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Vaginal Bleeding: What’s Normal & What’s Not (+ 6 Natural Tips for Women’s Health)

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Vaginal bleeding - Dr. Axe

Most women of child-bearing age experience normal vaginal bleeding associated with their menstrual cycle. However, women of all ages can experience abnormal vaginal bleeding, including spotting between periods caused by reproductive system problems, underlying medical problems or because of certain medications.

To be considered abnormal, the vaginal bleeding occurs outside of a normal menstruation guideline. This can mean that the flow during the period is excessively heavy or there is spotting between periods. Abnormal vaginal bleeding or spotting can also occur in very young girls before they’ve entered menstruation (menarche) and it can also occur after menopause. (1)

Irregular menstrual bleeding may be a sign of a potentially serious medical condition. If you experience vaginal bleeding that is outside of your normal cycle, please check with your physician as soon as possible, especially if you are pregnant.

There are a number of causes of abnormal bleeding, and conventional treatments focus on addressing the underlying causes. Many conditions can be effectively treated with certain prescription medications, or in some cases surgery. The key is to get an accurate diagnosis as soon as possible so treatment can begin.

A woman’s reproductive health must be a top priority, and annual pelvic exams, certain imaging tests and blood tests can help you and your doctor make the right choices for your wellness.


What Is Vaginal Bleeding?

Vaginal bleeding is a normal part of the menstruation cycle. However, when bleeding occurs outside of what the medical community considers the “norm,” it may be a sign of an underlying health concern that needs to be diagnosed and treated by your doctor.

Understanding your menstrual cycle, and keeping track of your menstrual cycle, can help your doctor determine if your vaginal bleeding is normal, or abnormal. Some signs of abnormal vaginal bleeding include: spotting before periods, spotting after period ends, brown spotting between periods, a very heavy menstrual flow and vaginal bleeding after sexual intercourse.


The Menstrual Cycle (Normal Bleeding)

From puberty to menopause, a woman’s body undergoes a monthly cycle called the menstrual cycle. This can last anywhere from 21 days to 45 days and each part of the cycle is responsible for different physical processes and symptoms as hormone levels rise and fall. (2)

A cycle starts on the first day of your last period and ends on the first day of the next period. For some women, the cycle length will remain fairly consistent throughout their child-bearing years. However, for others, the cycle can change quite dramatically.

During the middle of your monthly cycle, the ovaries release an egg. If it isn’t fertilized, you experience a menstrual flow. This is the way the body sheds the lining of the uterus, keeping it healthy and ready for the following cycle.

A normal blood flow rate can be light, moderate or heavy, and this can change with age and hormonal shifts. During the first few years of having a period, the cycle may be unpredictable, longer with heavier menstrual flows, than later in life. (3) As a woman enters perimenopause and gets closer to menopause, her cycle may also become irregular.


What Can Cause Vaginal Bleeding?

Vaginal bleeding, normal or abnormal, can occur at any life stage, including during a pregnancy, perimenopause, menopause or after menopause. Possible causes can include: (4)

Sexual & Reproductive Health Concerns

  • Adenomyosis, a thickening of the uterus
  • Cervical or uterine polyp, common benign tumors
  • Uterine Fibroids, a common non-cancerous tumor
  • Pregnancy
  • Ectopic pregnancy, when a fertilized egg implants and grows outside of the uterus (5)
  • Miscarriage, a spontaneous loss of pregnancy before the 20th week (6)
  • Polycystic Ovarian Syndrome, a very common hormonal disorder often associated with infertility
  • Sexual Intercourse
  • Perimenopause
  • Endometriosis, a painful condition where the tissue inside the uterus grows outside the uterus (7)
  • Vaginal atrophy, a condition where the vaginal walls thin, dry and become inflamed, often after menopause (8)

Underlying Medical Conditions

  • Celiac disease, or gluten-sensitivity
  • Kidney or liver disease
  • Thrombocytopenia, a condition of low blood platelet count (9)
  • Von Willebrand disease, a chronic, lifelong bleeding disorder that prevents proper clotting (10)

STDs and Infections

  • Chlamydia, a very common bacterial infection spread through sexual contact
  • Gonorrhea, a bacterial infection that can spread through incidental contact with an infected partner
  • Cervicitis, an inflammation of the cervix caused by an infection or an STD (11)
  • Pelvic Inflammatory Disease (PID), an infection of the reproductive organs (12)
  • Ureaplasma vaginitis, typically harmless bacteria that create a colony of bacteria leading to an infection (13)
  • Bacterial vaginosis, a common and generally mild vaginal infection, caused by bacteria.

