7 Causes of Vaginal Bleeding After Sex, Menopause & Periods
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Are you experiencing vaginal bleeding outside of your normal menstrual cycle, after sex, or after menopause? It's important to recognize patterns of vaginal bleeding outside of your normal menstrual cycle so you can talk to your doctor. Read below learn seven possible causes of vaginal bleeding and possible treatment options.
Vaginal bleeding symptoms
Many women of child-bearing age have experienced symptoms of vaginal bleeding and thought, "it must be that time of the month again." However, at times, symptoms of vaginal bleeding should make women in this age range stop and think "or is it?"
Vaginal bleeding symptoms can be normal or abnormal. Normal vaginal bleeding (menstruation) happens every 21 to 35 days. The bleeding occurs because the uterus sheds its lining, and a new reproductive cycle begins. Vaginal bleeding symptoms unrelated to a normal menstrual cycle are considered abnormal.
The definition of a "normal menstrual cycle" is different for every woman. A menstrual cycle for one woman may last for a few days but for another woman may last a week or more. Be cautious of symptoms of vaginal bleeding that are different from your regular pattern.
For example, abnormal patterns of vaginal bleeding include bleeding that:
- Is lighter or heavier than your normal flow
- Occurs when you are not expecting your menstrual period
- Unexpected stage of life: Occurs during a time in your life when it is not expected such as before puberty, during pregnancy or after menopause (which is defined as 12 or more consecutive months without a menstrual period).
Being able to recognize patterns of vaginal bleeding that stray outside of your normal menstrual cycle is very important. You should always seek medical care and follow up with your doctor if you experience symptoms of abnormal vaginal bleeding.
Vaginal bleeding causes
The causes of vaginal bleeding are numerous, and the list can seem daunting. However, not all abnormal vaginal bleeding indicates a serious condition. This is why it is important to see your doctor in order to evaluate the cause of your symptoms and receive proper treatment.
Vaginal bleeding can be a sign of infection, such as the following.
- Bacterial infections: Infections such as chlamydia and gonorrhea can infect the reproductive tract and cause irritation and inflammation, especially after sexual intercourse, that can result in abnormal vaginal bleeding and other STD symptoms in women.
- Fungal infections: Fungal infections such as yeast also often affect the vaginal canal and result in inflammation that results in bleeding.
Benign uterine conditions
Although benign, these conditions can result in bleeding.
- Obstruction: Sometimes abnormal vaginal bleeding can be caused by masses in the reproductive organs such as fibroids that are not cancerous.
- Hormonal imbalances: Conditions of the uterus that occur as a result of hormonal imbalances such endometriosis and adenomyosis can result in heavy periods that are not your usual pattern.
Medications and medical devices
Certain contraceptive methods or medications can result in vaginal bleeding.
- Contraceptives methods: Birth control pills can cause vaginal bleeding symptoms if they are not used properly. Abnormal vaginal bleeding is also a known side effect of Intrauterine devices (IUDs).
- Medications: Medications such as blood thinners can cause you to bleed more during your menstrual cycle.
Blood or clotting disorders can result in vaginal bleeding.
- Functional: Medical conditions such as von Willebrand disease (clotting disorder) that affect the way different components of your blood function can result in vaginal bleeding.
- Synthetic: Your liver and to lesser extent your kidney are organs that are very important in making the components of your blood that regulate bleeding. If there is a malfunction in these organs such as liver disease or kidney disease, you may experience abnormal vaginal bleeding as well.
Cancers or precancerous conditions can result in vaginal bleeding.
- Cancer of the reproductive tract: Vaginal bleeding in women who have started menopause may be caused by cancers of any part the reproductive tract such as the ovary, vagina and uterus.
- Endometrial hyperplasia: This is a precancerous condition that can cause abnormal vaginal bleeding.
Endocrine system factors
Hormone imbalances such as Polycystic Ovarian Syndrome (PCOS) can interfere with your normal menstrual cycle and cause abnormal vaginal bleeding .
