopy.

Please contact our office if you have any symptoms of abnormal vaginal bleeding for an appointment and evaluation.

Evaluation of Abnormal Vaginal Bleeding

If you have any abnormal bleeding, please call the office to see Dr. Fleming for an evaluation.

  • Physical and pelvic exam
  • Evaluation for uterine, vaginal and cervical infection
  • Pap smear if not up to date
  • Possible ultrasound based on symptoms and examination results
  • Pregnancy check if you are at risk
  • Blood work if Dr. Fleming feels it is indicated
  • Possible biopsy of the uterus
  • Possible hysteroscopy procedure

Uterine/endometrial Biopsy Procedure

  • Short procedure done in the office to help determine cause of abnormal bleeding
  • Done in women with heavy or irregular periods, bleeding after menopause, bleeding after taking a breast cancer drug called Tamoxifen, or a thickened uterine lining seen on ultrasound.
  • Done to rule out cancer and precancer cells of the uterus
  • Anesthesia is not necessary but 600mg Ibuprofen taken with food, or 650mg Tylenol (if you cannot take Ibuprofen), taken 30 minutes before your visit, may help with the discomfort of the procedure.

Office Hysteroscopy

At Women’s Wellness Center, we provide the convenience of in-office hysteroscopy. A local anesthetic is used prior to the start of this procedure, and it is usually very well tolerated. The procedure involves inserting a slim instrument with a light and camera on the end, through your cervix and into your uterus. A small amount of sterile saline fluid is then inserted into the uterus through this tube, allowing your provider to visualize the lining of your uterus on a video screen. We will take note of any areas that look abnormal. If a polyp or other lesion is found, an instrument is inserted under direct visualization, and a tissue sample is obtained. This biopsy or polyp will be sent to the lab for further evaluation.

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