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When to see a doctor
By Mayo Clinic staffIf you're pregnant, contact your doctor immediately if you notice vaginal bleeding.
In general, anytime you experience unexpected vaginal bleeding, consult your doctor. Whether or not vaginal bleeding is normal depends on your age and the circumstances.
You should contact your doctor in the following situations:
- Postmenopausal women not taking hormone therapy should see a doctor if they experience vaginal bleeding.
- Postmenopausal women taking cyclic hormone therapy may experience some vaginal bleeding. A cyclic hormone therapy regimen — oral estrogen daily plus oral progestin for 10 to 12 days a month — can lead to bleeding that resembles a period (withdrawal bleeding) for a few days out of the month. If you have bleeding other than expected withdrawal bleeding, contact your doctor.
- Postmenopausal women taking continuous hormone therapy — a low-dose combination of estrogen and progestin daily — may experience light, irregular bleeding for the first six months. If bleeding persists longer or heavy bleeding begins, see your doctor.
- Girls who don't have any other signs of puberty or are younger than age 8 should have any vaginal bleeding investigated.
The following situations are likely normal, but talk to your doctor if you are concerned:
- Newborn girls may have some vaginal bleeding during the first month of life. Bleeding that's excessive or lasts longer should be checked out.
- Teenagers who have just begun having periods may experience irregular cycles during the first few years. In addition, many girls and women have light spotting for a few days before menstruating.
- Women starting birth control pills may experience occasional spotting the first few months.
- Women nearing menopause (perimenopause) may experience increasingly heavy or irregular periods. Ask your doctor about possible treatments to minimize your symptoms.
References
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 128. Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstetrics and Gynecology. 2012;120:197.
- South-Paul JE, et al. Current Diagnosis & Treatment in Family Medicine. 3rd ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=52. Accessed Mar. 4, 2013.
- Schmitz G, et al. Genitourinary emergencies in the nonpregnant woman. Emergency Medicine Clinics of North America. 2011:29;621.
- Goodman AK. Initial approach to the premenopausal woman with abnormal uterine bleeding. http://www.uptodate.com/home. Accessed March 4, 2013.
- AskMayoExpert. What are the most common causes of abnormal uterine bleeding? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- AskMayoExpert. What are the most common causes of postmenopausal vaginal bleeding? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- Casper RF. Clinical manifestations and diagnosis of menopause. http://www.uptodate.com/home. Accessed March 10, 2013.
- Goodman AK. Postmenopausal uterine bleeding. http://www.uptodate.com/home. Accessed March 4, 2013.
- Zacur HA. Managing an episode of severe or prolonged uterine bleeding. http://www.uptodate.com/home. Accessed March 4, 2013.
- Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/208746819-6/0/1608/0.html. Accessed March 5, 2013.
- Tsai MC, et al. Office diagnosis and management of abnormal uterine bleeding. Clinical Obstetrics and Gynecology. 2012;55:635.
- Paradise J. Evaluation of vaginal bleeding in children and adolescents. http://www.uptodate.com/home. Accessed March 12, 2013.
- Hickey M, et al. Unscheduled bleeding in continuous combined hormone therapy users. Maturitas. 2011;70:400.
- Fritz MA, et al., eds. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2011. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=booktext&D=books&AN=01437507$&XPATH=/PG(0). Accessed March 12, 2013.
- Goodman AK. Overview of causes of genital tract bleeding in women. http://www.uptodate.com/home. Accessed March 22, 2013.
- Frequently asked questions. Gynecologic problems FAQ162. Perimenopausal bleeding and bleeding after menopause. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq162.pdf?dmc=1&ts=20130329T1216499168. Accessed March 22, 2013.
- General information about vaginal cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/vaginal/Patient/page1. Accessed March 21, 2013.
- Shah SH, et al. Uterine sarcomas: Then and now. American Journal of Roentgenology. 2012;199:213.
- Gonorrhea - CDC Fact Sheet. Centers for Disease Control and Prevention. http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm. Accessed March 21, 2013.
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