Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Abnormal Vaginal Bleeding (Irregular Periods) in Adults

Overview

Abnormal vaginal bleeding is common for women of all ages. Bleeding can also come from the uterus and other pelvic organs.

A typical menstrual cycle is between 24 and 35 days long with 4 to 7 days of bleeding. Average blood loss is about 3.5 tablespoons (3 to 4 pads or tampons a day).

You may have light bleeding (spotting) for 1 to 2 days around the middle of your cycle, between periods. Let us know if you:

  • Suddenly start spotting or start spotting in your 40s.
  • Continue to have irregular or unusually heavy bleeding.

Treatment depends on the cause of the abnormal bleeding but may include medication, nonsurgical procedures, and surgery.

Heavy or Frequent Bleeding

You may have too heavy or frequent bleeding if:

  • Your periods regularly last more than 10 days.
  • Your usual flow is heavy (more than 6 saturated pads or tampons per day).
  • You pass large clots.
  • You have frequent periods with cycles shorter than 21 days.
  • You have frequent spotting or irregular bleeding.

If you have any of these issues, especially if one continues beyond 2 years from the time you begin menstruating, schedule an appointment.

Infrequent or No Bleeding

Call us if you:

  • Have no period by age 16.
  • Frequently skip periods or go more than 3 months between periods, especially if your periods started more than 2 years earlier.
  • Have monthly pelvic pain with no bleeding by age 13.

Common Causes of Heavy or Frequent Bleeding

Heavy or frequent bleeding has many causes, including the following conditions:

Dysfunctional uterine bleeding (DUB) is irregular bleeding from the uterus. The bleeding can be heavy or light and is usually caused by changes in hormone levels. Sometimes, the ovaries fail to release an egg (anovulation), which may cause unusual bleeding.

We make a diagnosis of DUB after ruling out other causes of the heavy bleeding, such as fibroids, endometriosis, or polyps.

To help us make the correct diagnosis and identify proper treatment, your evaluation may include:

  • A pelvic exam
  • Blood and urine tests
  • A biopsy of the lining of the uterus

Endometriosis occurs when parts of the lining of the uterus (endometrium) attach to organs outside the uterus in the abdominal area, creating implants. During the menstrual cycle, these implants swell and bleed, which may cause pain and abnormal bleeding.

Treatment for endometriosis usually includes medications and/or surgery to remove the implants.

Adenomyosis occurs when the lining of the uterus grows into the muscle layer of the uterus. It can cause:

  • Long or heavy bleeding
  • Painful menstruation
  • Pelvic pain with intercourse

Most women do not need treatment for adenomyosis unless it is causing a lot of pain or bleeding. Treatments may include medications and surgery.

Bleeding disorders may cause heavy periods, starting with your first periods in adolescence. Bleeding disorders may reflect certain hereditary conditions:

  • von Willebrand disease
  • Idiopathic thrombocytopenia purpura
  • Platelets dysfunction

If we suspect these conditions, we may order blood tests. Treatment depends on diagnosis and the severity of your symptoms.

Common Causes of Light or No Bleeding

Light or infrequent bleeding may be caused by one of the following conditions:

Ovulation disorders

These are the most common cause of irregular and infrequent periods. Ovulation occurs when your ovary releases an egg. 

Polycystic ovary syndrome (PCOS) is the most common ovulation disorder. When your hormones (estrogen and progesterone) are out of balance, you can develop small cysts in your ovaries and have irregular periods. Treatment focuses on balancing hormone levels. For more information, see PCOS.

Dysfunctional uterine bleeding (DUB) is due to hormone irregularities that affect ovulation and cause irregular bleeding.  

We diagnose DUB after ruling out other causes of irregular bleeding, such as PCOS, fibroids, or polyps. 

Other problems

Stress can cause irregular bleeding or missed periods. Travel, relationships, family problems, and work issues can all cause stress.

Too little body fat may prevent your ovary from releasing an egg. If you do not ovulate, you may not have a period. This happens more often in women who are intense athletes, gymnasts, or ballet dancers.

Eating disorders (anorexia and bulimia) and malabsortion disorders like celiac sprue, Crohn’s disease, or ulcerative colitis can interfere with ovulation and stop menstrual cycles.

Too much body fat may also cause irregular bleeding. Sudden weight gain or weight loss may also affect normal menstrual cycle bleeding.

Growths in the Pelvic Organs

In some cases, unusual bleeding is caused by a growth on or near the uterus or cervix. 

Uterine fibroids are noncancerous growths in the wall of the uterus. Fibroids:

  • Can be as small as a seed or as large as a grapefruit. 
  • Can grow as a single tumor or in several places in the uterus. 
  • Are most common in women in their 40s and 50s but may occur in younger women.

