What Causes Bloody Vaginal Discharge?
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While there is an array of color and consistency to vaginal discharge, it it's quite common and normal to have bloody vaginal discharge after your period. Other causes of bloody mucus or brown discharge can arise from periods based on your age, bacterial or yeast infections or an STD. Read below for associated symptoms, other causes, and treatment options.
Abnormal, blood vaginal discharge explained
Vaginal discharge is part of a healthy female body. It is a combination of cells and bodily fluids excreted through the vagina and usually appears as a white or clear mucus-like secretion without a strong odor. However, sometimes, the quantity and quality of vaginal discharge can change. You can stay on top of these changes and understand which ones are concerning if you are mindful of other symptoms. For example, vaginal discharge that appears abnormal may have an odor or color you have never experienced.
Other accompanying symptoms
Bloody vaginal discharge may look red, but sometimes, it can also look brown. You may also experience the following.
What causes blood vaginal discharges?
See a physician promptly if you notice symptoms that stray from your expected menstrual patterns. Your physician will likely determine a diagnosis and treatment plan with urgency.
Causes of bloody vaginal discharge related to the reproductive cycle include the following.
- Menstrual cycle: Discharge that appears bloody can be the result of menstrual residue mixing with vaginal discharge. Often the amount of discharge your body produces increases at the end of your menstrual cycle, so discharge can often look brown or rusty.
- Pregnancy complications: Bloody discharge that occurs during pregnancy, a time when you should NOT expect bleeding, can be a sign of severe pregnancy complications such as miscarriage or placental abruption, a condition where the placenta separates from the lining of the uterus.
- Age-related: Similarly to pregnancy, women can experience bleeding during the early stages of puberty and the final stages of menopause. This irregular bleeding can mix with discharge, creating a bloody or brown appearance.
Cancerous causes of bloody vaginal discharge may include the following.
- Cervical: The cervix is the lower part of the uterus that connects to the vagina. The cervix is susceptible to the sexually transmitted infection, Human Papillomavirus (HPV), that can transform the cells of the cervix into cancer cells. Bloody or brown vaginal discharge can be a sign of cervical cancer.
- Uterine/Endometrial: The endometrium is the layer of cells that line the uterus. Women of menopausal age are at risk for the development of cancerous cells within this lining, called endometrial or uterine cancer. Blood-tinged discharge can be a sign of this type of cancer as well.
The female reproductive system is open to the environment via the vagina, making it particularly susceptible to infection by not only outside organisms but organisms already present within its walls. Irritation from such infectious causes can result in bleeding that mixes with discharge.
- Bacterial: Bacteria that normally inhabit the vagina can overgrow and cause an infection that leads to abnormal vaginal discharge. Furthermore, many sexually transmitted infections due to bacteria, such as gonorrhea and chlamydia, can cause similar symptoms.
- Fungal: Yeast is a type of fungus present in the vagina. When this amount of yeast is thrown off balance, it can overgrow and cause an infection that results in vaginal itching and abnormal discharge.
Other causes may include the following.
- Obstructive: Any object inserted into the vagina that can obstruct the flow of vaginal fluid may result in abnormal vaginal discharge. For example, intrauterine devices (IUDs) can change the amount, quality, and consistency of your vaginal discharge as well as your menstrual cycle.
- Anatomical: Rarely, an abnormal opening between the vagina and the rectum or the vagina and the bladder, called a fistula, allows feces or urine to leak into the vagina. This leak will result in brown discharge with a foul odor.
This list does not constitute medical advice and may not accurately represent what you have.
Ovulation pain (mittelschmerz) or midcycle spotting
Mittelschmerz is a German word that translates as "middle pain." It refers to the normal discomfort sometimes felt by women during ovulation, which is at the midpoint of the menstrual cycle.
Each month, one of the two ovaries forms a follicle that holds an egg cell. The pain occurs when the follicle ruptures and releases the egg.
This is a dull, cramping sensation that may begin suddenly in only one side of the lower abdomen. In a few cases, there may be vaginal spotting. Mittelschmerz occurs about 14 days before the start of the next menstrual period.
Actual Mittelschmerz is not associated with nausea, vomiting, fever, or severe pelvic pain. These symptoms should be evaluated by a medical provider since they can indicate a more serious condition.
Diagnosis is made through patient history.
Treatment requires only over-the-counter, nonsteroidal anti-inflammatory drugs to relieve the pain. An oral contraceptive will stop the symptoms, since it also stops ovulation.
Top Symptoms: abdominal pain (stomach ache), last period approximately 2 weeks ago, vaginal bleeding, bloody vaginal discharge, pelvis pain
Symptoms that always occur with ovulation pain (mittelschmerz) or midcycle spotting: last period approximately 2 weeks ago
Endometriosis is a condition where the tissue that normally forms the lining of the uterus – the endometrium – also begins growing on the outside of the ovaries and fallopian tubes. This out-of-place endometrium still thickens and bleeds each month, causing pain, scar tissue, and adhesions.
