Vaginal Bleeding - Abnormal

Vaginal Bleeding - Abnormal

Is this your symptom?

  • Menstrual bleeding is not normal when any of these happen:
  • More than 7 days (1 week) of bleeding
  • More than 6 well-soaked pads or tampons per day
  • Periods come more than one time every 21 days
  • Any bleeding or spotting between normal periods

Some Basics...

  • A woman should tell her doctor if she is bleeding more than normal. This means using 2 or more tampons or pads than she normally uses per day. Periods that last 3 or more days longer than normal should also be discussed.
  • The first day of menstrual bleeding is the first day of a new cycle. The length of the cycle varies from woman to woman. The range is 24-35 days. The average cycle length is 28 days.
  • Menstrual bleeding normally lasts 3-7 days. The most bleeding often happens during the first 3 days of a period.
  • Ovulation often happens close to day 14 of the cycle. Women may bleed at this time though it is the middle of their cycle.
  • Heavy vaginal bleeding can cause iron deficiency anemia. It is the most common cause of anemia in women of childbearing age.

Caution - Pregnancy

  • All women of childbearing age with vaginal bleeding should consider the chance that they are pregnant.
  • In early pregnancy, vaginal bleeding can be a sign of serious problems. These include miscarriage or tubal pregnancy.

When to Call for Vaginal Bleeding - Abnormal

Call 911 Now

  • Passed out (fainted)
  • Very weak (can't stand)
  • You think you have a life-threatening emergency

Call Doctor Now or Go to ER

  • Moderate vaginal bleeding (soaking 1 pad or tampon per hour for 6 or more hours)
  • Pregnant or could be pregnant
  • Passed tissue (gray-white)
  • Pale color of skin that is new or getting worse
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Spotting after a procedure (biopsy) or pelvic exam (pap smear) that lasts more than 3 days
  • You think you need to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Menstrual bleeding lasts more than 7 days
  • Menstrual cycle is less than 21 days or more than 35 days
  • Menstrual bleeding with 6 or more soaked pads or tampons per day
  • Missed period happened 2 or more times in the last year and cause is not known
  • Bleeding or spotting happens between normal periods
  • Irregular bleeding happens more than 2 cycles (2 months) and using birth control (pills, patches, Depo-Provera, Norplant, or vaginal ring)
  • Yellow, green, or gray vaginal discharge
  • You have other questions or concerns

Self Care at Home

  • Normal period
  • Mild vaginal bleeding

Care Advice

Mild Vaginal Bleeding

  1. What You Should Know:
    • A woman should tell her doctor if she is bleeding more than normal. This means using 2 or more tampons or pads than she normally uses per day. Periods that last 3 or more days longer than normal should also be discussed.
    • There are some common causes of mild vaginal bleeding. Birth control can also cause irregular bleeding.
    • Here is some care advice that should help.
  2. Spotting After a Procedure or Pelvic Exam:
    • The cervix bleeds easily. Even an internal exam, Pap smear, or biopsy can cause some spotting.
    • This spotting should decrease within 24-72 hours.
  3. Spotting After First Time You Have Sex:
    • This is common. You may have mild bleeding after the first time you have sex.
    • It should stop within 48 hours and not start again.
  4. Iron and Anemia:
    • Heavy periods can cause iron deficiency anemia. It is the most common cause of anemia in women of childbearing age.
    • Women with heavy periods should eat foods rich in iron. They can also take a daily multivitamin pill with iron.
  5. Pregnancy Test, When in Doubt:
    • If there is a chance that you might be pregnant, use a urine pregnancy test.
    • You can buy a pregnancy test at the drugstore.
    • It works best first thing in the morning.
    • Follow all package instructions.
  6. Call Your Doctor If:
    • Pregnancy test is positive
    • You have trouble with the at-home test
    • Bleeding becomes worse
    • You think you need to be seen
    • You get worse

