Abnormal Bleeding FAQ

At The Woman’s Health Pavilion, we are experienced in diagnosing the causes for abnormal vaginal bleeding for our patients in Long Island, Queens, and Brooklyn. We offer patients effective treatment options—including advanced, minimally-invasive procedures—to restore freedom and quality of life. To help you assess your symptoms and learn more about abnormal bleeding, you can review answers to some frequently asked questions below.

To discuss your concerns with one of our gynecologists or other experienced practitioners, request an appointment at any of our Queens or Long Island locations. We see patients 7 days a week and offer same-day appointments for urgent conditions.

What is considered abnormal bleeding?

A normal menstrual period lasts up to 7 days and occurs every 21 to 35 days. Vaginal bleeding is considered “abnormal” when any of the following occurs:

• Periods more often than every 21 days
• Periods less often than every 35 days
• Absent periods
• Spotting/bleeding between periods, including bleeding with intercourse
• ANY bleeding after menopause
• Periods that last longer than a week
• Heavy menstrual bleeding

What causes abnormal bleeding?

In general, the causes of abnormal bleeding can be grouped into the following two categories:

Hormonal Causes

• Pregnancy and breastfeeding
• Birth control pills
• Hormonal intrauterine devices
• Menopause
• Polycystic ovary syndrome (PCOS)
• Underactive/overactive thyroid
• Changes in weight or diet
• Stress
• Extremely strenuous exercise routines (e.g., long-distance running)

Non-hormonal Causes

• Infections of the uterus, cervix, or vagina
• Uterine fibroids
• Endometrial polyps
• Pelvic inflammatory disease (PID)
• Sexually transmitted infections such as chlamydia
• Urinary tract infections (UTI) can cause blood in the urine, which may be mistaken for vaginal bleeding
• Hormonal Intrauterine devices (IUD)
• Cancer of the uterus, cervix, or vagina

How do you diagnose the cause of abnormal bleeding?

Causes of abnormal bleeding vary with a woman’s age, symptoms, and medical history. To develop an accurate diagnosis, we may perform one or more of the following diagnostic tests:

• Visual examination of the vagina and cervix
• Transvaginal ultrasound to detect polyps, fibroids, and ovarian cysts
• Pap smear to check for cervical cancer
• Cultures to check for infection
• Hormonal blood tests
• Sonohysterogram to look for endometrial polyps and fibroids inside the uterus
• Endometrial biopsy (collecting a small sample of the lining of the uterus)
• Magnetic resonance imaging (MRI) to view the reproductive organs

Is it important to see a medical practitioner for abnormal bleeding?

Yes. If you have abnormal vaginal bleeding, you should be evaluated by an experienced practitioner. While not common, abnormal bleeding may be caused by gynecologic cancers and other serious conditions. Before coming in, we recommend keeping a record of your concerns, which may include:

• How long the bleeding lasts
• How often your abnormal bleeding occurs (or doesn’t occur)
• Whether the bleeding is heavy, very light (spotting), or absent
• Any patterns of abnormal bleeding you have noticed

Are there times when abnormal bleeding is not cause for concern?

It is typical for periods to be irregular when a young woman first begins menstruation. It can take a year or 2 for her hormonal cycle and menstrual pattern to become regular. Also, women approaching menopause (usually in their late 40s) may notice that periods become heavier and occasionally skip. Bleeding can also occasionally occur at the time of ovulation, even when no problems are present.

Could something be wrong if I have bleeding while I’m pregnant?

Spontaneous vaginal bleeding is not normal during pregnancy, but it is common. In early pregnancy, bleeding may be a sign of early miscarriage or an ectopic pregnancy, which can be life-threatening. In later pregnancy, bleeding may indicate the start of labor. If you notice any bleeding during your pregnancy, you should be promptly evaluated.

What are possible causes of bleeding after intercourse?

Bleeding during or after intercourse is not only embarrassing, it can be a cause for serious concern. Bleeding with intercourse may be caused by:

• Infections such as chlamydia, gonorrhea, or herpes
• Thinning of the vaginal lining due to menopause or breastfeeding
• Injury to the vaginal opening or inner wall of the vagina
• Polyps or other benign growths of the cervix
• Cervical or uterine cancer

We can offer prompt evaluation and treatment to evaluate and eliminate bleeding associated with intercourse.

How is abnormal bleeding treated?

Because there are so many potential causes of abnormal vaginal bleeding, treatment will depend on the working diagnosis. Common approaches include:

• Birth control pills can be used to regulate periods
• Antibiotics may be used to treat gynecologic infections
• A progestin-containing intrauterine device may be used to control heavy periods
• Endometrial ablation can be used to treat heavey periods. Endometrial ablation inactivates the lining of the uterus, resulting in permanently light (or absent) periods
• Myomectomy surgically removes fibroids from the uterus
• Hysterectomy surgically removes the uterus itself

While we recommend surgical options only when necessary, these procedures have given many patients permanent relief from concerns that have negatively impacted them for many years.

Why choose The Woman’s Health Pavilion for treatment of abnormal bleeding?

Our highly trained and experienced OBGYN team specializes in the care of gynecologic conditions. We have expertise in treating both common and rare causes of abnormal vaginal bleeding. We offer minimally invasive options for most patients when their conditions require a surgical treatment. In fact, The Woman’s Health Pavilion is nationally recognized as a Center of Excellence in Minimally Invasive Gynecology.