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:

• Uterine reasons for abnormal bleeding
• Cervical reasons for abnormal bleeding
• Vaginal reasons for abnormal bleeding
• Hormone and Endocrine factors in abnormal vaginal bleeding
• Other causes of abnormal vaginal bleeding

Evaluation of Abnormal Vaginal Bleeding
Uterine/endometrial Biopsy 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)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

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

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.