Vaginal & Ovulation Bleeding: When Should You See a Doctor?

Thankfully, most of the time your period will come and go without causing much fuss. But what about those times when your cycle gets thrown out of whack and you have abnormal bleeding? Should you be concerned?

Every woman is different when it comes to her cycle. However, when period changes happen – such as a heavier or lighter flow than usual or timing abnormalities – it can be hard to decide if you need to call your doctor or if what you’re experiencing is in the range of normal.

It’s a good idea to always track your menstrual cycles, including how heavy your flows are, how long they last and how many tampons or pads you use during a single cycle. This information can be useful for your doctor.

We spoke to INTEGRIS Health OB-GYN Dr. Elise Schrop to get her insights on a scary topic. What causes abnormal bleeding, just what is “abnormal” anyway, and when should you consult your doctor? 

"Abnormal bleeding is a very common problem for women," Dr. Schrop says. "In fact, about a third of office visits to the gynecologist are for abnormal bleeding. It can happen to women of all ages but most commonly occurs in the first several years after a young woman starts having a period and as women start to make the transition to menopause."

What is considered normal menstrual bleeding?

Normal menstrual bleeding is when menstrual periods last four to seven days, with a normal cycle occurring every 21 to 35 days.

Most woman have a definition of what “normal” looks like for them. Many women already know that on average, menstrual periods last four to seven days, with a normal cycle occurring every 21 to 35 days. But did you know this interesting fact? Blood loss during a period averages about 40 ccs, or the equivalent of only three tablespoons.

What is abnormal bleeding?

Abnormal bleeding during a menstrual cycle can look like any the following problems.

• Your periods occur less than 21 days apart (polymenorrhagia)
• Your periods occur more than 35 days apart (oligomenorrhea)
• You miss three or more periods in a row
• Your blood flow is much heavier or lighter than usual
• Your periods last longer than seven days
• You experience excessive pain, cramping, nausea or vomiting during your periods (dysmenorrhea)

When should you see a doctor about abnormal bleeding?

"You need to see a doctor if you don’t have a monthly period or have more than one period per month. Feeling lightheaded or dizzy when you stand is also concerning," says Dr. Schrop. She also urges women to see a doctor if they experience bleeding after going through menopause, or if they experience bleeding while pregnant.

Finally, Dr. Schrop says to see a gynecologist if you are experiencing any of the following:

• Bleeding that requires more than one tampon or sanitary pad in an hour, for several hours in a row
• Bleeding or spotting between periods
• Bleeding after having sex
• Severe pain
• Fever
• Abnormal discharge or color
• Unexplained weight gain or loss
• Unusual hair growth
• New onset of acne
• Nipple discharge 

What is menorrhagia?

Menorrhagia is menstrual bleeding that lasts more than 7 days, excessively heavy and prolonged menstrual periods. A blood flow of 80 ccs (five tablespoons) or more that lasts longer than seven days may signal that you have menorrhagia. With menorrhagia, women may find they need to use several tampons and/or sanitary pads per hour throughout the day or wake up in the middle of the night simply to change the pad.

If heavy and prolonged periods interfere with living your daily life consult your doctor. Excessive blood loss can also lead to anemia, an iron deficiency, and may signal other medical conditions. Anemia can cause fatigue, pale skin, shortness of breath or dizziness.

What is metrorrhagia?

Metrorrhagia is bleeding that occurs between periods or is not directly associated with your normal menstruation. This can consist of light or heavy bleeding or spotting that may be accompanied by abdominal pain or cramps. Metrorrhagia is more common for teenagers and women nearing menopause.

Why are there bleeding irregularities?

"The most common causes of bleeding irregularities depend on your age," Dr. Schrop says. "Commonly, bleeding irregularities can come from not ovulating regularly (irregular ovulation can be caused by several things, including abnormalities of the uterus and pregnancy). Less commonly, bleeding irregularities can indicate pre-cancer or cancer."