Thyroid Problems

  • Hyperthyroidism, a condition where the thyroid gland is overactive.
  • Hypothyroidism, a condition where the thyroid gland doesn’t produce enough hormones

Medications/Devices

  • Forgotten tampon
  • IUD
  • Tamoxifen side effect, a breast cancer treatment (14)
  • Stopping/starting/changing birth control or hormone therapy called “withdrawal bleeding”

Cancer & Precancerous Conditions

  • Cervical cancer
  • Endometrial cancer
  • Ovarian cancer
  • Uterine sarcoma
  • Vaginal cancer

Physical Trauma

  • Blunt force trauma injury to the vagina or cervix
  • Penetrating injury to the vagina or cervix
  • Sexual abuse
Vaginal bleeding: what's normal and what's not - Dr. Axe

Risk Factors

Certain medical conditions, habits and lifestyle choices can increase your risk for developing abnormal vaginal bleeding including: (15, 16, 17)

  • Age. Abnormal bleeding can be more common in younger women and in women just before menopause
  • Overall reproductive health as underlying conditions like fibroids, polyps, PCOS and irregular periods may increase your risk
  • Certain types of cancer including endometrial, ovarian, uterine and cervical cancer
  • Bleeding disorders
  • Being overweight
  • Sexual history of multiple partners
  • History of sexually transmitted infections
  • The use of certain medications including tamoxifen, oral contraceptives, IUDs, hormone replacement therapies, corticosteroids, antipsychotics and anticoagulants
  • Taking supplements like ginkgo, soy or ginseng

Diagnosis & Conventional Treatment

If you have unexpected vaginal bleeding, brown discharge or spotting between periods, please consult your doctor. Diagnosing the root cause of abnormal vaginal bleeding may require a variety of diagnostic tests, including blood tests, ultrasounds, pelvic examinations, MRIs and CT scans. In some cases, biopsies and sonohysterography tests may be requested.

Your physician will ask about your menstrual cycle, including where you are in your current cycle, and how your symptoms differ from your normal symptoms.

Once a determination of the cause of the irregular period or abnormal bleeding is complete, your physician will determine your treatment plan. Options, depending on the underlying condition, may include: (18, 19)

  • Hormonal treatments: Birth control pills or patches to regulate hormone production
  • GnRH agonists: Medications to stop menstrual cycle and reduce the size of fibroids
  • NSAIDs: To combat excessive bleeding and relieve menstrual cramps
  • Antibiotics: For certain infections and STDs
  • Surgical interventions: Endometrial ablation, uterine artery embolization, myomectomy or hysterectomy may be recommended depending on the diagnosis

6 Natural Tips for Women’s Reproductive & Sexual Health

1. Have Annual Pelvic Examinations. 

A woman’s first pelvic examination should occur prior to turning 21 or when she becomes sexually active. A gynecological examination is quick, painless and only takes a few moments. For many women, it can be stress-inducing and embarrassing, but your health care provider should be gentle and reassuring. (20)

In addition to annual pelvic exams, you should make an appointment with your gynecologist if you experience any of the following:

  • Menstrual periods have not started by the age of 15
  • Menstrual periods have not started within three years of breast development
  • Brown discharge that burns, smells bad and causes itching
  • If your sexual partner has an STD
  • Vaginal bleeding lasts more than 10 days
  • Unexplained lower belly pain
  • Pelvic pain
  • Unexplained pain around the vulva
  • Missed periods
  • Debilitating menstrual cramps

2. Practice Safe Sex.

STDs like chlamydia and gonorrhea are major risk factors for abnormal vaginal bleeding. Using condoms properly can help protect you from sexually transmitted infections, but keep in mind that condoms do have an 18 to 21 percent failure rate according to the Centers for Disease Control and Prevention. (21)

Being in a committed and monogamous relationship where both partners have been tested and treated for any STDs is the safest way to prevent STD exposure.

