Irregular vaginal bleeding: should I be concerned?

If women are experiencing irregular bleeding they may feel anxious and concerned that it is a sign of something more serious. Renowned consultant obstetrician and gynaecologist Dr Tilottama Nandy explains more about the condition, including what provokes it and when it is necessary to seek medical advice.

What is irregular vaginal bleeding?

Irregular vaginal bleeding is any bleeding that falls outside the expectation of a regular menstrual bleed during menstrual life, such as bleeding in between periods or after sex.

Vaginal bleeding is not expected or normal within post-menopausal women, therefore any bleed should be reported urgently to the GP.

What provokes irregular vaginal bleeding?

Irregular vaginal bleeding may arise due to various factors. Cancer of any of the reproductive organs (uterus, cervix, ovaries, vagina, vulva) may present with irregular bleeding, and would be important to exclude. In some cases, pre-cancerous stages may also cause irregular bleeding.

Common causes of irregular vaginal bleeding include the following:

• infection (including sexually transmitted infections)
• polyps and fibroids
• endometriosis and adenomyosis
• polycystic ovarian syndrome (PCOS)
• trauma and foreign bodies (e.g. retained tampon)
• certain medications (e.g. anticoagulants, emergency contraception)
• non-compliance with the contraceptive pill
• inflammation
• dysfunctional bleeding associated with perimenopause.

How serious is irregular vaginal bleeding?

The majority of irregular vaginal bleeding cases will have a treatable cause, however, accurate and timely diagnosis is crucial.

undiagnosed and untreated irregular bleeding may have far-reaching implications depending on the cause, and can be linked to medical issues such as the development of cancer, anaemia, pelvic inflammatory disease, chronic pelvic pain, and fertility issues.

When is it necessary to seek medical advice for abnormal bleeding?

Post-menopausal and prepubertal females should seek medical advice immediately if they notice any bleeding. The significance of excluding cancer holds particular importance within this specific group of women.

Women in the menstrual phase of their life should seek early and prompt advice within one to two months if they notice a pattern of alteration from their normal bleeds, and more urgently if they are experiencing other associated symptoms, such as pain.

Are there any ways to prevent irregular vaginal bleeding?

It is advisable for women to use barrier contraception to protect against sexually transmitted diseases, and to attend for cervical screening as per the national programme guidelines. Where there is a known process that may contribute to irregular bleeding (e.g. polycystic ovarian syndrome, endometriosis or adenomyosis), being on treatment to regulate the bleeds and maintaining compliance with this may be protective.

Most women will experience irregular vaginal bleeding for one reason or another at some point in their lives, and the most essential advice is to seek advice from the GP or gynaecologist in order to resolve this issue.

If you are concerned about irregular bleeding and would like to book a consultation Dr Nandy, simply visit her Top Doctors profile today.