10 Causes of Bleeding Irregularities

1. Stress and lifestyle changes – Stress and lifestyle changes, such as gaining or losing weight, dieting, changing exercise routines, traveling, illness and other disruptions to your normal daily routine can impact your menstrual cycle and cause irregularities.
2. Birth control – Going on or off birth control pills can affect your menstruation. Some women may experience irregular periods or miss periods for up to six months after stopping birth control pills. Other forms of birth control, such as IUDs, can cause period irregularities (lighter or heavier flows) or cause your period to stop. Birth control pills that only contain progestin (no estrogen) may cause bleeding between periods.
3. Medications – Some anti-inflammatory drugs, anticoagulants (blood thinners), hormone medications or steroids can affect menstrual bleeding. 
4. Hormone imbalances – An excess of estrogen and progesterone can cause heavy bleeding. This is most common for girls in the first year or so of having her first period and for women nearing menopause.
5. Uterine polyps or fibroids – Uterine polyps are small growths in the lining of the uterus, while fibroids are tumors that attach to the wall of the uterus. Both are usually benign (noncancerous) but can cause heavy bleeding and pain during periods.
6. Pregnancy complications – Pregnancy should interrupt normal menstruation although some spotting during the first trimester is often no cause for concern. Bleeding heavily during pregnancy may be a sign that you are experiencing a miscarriage or an ectopic pregnancy (when a fertilized egg implants itself in the fallopian tube rather than the uterus). Consult your doctor right away if you experience bleeding during pregnancy.
7. Endometriosis – Endometriosis occurs when the endometrial tissue that lines your uterus begins to grow outside the uterus, sometimes growing on the ovaries, fallopian tubes, intestines or other digestive organs. This condition can cause painful bleeding, cramps and painful intercourse.
8. Pelvic inflammatory disease – Pelvic inflammatory disease (PID) is a bacterial infection that can cause heavy vaginal discharge with unpleasant odor, irregular periods, pelvic or lower abdominal pain, fever, nausea, vomiting or diarrhea.
9. Polycystic ovary syndrome – Polycystic ovary syndrome occurs when the ovaries release abnormal amounts of androgens (male hormones), causing cysts to form. These ovarian cysts can cause hormonal changes that can prevent ovulation and menstruation from occurring. Women with PCOS may experience irregular periods or stop menstruating completely.
10. Premature ovarian insufficiency – Premature ovarian insufficiency occurs in women under 40 whose ovaries do not function properly, causing their menstrual cycle to stop prematurely (similar to menopause). This can occur in women being treated for cancer with chemotherapy and radiation or those who have a family history of the condition.

Treating abnormal periods

Treatment for abnormal or irregular period bleeding will depend on your overall health and the cause of the abnormality.

Dr. Schrop says, "At home, taking NSAIDs such as ibuprofen during periods of heavy bleeding can lessen bleeding and control pain, but will not resolve any underlying problem. Taking a warm bath or using a heating pad might provide some temporary relief, but there is nothing women can do at home to resolve abnormal bleeding without seeing a gynecologist." Also, it’s important to note that aspirin is not recommended to treat menstrual pain as it can cause heavier bleeding.

Dr. Schrop reminds women they do not have to live with abnormal bleeding. "There are many different conditions that can cause abnormal bleeding," she says. "You will only be able to determine the cause after a visit with your gynecologist and appropriate tests are done. It can take several visits to complete the evaluations and explain treatment options."

Medical treatment for abnormal bleeding may include hormones such as estrogen or progestin to control heavy bleeding, low-dose birth control to control bleeding, iron supplements to treat anemia caused by heavy bleeding or an intrauterine device (IUD) to lessen heavy bleeding.

For more severe issues, surgery or even a hysterectomy (the removal of the uterus) may be necessary to correct bleeding irregularities.

If you’re concerned about abnormal period bleeding, find an INTEGRIS Health OB-GYN near you. Dr. Schrop practices at INTEGRIS Canadian Valley Women's Care. For more information on female health, check out the INTEGRIS On Your Health blog.