Irregular Vaginal Bleeding While Using Birth Control

  1. Spotting Between Periods and Taking Birth Control Pills:
    • This is common. You may have breakthrough bleeding or spotting with most of these pills.
    • It is likely to happen during the first three pill pack cycles.
  2. Spotting Between Periods and You Forgot to Take a Birth Control Pill:
    • Missing a pill may cause breakthrough bleeding or spotting.
    • If you forget to take more than one pill a month, use a "back-up" birth control method (condom). Keep using a back-up method until you start the next pill pack.
  3. Irregular Bleeding and Using Implanon or Depo-Provera: This is common. Irregular bleeding may be heavier or lighter bleeding than normal. It may also be more or less frequent bleeding than your normal period.
  4. Irregular Bleeding and Using the Birth Control Patch: This is common. You may have breakthrough bleeding or spotting with these patches. This is likely to happen during the first 3 cycles (months).
  5. Irregular Bleeding and Using the Vaginal Contraceptive Ring (NuvaRing): This is not common. You should not have breakthrough bleeding or spotting with NuvaRing. However, it can happen during the first 1-2 months of use (first 2 cycles).
  6. Diary: Keep a record of the days you have any bleeding or spotting.
  7. Call Your Doctor If:
    • Irregular bleeding happens more than 2 cycles (2 months)
    • Bleeding becomes worse
    • You think you need to be seen
    • You get worse

Missed Combined Hormone Birth Control Pill - Placebo or Reminder Pill

  1. Diretions for Missed Placebo Pills:
    • Follow these directions if you missed one or more placebo pills (reminder pills).
    • Throw away the missed pill or pills.
    • Continue taking the rest of the pills on the usual day.
    • You are not at increased risk for pregnancy.
    • You do not need to use a "back-up" form of birth control.
    • Example: Missed pill(s) during days 22-28 of a 28-day pack.
  2. Tips for Remembering to Take Pills on Time:
    • Set an alarm on your watch or phone.
    • Combine taking the pill with a daily routine.
    • For example, take it after brushing your teeth in the morning.
    • When traveling, keep your pill pack with you in your purse or carry-on bag.
  3. Pregnancy Test, When in Doubt:
    • If there is a chance that you might be pregnant, use a urine pregnancy test.
    • You can buy a pregnancy test at the drugstore.
    • It works best first thing in the morning.
    • Follow all package instructions.
  4. Call Your Doctor If:
    • Bleeding becomes worse
    • You think you need to be seen
    • You get worse

Missed Combined Hormone Birth Control Pill - Active Hormone Pill

  1. Late Taking 1 Active Pill (Less than 24 Hours Since a Pill Should Have been Taken):
    • Follow these directions if you are late taking an active hormone pills (not placebo pills).
    • Take the late pill as soon as possible.
    • Take the next pill at the usual time. This means you may need to take 2 pills at one time or 2 pills on the same day.
    • There is little or no risk of becoming pregnant with 1 late pill.
    • You do not need to use a back-up method of birth control.
  2. Missed 1 Active Pill (24-48 Hours Since a Pill Should Have been Taken):
    • Follow these directions if you missed 1 or more active hormone pills (not placebo pills).
    • Take the missed pill as soon as possible.
    • Take your next pill at the usual time. This means you may need to take 2 pills at one time or 2 pills on the same day.
    • There is little or no risk of becoming pregnant with 1 missed pill.
    • You do not need to use a back-up method of birth control.
  3. Missed 2 Pills (2 or more) on Days 1-14 || 21-Day or 28-Day Pack Users:
    • Follow these directions if you missed 2 active hormone pills (not placebo pills).
    • Take one of the missed pills (most recently missed) as soon as possible.
    • Throw away other missed pills.
    • Continue taking the rest of your pills in your pack on the usual time, even if this means you take 2 pills on the same day.
    • Use a back-up contraception method (e.g., condom) or avoid having sex until you have taken the pills for 7 days in a row without missing any.
    • Consider emergency contraception if unprotected sex in the past 5 days.
  4. Missed 2 Pills (2 or more) on Days 15-21 || 21-Day or 28-Day Pack Users:
    • Follow these directions if you missed 2 active hormone pills (not placebo pills).
    • Take one of the missed pills (most recently missed) as soon as possible. Throw away other missed pills.
    • Continue taking the rest of your pills in your pack on the usual time, even if this means you take 2 pills on the same day.
    • Skip the placebo (reminder) pills (or hormone-free week if using a 21-day pack). Start a new pack the very next day.
    • Use a back-up contraception method (e.g., condom) or avoid having sex until you have taken the pills for 7 days in a row without missing any.
    • Consider emergency contraception if unprotected sex in the past 5 days.
  5. Pregnancy Test, When in Doubt:
    • If there is a chance that you might be pregnant, use a urine pregnancy test.
    • You can buy a pregnancy test at the drugstore.
    • It works best first thing in the morning.
    • Follow all package instructions.
  6. Emergency Contraceptive Pills (ECP) - When to Consider:
    • Emergency contraception pills (ECPs) can be used by any woman who is worried she might become pregnant.
    • ECPs should be taken as soon as possible within 5 days after unprotected sex.
    • The sooner ECPs are taken, the more effective they are.
  7. Tips For Remembering to Take Pills on Time:

