Abnormal vaginal bleeding can relate to an issue with your reproductive system (a gynecologic condition) or to other medical problems or certain medications. If you have reached menopause — defined as 12 consecutive months, give or take, without a menstrual period — subsequent vaginal bleeding may be a cause for concern and should be evaluated.
Possible causes of abnormal vaginal bleeding include:
Cancers and precancerous conditions
- Cervical cancer
- Endometrial cancer (uterine cancer)
- Endometrial hyperplasia
- Ovarian cancer
- Uterine sarcoma
- Vaginal cancer
Endocrine system factors
- Hyperthyroidism (overactive thyroid)
- Hypothyroidism (underactive thyroid)
- Polycystic ovary syndrome (PCOS)
- Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)
Fertility and reproduction factors
- Ectopic pregnancy (in which the fertilized egg implants and grows outside of the uterus, such as in a fallopian tube)
- Fluctuating hormone levels
- Miscarriage (before the 20th week of pregnancy)
- Pregnancy
- Random ovulatory cycles
- Sexual intercourse
- Perimenopause (the transition time before menopause)
- Vaginal atrophy (genitourinary syndrome of menopause)
Infections
- Cervicitis
- Chlamydia trachomatis
- Endometritis
- Gonorrhea
- Pelvic inflammatory disease (PID)
- Ureaplasma vaginitis
- Vaginitis
Medical conditions
- Celiac disease
- Severe systemic disease, such as kidney or liver disease
- Thrombocytopenia (low platelet count)
- Von Willebrand disease (and other blood clotting disorders)
Medications and devices
- Forgotten (retained) tampon
- Intrauterine device (IUD)
- Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)
- Tamoxifen side effect
Noncancerous growths and other uterine conditions
- Adenomyosis
- Cervical polyps — noncancerous (benign) growths on your cervix
- Uterine fibroids
- Uterine polyps (endometrial polyps)
Trauma
- Blunt trauma or penetrating injury to the vagina or cervix
- Sexual abuse
Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 128. Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstetrics and Gynecology. 2012;120:197.
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- Frequently asked questions. Pregnancy FAQ090. Early pregnancy loss. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Early-Pregnancy-Loss. Accessed April 18, 2019.
- Walls RM, et al., eds. Vaginal bleeding. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed April 18, 2019.
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