Vaginal Bleeding

Vaginal bleeding outside of a normal period deserves attention. Some causes are common and benign; some are serious. What matters is when the bleeding is happening — in a young girl, in pregnancy, between periods, after sex, or after menopause.

When to see a Health Expert

• Any bleeding in a girl before puberty — urgent evaluation.
• Bleeding in pregnancy — any amount; especially with pain — go to hospital now.
• Heavy periods — soaking through protection hourly, large clots, flooding, weakness.
• Bleeding between periods — persistent spotting.
• Bleeding after sex — more than occasionally.
• Periods closer than 21 days or longer than 35 days regularly.
• Post-menopausal bleeding — any bleeding after 12 months without a period; always needs investigation to rule out cancer.

Common causes

• Hormonal imbalance — PCOS, thyroid, stress, weight changes.
• Fibroids, adenomyosis — heavy or prolonged bleeding.
• Polyps — in cervix or uterine lining; cause spotting or intermenstrual bleeding.
• Infection / cervicitis — bleeding after sex; often with discharge.
• Contraceptive methods — particularly early weeks of new method.
• Pregnancy-related — miscarriage, ectopic pregnancy, placental causes.
• Cancer of cervix, uterus or vagina — bleeding after sex or after menopause is a particularly important warning.

What a Health Expert will check

• History and examination.
• Pregnancy test.
• Pelvic ultrasound.
• Cervical examination and Pap / HPV test.
• Blood tests — haemoglobin, thyroid, clotting.
• Endometrial biopsy in post-menopausal bleeding.
• Hysteroscopy for persistent abnormal bleeding.

Important — silence doesn't help

Many Indian women wait months or years with abnormal bleeding out of embarrassment. Most causes are readily treatable; cancers caught early are largely curable. The visit, the questions, and the tests are routine for the gynaecologist.