Merck Manual

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Some Causes and Features of Vaginal Bleeding

Some Causes and Features of Vaginal Bleeding


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

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)

  • A slow heart rate

  • Weight gain

  • Intolerance of cold

  • Dry and coarse skin

  • Coarse facial features and dullness of facial expression

  • Sluggishness

Blood tests to measure thyroid hormone levels

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

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:

  • Urine and blood tests to measure hCG, produced by the placenta

  • Sometimes for a suspected ectopic pregnancy, laparoscopy (insertion of a thin viewing tube into the abdomen) or laparotomy (a large incision into the abdomen enabling doctors to directly view organs)

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

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

At any age

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:

  • Examination under a microscope and analysis of a sample of the discharge

  • Tests to detect sexually transmitted infections using a sample of secretions taken from the cervix

* 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.