Risk factors include short menstrual cycles that begin at a young age, with menopause at an older age; never giving birth; uterine abnormalities; family history; and alcohol use.
Symptoms include severe pelvic pain, cramping, and excessive bleeding during menstruation. There may be pain during sexual intercourse and sometimes during bowel movements and urination. Diarrhea, constipation, nausea, and bloating are also common, as is difficulty becoming pregnant.
Endometriosis can be confused with other conditions, such as pelvic inflammatory disease or irritable bowel syndrome. Permanent infertility can occur with untreated endometriosis.
Diagnosis is made by pelvic examination, ultrasound, and sometimes laparoscopy.
Treatment involves over-the-counter pain relievers and hormone therapy, including contraceptives. Surgery may be done to remove endometriosis tissue. As a last resort, removal of the ovaries and the uterus may be recommended.
Top Symptoms: vaginal discharge, abdominal pain (stomach ache), vaginal bleeding, pelvis pain, painful periods
Urgency: Primary care doctor
Pelvic inflammatory disease
Pelvic inflammatory disease, or PID, is the general term for a bacterial infection of a woman's reproductive organs.
PID is most often a complication of a sexually transmitted disease (STD) such as gonorrhea or chlamydia. However, it is possible to get PID from other causes.
Any woman can be affected. It is most often found in sexually active women under age 25, especially those who have had PID before, have multiple partners, and/or douche frequently.
Symptoms include fever, lower abdominal pain, foul-smelling vaginal discharge, pain and/or bleeding during sex, and pain on urination.
Untreated PID can cause infertility due to damaged tissue in the reproductive tract, as well as chronic pelvic and abdominal pain. Unprotected sex partners will be infected as well.
Diagnosis is made through symptoms, pelvic examination, vaginal and cervical swabs, and urine tests.
Treatment is with a course of antibiotics. Be sure to finish all of the medication as directed, even when you begin feeling better.
To prevent PID, have all partners (male or female) tested for STDs and avoid unprotected sexual contact.
Top Symptoms: fever, abdominal pain or unusual vaginal discharge, vaginal discharge, nausea or vomiting, vaginal bleeding, pelvis pain
Symptoms that always occur with pelvic inflammatory disease: fever, abdominal pain or unusual vaginal discharge
Urgency: In-person visit
A cervical polyp is a growth that develops on the surface of the cervix. The cervix is the gynecological structure of the female reproductive system that connects the uterus to the vagina.
Symptoms are often absent with cervical polyps. However, in some cases, you may experience bleeding betw..
Endometrial polyps are growths or masses that occur in the lining of the inner wall of the uterus and often grow large enough to extend into the uterine cavity. They attach to the uterine wall by a large base (these are called sessile polyps) or a thin stalk (these are called peduncul...
Chlamydia trachomatis is a type of bacteria best known for causing the sexually transmitted infection known simply as chlamydia. It is among the most common sexually transmitted diseases (STDs), with more than a million cases reported each year in the U.S. alone.
However, the sy...
Gonococcal cervicitis is an inflammation of the cervix – the passageway at the lower end of the uterus – caused by the bacteria Neisseria gonorrhoeae, or gonorrhea.
Gonorrhea is a sexually transmitted disease (STD) and spreads through unprotected sexual contact.
Symptoms include abnormal vaginal discharge, pain or discomfort during sex, and vaginal bleeding after sex. However, some women have few or no symptoms.
If not treated, gonococcal cervicitis can lead to further infection of the reproductive tract and to pelvic inflammatory disease, which can cause sterility.
Diagnosis is made after a cervical swab is taken and tested.
Treatment is through a course of oral antibiotics. Women diagnosed with gonococcal cervicitis should be further tested for other common STDs such as chlamydia and trichomoniasis, as they are often found at the same time.
The best prevention for gonorrhea is the use of a condom during sex, as well as testing of all sex partners so that they can be treated and not re-infect anyone.
Cervicitis in general can be prevented by not exposing the cervix to douching or other irritants.
Top Symptoms: vaginal discharge, vaginal bleeding, painful sex, yellow pus vaginal discharge, heavy menstrual flow
Symptoms that never occur with gonococcal cervicitis: improving vaginal discharge
Urgency: Primary care doctor
Normal case of spotting
Spotting refers to small amounts of vaginal bleeding that occur between normal menstrual periods – just enough to leave a small spot of blood on a pad or on clothing.
Sometimes spotting has serious a cause, but very often it is triggered by fluctuating hormone levels from simple causes:
- Abnormal thyroid levels.
- PCOS (polycystic ovarian syndrome.)
- Changing any sort of female hormone therapy, including birth control pills.
- Sexual intercourse.
- Early pregnancy.
- Early menopause.
