What do you do if you are bleeding, but it is not time for your period or your period is longer or heavier than usual? Don’t panic. I know it looks like a lot of blood, but it is extremely rare to bleed to death from abnormal vaginal bleeding. Women of childbearing age are usually relatively young and healthy, and, therefore, have a healthy bone marrow that can keep up with the blood you are losing. The first thing you need to know is if you are pregnant. If you are pregnant and bleeding, that is a totally different blog post.
We’re available Sunday-Thursday, 10AM-10PM and Friday-Saturday 11AM-11PM
If you are not pregnant, try to get an idea of how many pads or tampons you are using in an hour. That will quantify the bleeding. Remember that as you go through your menstrual cycle, you build up a lining of blood in your uterus. Most of the blood you are seeing has built up over the course of a month. If you miss your period, you will have an even thicker lining to shed and, therefore, more blood. Blood clots are also distressing to many women. Your uterus is about the size of your clenched fist. If the blood coagulates in the middle of it, you can pass pretty good size clots and it can be normal to pass several clots.The fact that your blood is clotting is actually a good thing. Clotting of your blood keeps you from bleeding to death.
There are many causes of abnormal vaginal bleeding when you are not pregnant and most of them are problematic, but usually not life-threatening. These causes include the following: uterine fibroids, non-cancerous tumors of the uterine lining – called polyps, tears or sores of the vagina, IUDs, effects of certain medication – such as blood thinners, birth control pills, steroids, certain tranquilizers, or ginseng, infection of the vagina, cervix, uterus, or fallopian tubes, endometriosis, ovarian cysts or tumors, polycystic ovarian disease, or thyroid disorders. None of these conditions is considered life-threatening.
Rarely is abnormal bleeding due to cancer of the uterus or ovaries. Uterine and ovarian cancers are more common in postmenopausal women. A woman’s lifetime risk of uterine cancer in the United States is approximately 2.7%. Estimated lifetime risk of ovarian cancer is approximately is 1.3%. So, statistically it is very unlikely you have cancer.
If you are having abnormal vaginal bleeding you will need to be evaluated by your family physician. Your family physician can often evaluate simple causes of abnormal vaginal bleeding by taking your medical history, doing a thorough physical exam, and some simple blood tests. You may also need an ultrasound of your pelvic organs to look for abnormalities such as uterine polyps or fibroids, ovarian cysts or tumors, or position of your IUD. Cases of abnormal vaginal bleeding that are more complicated may be referred to a Gynecologist, who is a specialist in the female reproductive system. The gynecologist may order more specialized blood test and do more specialized imagig studies. Sometimes abnormal vaginal bleeding can be treated with medication such as antibiotics for infection, changing a medication dose, or taking birth control pills or similar hormones to regulate your menstrual cycles. Sometimes the gynecologist may need to remove your IUD and help you change to another method of birth control. Occasionally, the gynecologist will need to look inside your uterus, called a hysteroscopy, or take a sample of the lining of your uterus to test for abnormal cells, called a uterine biopsy. Most of this evaluation can be done as an outpatient.
If you are concerned about the amount you are blleding we can evaluate you in our urgency center. You should be evaluated immediately if you have sudden, severe pain in your pelvis associated with the bleeding, you are soaking through more than one pad or tampon per hour for more than two hours, you feel light-headed as though you might faint, you are passing out, if you have a fever (temperature >100.5), or you think you may be pregnant as these findings can indicate an emergency condition. Hopefully, this will give you a better idea of what to do if you have abnormal vaginal bleeding.