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Causes of Vaginal Bleeding After Sex, Menopause & Periods

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Last updated April 24, 2024

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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 quiz

Take a quiz to find out what's causing your vaginal bleeding.

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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.

Pregnancy-related factors

Consider possible pregnancy if you experience abnormal vaginal bleeding symptoms. The bleeding can signify a pregnancy or problems with a pregnancy such as miscarriage or ectopic pregnancy.


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 disorders

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 [10].


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.

Rarity: Common

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

Uterine fibroids

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.

Rarity: Common

Top Symptoms: vaginal bleeding, pelvis pain, abdominal cramps (stomach cramps), painful periods, irregular period

Urgency: Primary care doctor

Polycystic ovary syndrome

Polycystic ovary syndrome, or PCOS, is a condition in which a woman's ovaries do not correctly release one egg cell per month (ovulate) as is normal. Instead, the egg cells remain on the surface of the ovary and fluid-filled cysts form around them.

The cause is not entirely known, but PCOS can be caused by significant weight gain because that brings about hormonal imbalance and insulin resistance. There may also be hereditary factors.

Symptoms include very irregular and abnormal menstrual periods. There may be signs of excess male hormones such as acne, facial and body hair, or even male pattern baldness.

Untreated PCOS can lead to infertility, complications of pregnancy, abnormal uterine bleeding, depression, and endometrial cancer.

Diagnosis is made through symptoms, pelvic examination, blood tests, and ultrasound.

PCOS is often treated with birth control pills, which suppress ovulation, regulate the monthly cycle, and decrease male hormone production. Maintaining normal body weight can often help the condition.

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.

Rarity: Common

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

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.

Rarity: Common

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

Urgency: Self-treatment


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.

Rarity: Uncommon

Top Symptoms: vaginal discharge, abdominal pain (stomach ache), vaginal bleeding, pelvis pain, painful periods

Urgency: Primary care doctor

Endometrial polyp

Endometrial polyps are noncancerous growths in the uterine cavity. Associated symptoms include spotting and bleeding during or after sexual intercourse.

You should speak with your primary care physician or OB/GYN about these symptoms.

Ectopic pregnancy

Ectopic pregnancy, or tubal pregnancy, means that a fertilized egg has not implanted in the uterus as it should. Instead, it has attached elsewhere – usually inside one of the fallopian tubes.

The condition is caused by scarring and damage to the fallopian tube from pelvic inflammatory disease or injury; by hormonal imbalance; or possibly by abnormal development of the fertilized egg. Other risk factors include smoking, use of an IUD, and use of fertility drugs.

Early symptoms include light vaginal bleeding, pelvic discomfort, and sometimes referred shoulder pain. Later symptoms include sudden severe pain on one side of the lower abdomen, vaginal bleeding, shoulder pain, and fainting.

The fallopian tube cannot accommodate a growing pregnancy. Eventually it will rupture, causing uncontrolled bleeding within the abdomen. If ectopic pregnancy is suspected, take the patient to the emergency room or call 9-1-1.

Diagnosis is made through pelvic examination, blood tests, and ultrasound.

Treatment almost always requires surgery, though in some cases medications can be used.

Prevention involves avoiding pelvic inflammatory disease by always practicing safe sex.

Cervical polyp

Cervical polyps are noncancerous growths in the cervical canal. Associated symptoms include spotting and bleeding during or after sexual intercourse.

You should speak with your primary care physician or OB/GYN about these symptoms.

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.

Pregnancy care

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.

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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