Some Causes and Features of Vaginal Bleeding
Cause | Common Features* | Diagnostic Approach |
|---|---|---|
During infancy | ||
Exposure to the mother's estrogen before birth | A small amount of bleeding during the first 1–2 weeks of life | A doctor's examination |
During childhood | ||
A foreign object (body) in the vagina | Usually a foul-smelling discharge, often containing small amounts of blood Sometimes a history of having inserted an object into the vagina | A doctor's examination, sometimes done after the girl is sedated or given a general anesthetic |
Development of breasts and appearance of pubic and underarm hair (as occurs during puberty) at a young age | A doctor's examination X-rays of the hand and wrist to check for speeded-up growth of bones Blood tests to measure hormone levels | |
Sexual abuse | Difficulty walking or sitting and/or bruises or tears around the genitals, anus, or mouth Vaginal discharge or itching | A doctor's examination |
During the childbearing years | ||
Hormonal imbalance (ovulatory dysfunction) | Usually bleeding that occurs frequently or irregularly or that lasts longer or is heavier than typical menstrual periods | Tests to rule out other possible causes, including blood tests and usually ultrasonography, often using a handheld ultrasound device inserted in the vagina |
Fibroids (noncancerous tumors) in the uterus | Often no other symptoms With large fibroids, sometimes pain, pressure, or a feeling of heaviness in the pelvic area | Imaging, usually ultrasonography or sonohysterography (ultrasonography after fluid is injected into the uterus) If results are unclear, MRI |
Hormonal disorders, such as an underactive thyroid gland (hypothyroidism) |
| Blood tests to measure thyroid hormone levels |
Gestational trophoblastic disease (growth of abnormal tissue in the placenta related to a pregnancy) | Severe nausea and vomiting An abdomen that becomes larger much faster than it does in a normal pregnancy | Blood tests to measure human chorionic gonadotropin (hCG), a hormone produced by the placenta |
Excess body hair (hirsutism) Irregular or no menstrual periods, acne, and excess fat in the torso Darkened and thickened skin in the underarm, on the nape of the neck, and in skinfolds | Blood tests to measure levels of hormones, such as testosterone and luteinizing hormone Ultrasonography of the pelvis | |
Polyps in the cervix or uterus | Often no symptoms Bleeding that occurs between menstrual periods or after sexual intercourse | |
Complications due to an unrecognized pregnancy
| Crampy pelvic pain (in the lowest part of the torso) or back pain Sometimes passage of tissue through the vagina (usually occurs in a miscarriage) If an ectopic pregnancy ruptures, constant pelvic pain and sometimes light-headedness, fainting, or dangerously low blood pressure (shock) | A pregnancy test Usually ultrasonography of the pelvis For a suspected ectopic pregnancy:
|
Spotting or bleeding between periods (breakthrough bleeding) usually during the first months that oral or other hormonal contraceptives are used | Often no other symptoms | A doctor’s examination |
After menopause | ||
Thinning of the lining of the vagina† | Vaginal dryness Pain during sexual intercourse | Examination under a microscope and analysis of a sample of discharge |
Thickening of the lining of the uterus (endometrial hyperplasia) | Often no other symptoms | Hysteroscopy (insertion of a viewing tube through the vagina to view the uterus) or sonohysterography Biopsy of tissue taken from the lining of the uterus |
Cancer of the lining of the uterus (endometrium) | Often no other symptoms until the cancer is advanced Sometimes vaginal bleeding or a brown or bloody vaginal discharge Pain that develops gradually Sometimes weight loss | A biopsy Sometimes imaging of the pelvis such as ultrasonography, hysteroscopy (insertion of a viewing tube through the vagina to view the uterus), or sonohysterography |
At any age | ||
Bleeding disorders due to drugs, liver disorders, or hereditary disorders (such as von Willebrand disease) | Easy bruising Excessive bleeding during toothbrushing or after minor cuts A rash of tiny reddish purple dots (petechiae) or larger splotches (purpura), indicating bleeding in the skin | A complete blood cell count, including the number of platelets Blood tests to assess the blood’s ability to clot |
Injury (including that resulting from sexual abuse) | Sometimes a history of injuries Often vaginal discharge | Sometimes a doctor's examination alone If sexual abuse is suspected:
|
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Thinning of the lining of the vagina is part of the genitourinary syndrome of menopause, which also includes pain during sexual intercourse, urinary urgency, and urinary tract infections. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||