Trauma to the vagina can result in vagina bleeding, such as the following.
- Trauma examples: Blunt trauma, penetrating injury to the vagina/cervix and sexual abuse can all cause vaginal bleeding.
- A retained tampon: It would take multiple days for this to be considered traumatic and lead to vaginal bleeding.
This list does not constitute medical advice and may not accurately represent what you have.
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
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
Polycystic ovary syndrome (PCOS) is a hormonal condition very common in women of reproductive age, resulting in menstrual abnormalities as well as an excess of the androgen testosterone. PCOS can affect a woman's overall health and appearance and often has a si...
Ectopic pregnancy is a fairly common condition (one to two percent of all pregnancies). An ectopic pregnancy is one that occurs outside the uterus, which is the normal site of fetal development.
The hallmark symptoms of an ectopic pregnancy include severe abdominal pain, vaginal bleed...
Uterine fibroids are benign growths in the wall of the uterus and most often appear during childbearing years. Fibroids are almost never associated with cancer.
Those at higher risk include black women and women who started their periods at a young age. Other risk factors are vitamin D deficiency, poor diet, obesity, drinking alcohol, and family history of fibroids.
Fibroids can cause pelvic pressure and pain, severe menstrual cramping, and heavy menstrual bleeding that leads to anemia. Quality of life is diminished due to the chronic pain and discomfort. Though fibroids don't always make it impossible to become pregnant, infertility and pregnancy loss may occur as well as pre-term delivery.
Fibroids can be diagnosed through a routine pelvic exam or ultrasound in a doctor's office.
A gynecologist can prescribe various medications to ease the symptoms and regulate the menstrual cycle. There are also a number of surgical techniques, some minimally invasive, to shrink or remove the fibroids while leaving the uterus in place. Hysterectomy, or removal of the uterus, is an option in some cases.
Top Symptoms: vaginal bleeding, pelvis pain, abdominal cramps (stomach cramps), painful periods, irregular period
Urgency: Primary care doctor
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
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.
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
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...
Vaginal bleeding treatments and relief
Vaginal bleeding can be discomforting and distressing even during a normal menstrual cycle. Seeking prompt medical attention when you notice symptoms of abnormal bleeding will accelerate your diagnosis and allow you to get the appropriate treatment. Your treatment will depend on the cause of your symptoms and the results of any testing.
Depending on the cause, different medications can help address vaginal bleeding.
- Hormones: Many uterine conditions and endocrine system causes of abnormal bleeding are the result of an imbalance of hormones in the body. Your doctor may prescribe treatment in the form of these hormones in order to restore your body's balance.
- Antibiotics: Your doctor may prescribe antibiotics for certain infections of the reproductive tract that may cause your vaginal bleeding symptoms.
- Changes to your current regimen: If contraceptive methods or other medications are contributing to your symptoms, your doctor may discuss stopping your current medications in favor of a new regimen.
- Other treatment: If your vaginal bleeding symptoms are caused by an underlying bleeding disorder or systemic disease, your doctor will treat the primary disease first and monitor its effects on your vaginal bleeding.
When medications fail some causes of vaginal bleeding can be treated with surgical options that either remove masses or decrease the lining of the uterus. Most cancers of the reproductive organs are removed by surgery.
If your bleeding is caused by pregnancy-related factors your doctor will discuss available options for care.
When it is an emergency
Seek immediate medical attention if:
- You have sudden, severe pain in your belly or pelvis area
- Excessive bleeding: You are soaking through your usual pads or tampons every hour for 2 or more hours.
- You feel dizzy or lightheaded: Or you feel like you may faint
FAQs about vaginal bleeding
Here are some frequently asked questions about vaginal bleeding.
Can stress cause vaginal bleeding?
No, stress cannot cause vaginal bleeding. Stress can, however, cause an earlier or later menstrual cycle and cause bleeding in-line with a new cycle. If you have new mid-cycle bleeding and have not consulted a clinician, you should seek medical evaluation. It may be a sign of anything from a sexually transmitted infection (STI), to fibroids, to a pregnancy, or it may have no definable cause.