You may not have any symptoms with fibroids. However, they can cause:

  • Bleeding and more frequent periods 
  • Menstrual cramps 
  • Back pain 
  • Difficulty with bowel movements or urination
  • Pain during intercourse 

When you do not have associated pain, the only sign of fibroids may be abnormal bleeding.

If your symptoms are severe, treatments could include medication, nonsurgical procedures, or surgery.

A cervical polyp is a small fingerlike growth on the cervix. Polyps also develop in the uterus. They are typically noncancerous (benign) and can cause heavy or irregular bleeding. 

Polyps can cause heavy or irregular bleeding. We can identify cervical polyps during a pelvic exam and usually remove them with a minor procedure.

Hormone-producing tumors are rare growths that can stop menstrual cycles. We diagnose these tumors with a physical exam, blood tests, and sometimes ultrasound. 

Cancers of the uterus, cervix, or vagina can also cause vaginal bleeding. We screen for these serious diseases with regular pelvic exams and Pap tests. 

Other Medical Conditions

The following medical conditions may cause abnormal bleeding.

Infections of the vagina, cervix, uterus, fallopian tubes, or ovaries, such as:

  • Sexually transmitted diseases (STDs)
  • Pelvic inflammatory disease (PID)
  • Genital warts on the vulva or in the vagina 

Treatment includes:

  • Minor office procedures
  • Prescription medications
  • Safer sex to greatly reduce the risk of STDs and genital warts

Urinary tract infection (UTI) may cause bleeding from the bladder. Signs of a UTI or bladder infection include:

  • Pink or light brown-colored urine, especially when you wipe
  • Blood in the urine
  • Pain when urinating
  • Frequent need to urinate

Thyroid problems may cause abnormal bleeding, especially in women over 40. 

  • An underactive thyroid (hypothyroidism) may cause heavy and prolonged vaginal bleeding.
  • An overactive thyroid (hyperthyroidism) may also cause unusual bleeding. 

A noncancerous growth in the pituitary gland may also be known as prolactinoma. The pituitary gland located at the base of your brain produces hormones, including prolactin. Too much prolactin in the blood may cause unusual vaginal bleeding.

Cushing’s syndrome can trigger irregular bleeding that is often light or infrequent. Cushing’s syndrome is caused by a growth in the pituitary gland that leads to too much cortisol in the blood. Cortisol is a hormone that helps your body respond to stress. 

Pregnancy

Pregnancy is the most common reason for missed periods. If you have skipped your period after having had sex, take a pregnancy test. Home pregnancy tests are accurate. 

You can also stop by our clinic lab. You do not need to make an appointment or bring any paperwork.

Spotting is common during the first trimester. It can happen after an internal exam in the office or after having sex. It happens because the cervix is sensitive to touch during pregnancy.

Miscarriage or tubal pregnancy 

Spotting can also be a sign of a miscarriage or tubal pregnancy. A tubal pregnancy occurs when the fertilized egg implants outside the uterus, most commonly in the fallopian tube.

If you are pregnant and experience bleeding or spotting, we may perform an ultrasound and order blood work to determine if the pregnancy is progressing normally. 

The female reproductive organs include the ovaries and fallopian tubes, the uterus, the cervix, and the vagina.


Medications That May Affect Bleeding

Many medications may cause unusual vaginal bleeding.

Hormonal contraception 

Birth control methods that contain hormones may cause changes to your menstrual patterns. Examples include:

  • Birth control pills
  • Patches and rings
  • The Depo-Provera shot
  • Implants containing progestin
  • IUDs (intrauterine devices)

If you are using your contraceptive method exactly as prescribed, irregular bleeding or lack of bleeding is probably not a cause for concern. 

However, if you have any symptoms of pregnancy (nausea, fatigue, or tender breasts), or if you have not used the method exactly as prescribed, take a pregnancy test.

Other medications 

Many other medications can cause changes to regular menstrual bleeding patterns, including:

  • Aspirin, Coumadin, and other anticoagulant medicines
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
  • Hormone therapy

In addition, medications or procedures used to treat other conditions can also cause irregular bleeding, including:

  • Psychiatric medications like antidepressants
  • Seizure medications like Dilantin
  • Prednisone and other corticosteroids
  • Medicines to prevent organ transplant rejection
  • Medications to treat cancer (chemotherapy) like Cytoxan or tamoxifen
  • Radiation therapy
  • Thyroid medicines, such as Synthroid or Levothroid

If you have changes in menstrual bleeding that may be related to prescribed medications, let us know. If you take a medication not prescribed by a doctor, stop taking it and call us.

Treatment

Together, we can determine the cause of your abnormal bleeding and identify the right treatment for you. During your appointment, we can talk about: 

  • The risks or complications of abnormal bleeding
  • How recovery will affect your daily activities 

Medication 

We may prescribe hormones (pills or injection) to help with irregular bleeding. 

