Hormonal vaginal bleeding is abnormal bleeding from the vagina that is due to changes in hormone levels.
Many women experience abnormal vaginal bleeding or spotting between periods sometime in their lives. 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 before age 9, when you are pregnant, or after menopause .
Every woman’s menstrual cycle, or period, is different. On average, a woman’s period occurs every 28 days. Most women have cycles between 24 and 34 days apart. It usually lasts 4 – 7 days.
Young girls may get their periods anywhere from 21 to 45 days or more apart. Women in their 40s will often notice their period occurring less often.
About every month, the levels of female hormones in a woman’s body rise and fall. Estrogen and progesterone are two very important hormones.
These hormones play an important role in ovulation, the time when the ovaries release an egg.
Dysfunctional uterine bleeding (DUB) most commonly occurs when the ovaries do not release an egg. Changes in hormone levels cause your period to be later or earlier and sometimes heavier than normal.
Symptoms of dysfunctional uterine bleeding may include:
- Bleeding or spotting from the vagina between periods
- Periods that occur less than 28 days apart (more common) or more than 35 days apart
- Time between periods changes each month
- Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 – 3 hours in a row)
- Bleeding lasts for more days than normal or for more than 7 days
Other symptoms caused by changes in hormone levels may include:
- Excessive growth of body hair in a male pattern (hirsutism)
- Hot flashes
- Mood swings
- Tenderness and dryness of the vagina
A woman may feel tired or have fatigue if she is loses too much blood over time. This is a symptom of anemia.
Exams and Tests
The health care provider will do a pelvic examination and may perform a Pap smear. Tests that may be done include:
- Complete blood count (CBC)
- Blood clotting profile
- Hormone tests
- Male hormone (androgen) levels
- Pregnancy test
- Thyroid function tests
- Pap smear and culture to look for infection
Your health care provider may recommend the following:
- Biopsy to look for infection, precancer, or cancer, or to help decide on hormone treatment
- Hysteroscopy, performed in the doctor’s office, to look into the uterus through the vagina.
- Transvaginal ultrasound to look for problems in the uterus or pelvis
Young women within a few years of their first period are often not treated unless symptoms are very severe, such as heavy blood loss causing anemia.
In other women, the goal of treatment is to control the menstrual cycle. Treatment may include:
- Birth control pills or progesterone only pills
- Intrauterine device (IUD) that releases the hormone progestin
- Ibuprofen or naproxen taken just before the period starts
The health care provider may recommend iron supplements for women with anemia.
If you want to get pregnant, you may be given medication to stimulate ovulation.
Women with severe symptoms that do not get better with other treatments may consider the following procedures if they no longer want to have children:
- Endometrial ablation or resection to destroy or remove the lining of the uterus
- Hysterectomy to remove the uterus
- D and C to remove polyps and diagnose certain conditions
Hormone therapy usually relieves symptoms. Treatment may not be needed if you do not develop anemia due to blood loss.
There is no home treatment for abnormal vaginal bleeding. With some types of vaginal bleeding, it may be okay to wait to see if the bleeding stops on its own.
Check your symptoms to decide if and when you should see a doctor. If the bleeding continues or gets worse, see your doctor to find out the reason for the bleeding.
If you are using tampons for abnormal vaginal bleeding, be sure to change them often, and do not leave one in place when the bleeding has stopped. A tampon left in the vagina may put you at risk for toxic shock syndrome (TSS) .
TSS is a rare but life-threatening illness that develops suddenly after a bacterial infection rapidly affects several different organ systems.
If you are age 40 or older, you may be experiencing perimenopause . For more information, see the topic Menopause and Perimenopause.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Abnormal bleeding returns.
- Bleeding increases or becomes severe enough to cause weakness or light-headedness.
- Fever or pain in the lower abdomen develops.
- Symptoms become more severe or frequent.
- Infertility (inability to get pregnant)
- Severe anemia due to a lot of blood loss over time
- Increased risk for endometrial cancer