Why am I bleeding between my periods?
Bleeding between periods can be caused by serious or benign causes. The most dangerous causes often involve pregnancy. A failed pregnancy, a pregnancy in which the egg implants in the fallopian tube, disconnection of the placenta from the uterus, or damage to the uterus can all cause bleeding. If you suspect any of these causes, you should seek medical evaluation as soon and as safely as possible. Otherwise, uterine fibroids, tumor, blood thinners, ruptured ovarian cysts and gynecological infections, and changes in contraceptive drugs can cause spotting.
Is vaginal bleeding an early sign of pregnancy?
No, vaginal bleeding is not an early sign of normal pregnancy. If you are pregnant and experience vaginal bleeding, you should visit your OBGYN for evaluation. Vaginal bleeding can be caused by many things other than pregnancy, including sexually transmitted infections, uterine growths called fibroids, and certain types of cancers.
Why am I still spotting after my period ends?
Continuous bleeding after a period can be caused by a many things. Most commonly, an abnormally long period may have no discernible cause. If it does not recur, it may require no further investigation. Continuous spotting may be a sign of a disorder in coagulation caused by either medication or a genetic disorder. It may also be a sign of infection of the vagina or cervix.
Why am I experiencing vaginal bleeding after menopause?
Vaginal bleeding after menopause may be due to medications, hyperplasia of the uterus, or some types of uterine cancer. Certain medications containing estrogen or progesterone can cause either hyperplasia or an increase in the amount of tissue in the uterus, which may cause bleeding or an excess sloughing off of tissue both of which will be seen as vaginal bleeding.
Questions your doctor may ask about vaginal bleeding
- Are you sexually active?
- Do you use birth control beside condoms?
- Do you bleed after having sex?
- Have you ever had any surgeries?
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.
- Vaginal Bleeding. U.S. National Library of Medicine: MedlinePlus. Updated July 30, 2018. MedlinePlus Link
- Matteson KA, Mumford S, Schmidt P, Yonkers KA. Your Menstrual Cycle. Office on Women's Health. Updated March 16, 2018. OWH Link
- Blahd WH, Husney A, Romito K. Abnormal Vaginal Bleeding. University of Michigan: Michigan Medicine. Updated November 20, 2017. Michigan Medicine Link
- Barad DH. Vaginal Bleeding. Merck Manual Professional Version. Updated September 2018. Merck Manual Professional Version Link
- Ectopic Pregnancy. U.S. National Library of Medicine: MedlinePlus. Updated August 23, 2018. MedlinePlus Link
- Burd I. Vaginal Bleeding in Early Pregnancy. U.S. National Library of Medicine: MedlinePlus. Updated November 11, 2016. MedlinePlus Link
- Endometriosis. U.S. National Library of Medicine: MedlinePlus. Updated March 13, 2018. MedlinePlus Link
- Adenomyosis. The Center for Innovative Gyn Care. CIGC Link
- Vaginal Bleeding. U.S. National Library of Medicine: MedlinePlus. Updated July 30, 2018. MedlinePlus Link
- Polycystic Ovary Syndrome. U.S. National Library of Medicine: MedlinePlus. Updated August 28, 2018. MedlinePlus Link
- Jacobson JD. Abnormal Uterine Bleeding. U.S. National Library of Medicine: MedlinePlus. Updated December 8, 2016. MedlinePlus Link
- Freitas De Medeiros S, Winck Yamamoto MM, Silva Barbosa J. Abnormal Bleeding During Menopause Hormone Therapy: Insights for Clinical Management. SAGE Journals. Published January 23, 2013. SAGE Journals Link
- Vaginal Hysterectomy. Cancer Treatment Centers of America. Cancer Center Link
- Endometrial Ablation. The American College of Obstetricians and Gynecologists. Published July 2017. ACOG Link
- Stopped or Missed Periods. NHS. Updated July 28, 2016. NHS Link