    • Set an alarm on your watch or phone.
    • Combine taking the pill with a daily routine.
    • For example, take it after brushing your teeth in the morning.
    • When traveling, keep your pill pack with you in your purse or carry-on bag.
  8. Call Your Doctor If:
    • Bleeding becomes worse
    • You think you need to be seen
    • You get worse

Missed Progestin-Only Pill (POP) or Took It Late

  1. Progestin-Only Pill (POP):
    • The Progestin-Only Pill (POP), also called the "mini-pill," is different from combined birth control pills.
    • POP pills contain only one hormone (progestin) instead of two (progestin and estrogen).
  2. Progestin-Only Pill (POP) - Directions for Missed or Late Pills:

    • Follow these directions if you miss a pill or take a pill more than 3 hours late.
    • Take the missed or late pill as soon as possible.
    • Keep taking the rest of your pills at your usual time every day.
    • This means you may need to take 2 at one time or 2 pills on the same day.
  3. Back-Up Form of Birth Control is Needed:

    • Follow these directions if you miss a pill or take a pill more than 3 hours late.
    • Avoid having sex or use a backup method of birth control.
    • You will need to do this until you have taken pills on time for two days in a row.
    • Examples of back-up birth control include condoms, spermicide, diaphragm, or sponge.
  4. Pregnancy Test, When in Doubt:

    • If there is a chance that you might be pregnant, use a urine pregnancy test.
    • You can buy a pregnancy test at the drugstore.
    • It works best first thing in the morning.
    • Follow all package instructions.
  5. Emergency Contraceptive Pills (ECP) - When to Consider:

    • Emergency contraception pills (ECPs) can be used by any woman who is worried she might become pregnant.
    • ECPs should be taken as soon as possible within 5 days after unprotected sex.
    • The sooner ECPs are taken, the more effective they are.
  6. Tips For Remembering to Take Pills on Time:

    • Set an alarm on your watch or phone.
    • Combine taking the pill with a daily routine.
    • For example, take it after brushing your teeth in the morning.
    • When traveling, keep your pill pack with you in your purse or carry-on bag.
  7. Call Your Doctor If:
    • Bleeding becomes worse
    • You think you need to be seen
    • You get worse

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Last Reviewed: 12/12/2017 1:32:10 AM
Last Updated: 5/7/2017 1:36:22 PM

Copyright 2000-2017. Health Navigator, Inc. All rights reserved.

First Aid - Shock - Adult or Teen
  • Lie down with the feet elevated (Reason: counteract shock).

Note: In this illustration the individual in shock is laying down and his feet have been placed up on a stack of blankets.