  • Progesterone-only pills are taken monthly (or less often) for 10 days. 
  • Birth control pills are taken daily. 
  • Both progesterone shots and luprolide shots can completely stop your periods. 

In addition, nonsteroidal anti-inflammatory drugs (ibuprofen or naproxen) can reduce heavy menstrual flow for some women.

An intrauterine device (IUD) is a small plastic or copper device shaped like a T that is placed into the uterus to prevent pregnancy. It can also be used to treat abnormal vaginal bleeding.

Uterine artery embolization (UAE) is used to treat uterine fibroids. With a UAE, a tiny tube is inserted into an artery in the upper thigh. Then, small particles are inserted into the tube to block blood flow to the fibroids. The fibroids shrink and become inactive.


Nonsurgical Treatment

In some cases, we may recommend treating your abnormal bleeding with nonsurgical methods.

A Mirena intrauterine device (IUD) may help control irregular vaginal bleeding. This plastic T-shaped device is placed inside the uterus during an office visit. It releases hormones that thin the uterine lining. 

Common side effects are: 

  • Lighter periods or no periods
  • Temporary spotting for a few months after insertion 
  • Mild abdominal cramping after insertion 

The Mirena also prevents pregnancy and lasts for 5 years. If you decide to get pregnant, it can be removed. If the Mirena slips out, we can insert a new one.

Endometrial (uterine) ablation controls abnormal bleeding by destroying the lining of the uterus with heat or another type of energy. 

Scar tissue develops and decreases the amount of bleeding during your period. Your period may stop altogether. 

We can perform this procedure in our office. We do not recommend this procedure if you think you might want to become pregnant in the future.

Uterine artery embolization (UAE) is used to treat uterine fibroids. With a UAE, a tiny tube is inserted into an artery in your upper thigh. 

We then insert small particles into the tube to block blood flow to the fibroids. The fibroids shrink and become inactive. 

As a result, your periods usually become lighter and pain may decrease. We do not recommend that you have a UAE if you are thinking about getting pregnant in the future.

Hysteroscopy is a procedure that we perform in the clinic to remove polyps or fibroids that cause symptoms. 

We use a small camera (hysteroscope) to look inside your uterus through the cervix. We then remove the polyps or fibroids through the cervix.

Surgical Treatment

When other treatments are not effective, we may recommend surgery. Together we can talk about the benefits and risks. The following are common types of surgery used to treat abnormal vaginal bleeding. 

Myomectomy removes fibroids. We make several small cuts or one large cut in the belly to remove the fibroids. 

We might remove the fibroids through the cervix and vagina instead. The uterus is left in place. 

The size and location of your fibroids help determine the best method to use. Once the fibroids are removed, your: 

  • Period may be lighter. 
  • Pelvic pain may decrease. 
  • Ability to get pregnant may improve.

Hysterectomy removes the uterus and may be used when you have:

  • Endometriosis 
  • Cancer 
  • A history of other treatments that fail 

The fallopian tubes, cervix, and ovaries may also be removed along with the uterus. After hysterectomy:

  • Vaginal bleeding, including your period, stops. 
  • You cannot get pregnant. 
  • You will go through early menopause if the ovaries are removed. 

Bleeding in the Genital Area

Bleeding in the genital area may also be caused by hemorrhoids or an injury.

Hemorrhoids 

Hemorrhoids occur when the veins around your bottom (rectum and anus) swell and bleed. They cause itching, pain, and a hard lump around the anus. Treatment typically includes nonprescription corticosteroid creams or hemorrhoid creams that contain lidocaine to reduce pain and swelling.

Hemorrhoids usually go away within a few days. Let us know if you have a hemorrhoid that does not heal. For more information about treatment, see Hemorrhoids. 

Injury or trauma 

Bleeding may occur around the rectum or vagina due to trauma to your genital area during:

  • Sex 
  • Tampon insertion
  • Strenuous exercise

If you forget to remove a tampon or have a foreign body in the vagina, you may develop irregular bleeding. We can check for these issues with a pelvic exam.

Find Help If a Partner Hurts or Threatens You

Unfortunately, abusive relationships are common. Abuse can be physical, sexual, or psychological harm. It may include pressuring or forcing you to have sex or do things you are not comfortable with, or refusing to use a condom to protect against pregnancy or sexually transmitted diseases (STDs). 

If this is happening to you, you can get help by talking to us, or you may:

  • Contact the National Domestic Violence Hotline at 1-800-799-7233 or 1-800-787-3224 for hearing/speech impaired, or at http://www.thehotline.org/ 
  • Visit the National Sexual Assault Hotline at 1-800-656-4673 or www.rainn.org 

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.