These changing hormone levels can happen to any woman who has not completed menopause. Those who have, and are not taking hormone therapy, should not be having any spotting at all.
No matter what a woman's age or situation, if spotting persists a gynecologist should be consulted to rule out any serious causes. The doctor can help manage hormone levels so that they remain at a normal level, not only preventing spotting but adding to a better quality of life for the patient.
Top Symptoms: vaginal bleeding or bloody discharge, bloody vaginal discharge, mild unexpected vaginal bleeding, vaginal bleeding, vaginal discharge
Symptoms that always occur with normal case of spotting: vaginal bleeding or bloody discharge
Symptoms that never occur with normal case of spotting: severe unexpected vaginal bleeding, vaginal pain, vaginal itch or burning, bleeding after sex, severe abdominal pain
Urgency: Wait and watch
Normal case of vaginal discharge
It is perfectly normal for every woman to have a clear or thin white vaginal discharge which is more or less constant.
The body protects the vaginal tissues by producing this light mucus from glands in the cervix and in the vaginal walls. This keeps the tissues lubricated so that they do not dry out and become irritated, and keeps the tissues slightly acidic because that helps to kill off any harmful germs.
The discharge is also a cleaning mechanism, clearing away any dead cells or bacteria as it moves out of the vagina. Douching is not necessary for normal discharge.
Vaginal discharge may change at different stages of life. During pregnancy, it becomes white and milky in appearance.
During and after menopause, the discharge lessens due to the drop in estrogen levels. If the dryness causes irritation or difficulty with sexual activity, a gynecologist can recommend an appropriate remedy.
Normal vaginal discharge never causes itching or has a foul smell, and is never any color other than clear or white.
Top Symptoms: vaginal discharge, mild vaginal discharge, white/gray vaginal discharge, clear vaginal discharge, severe vaginal discharge
Symptoms that always occur with normal case of vaginal discharge: vaginal discharge
Symptoms that never occur with normal case of vaginal discharge: vaginal itch or burning, painful urination, severe vaginal discharge, vaginal pain, abdominal pain (stomach ache), bleeding after sex, missed period, vulvovaginal odor
Urgency: Wait and watch
When and how to treat bloody vaginal discharge
If you notice blood-tinged vaginal discharge, think about the timing of your last menstrual cycle or recent sexual activity. Share this information with your physician if concerning symptoms persist.
When to see a doctor
If your symptoms occur outside of your cycle or sexual activity, make an appointment with your physician. Your physician may perform the following tests.
- Pelvic exam: Your physician will carefully inspect the outer genitals and use a device, called a speculum, or two fingers to open the vagina to examine the inner pelvic organs, such as the cervix and uterus.
- Pap smear: During a pap smear, your physician will sample cells from the cervix and examine them for abnormalities that indicate precancerous or cancerous conditions.
- Ultrasound of the uterus: An ultrasound uses sound waves that allow your physician to look for abnormalities in the lining of the uterus.
- Tissue samples of the vagina and uterus: Your physician will examine these tissues to assess for different types of infections or cancerous cells.
Your physician may prescribe the following, depending on your test results.
- Antibiotics: Antibiotics are available for many sexually transmitted infections and bacteria.
- Vaccination: A vaccine for HPV is available for women between the ages of 9 and 26. Your physician may suggest this to decrease your risk of cervical cancer.
- Changes to your current contraceptive regimen: If contraceptive methods or other medications are contributing to your symptoms, your physician may discuss stopping your current medications in favor of a new regimen.
- Surgery or radiation: If your symptoms are due to cancerous conditions, your physician will suggest surgery or radiation therapy. Chemotherapy is also an option for advanced cancers.
When it is an emergency
If you experience bloody vaginal discharge that becomes vaginal bleeding accompanied by abdominal pain, cramping, fever, or chills during any trimester of pregnancy, seek emergency medical attention immediately. These signs indicate severe pregnancy complications that require emergent care.
Questions your doctor may ask about bloody vaginal discharge
- Are you sexually active?
- Do you feel pain when you urinate?
- Do you use birth control beside condoms?
- Do you bleed after having sex?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Gambrah-Lyles is a resident pediatrician at the Children's Hospital of Philadelphia. She is a graduate of the University of Pennsylvania Perelman School of Medicine (2019). She graduated cum laude and received her undergraduate degree in Biochemistry and Spanish from Washington University in St. Louis (2013). Her research explores the intersections between neurology, public health, and infectious disease. She has investigated nutrition and cerebral palsy in Botswana, and completed a year-long project in Brazil, researching growth and developmental outcomes of Zika virus infection in pediatric patients as a Doris Duke International Scholar. Dr. Gambrah-Lyles speaks four languages, loves staying active, and enjoys sharing her love for medicine through teaching and writing.
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- Signs and Symptoms of Cervical Cancer. American Cancer Society. Updated December 5, 2016. American Cancer Society Link
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