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're in menopause — generally defined as 12 months, give or take, without a menstrual period — any vaginal bleeding may be a cause for concern and should be evaluated.

Possible causes of abnormal vaginal bleeding include:

Cancers and precancerous conditions

  1. Cervical cancer
  2. Endometrial cancer (uterine cancer)
  3. Endometrial hyperplasia
  4. Ovarian cancer
  5. Uterine sarcoma
  6. Vaginal cancer

Endocrine system factors

  1. Hyperthyroidism (overactive thyroid)
  2. Hypothyroidism (underactive thyroid)
  3. Polycystic ovary syndrome (PCOS)
  4. Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)

Fertility and reproduction factors

  1. Ectopic pregnancy
  2. Fluctuating hormone levels
  3. Miscarriage (before the 20th week of pregnancy)
  4. Pregnancy
  5. Random ovulatory cycles
  6. Sexual intercourse
  7. Perimenopause
  8. Vaginal atrophy (genitourinary syndrome of menopause)


  1. Cervicitis
  2. Chlamydia trachomatis
  3. Endometritis
  4. Gonorrhea
  5. Pelvic inflammatory disease (PID)
  6. Ureaplasma vaginitis
  7. Vaginitis

Medical conditions

  1. Celiac disease
  2. Severe systemic disease, such as kidney or liver disease
  3. Thrombocytopenia
  4. Von Willebrand disease (and other blood clotting disorders)

Medications and devices

  1. Forgotten (retained) tampon
  2. Intrauterine device (IUD)
  3. Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)
  4. Tamoxifen side effect

Noncancerous growths and other uterine conditions

  1. Adenomyosis
  2. Cervical polyps
  3. Endometrial polyps
  4. Uterine fibroids
  5. Uterine polyps


  1. Blunt trauma or penetrating injury to the vagina or cervix
  2. Sexual abuse

Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

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June 15, 2021