3. Use Contraception.

If you are not trying to get pregnant, talk to your doctor about your options for contraception and family planning. Today, there are many choices including:

  • IUD
  • Cervical caps
  • Contraceptive sponge
  • Diaphragm
  • Female or male condom
  • Fertility awareness based method (22)
  • Abstinence
Vaginal bleeding: exercise & women's health - Dr. Axe

4. Eat Healthy Foods.

A nutrient-dense diet that features organic fruits and vegetables, wild-caught fish, grass-fed beef, free-range poultry and cultured dairy can help you lose weight or maintain a healthy weight. If you take birth control pills or are prone to yeast infections, following a candida diet may help reduce candida symptoms.

There is now evidence that birth control pills can spur yeast infections in some women, and it has been recognized for many years that taking antibiotics can also cause yeast infections. This happens when the antibiotics kill off the unfriendly bacteria along with the friendly bacteria in your system. The body, including the gut and the vagina, need healthy bacteria to function optimally. (23)

5. Use Supplements.

Probiotics, 50 Billion CFUs daily. Probiotic benefits continue to be explored by researchers across the globe, and time and time again clinical trials show that probiotics are really imperative for vaginal health. In addition to combatting yeast infections, they help to balance pH levels in the vagina by introducing friendly bacteria. As a bonus, probiotics may also help relieve depression and anxiety, decrease inflammation, boost your immune system and help manage blood sugar levels. (24, 25, 26)

Sea Buckthorn Oil, 1,000 milligrams daily for vaginal dryness. In a clinical study of postmenopausal women with vaginal dryness, 3 grams of sea buckthorn oil daily improved vaginal pH and moisture levels over a three-month trial period significantly better than a placebo. This phytonutrient is packed with vitamins, minerals, and even protein and researchers are still finding new applications for this humble berry. (27)

Omega-3 Fatty Acids, 1 to 2 grams daily. Long regarded for helping to improve blood flow, circulation and heart health, research now shows that taking 1 to 2 grams of omega-3 fatty acids each day may help relieve severe PMS symptoms. Dysmenorrhea symptoms can be debilitating and include severe cramping, headaches, irritability, pain and even fainting spells. (28)

6. Exercise.

Healthy women should be getting at least 150 minutes of moderate aerobic exercise every week to help fight certain diseases, maintain a healthy weight and to reduce stress. Even better, according to the Mayo Clinic, is averaging at least 30 minutes of physical exercise daily, and, if you are trying to lose weight, aim for 300 minutes each week. (29)

Variety is the spice of life and varying your exercise routine can help you stay motivated while working a variety of muscle groups. In addition to your normal workout regimen of walking, running or strength training, try to incorporate some of the following aerobic activities into your routine:

Swimming: A great, all-around low-impact conditioning exercise, swimming benefits the mind, lowers blood pressure, reduces the risk for heart disease and is great for whole body toning.

Tennis: Few exercises provide as complete a workout as a good round of tennis. Tennis is great for lowering body fat and blood pressure, but it is also fantastic for improving endurance, flexibility, strength and balance. And, a little healthy competition between friends on the court can keep you working out while enjoying time socializing. (30)

Dancing: Much like tennis, depending on the type of dance you engage in, you can work virtually every muscle in your body. In fact, dancing can improve muscle strength and tone, reduce your risk for osteoporosis, improve balance and agility, help you lose weight and improve heart and lung health. (31)

Dancing is also a social activity, and another way to keep your exercise routine from getting boring. From ballet and tap dancing to hip hop and belly dancing, you can find a fun and aerobically challenging activity to help you reach your recommended exercise quota.

Jumping Rope: An exercise you can do virtually anywhere with little financial investment, jumping rope for just 15 to 20 minutes can burn as many calories running an eight-minute mile. It is great for the heart, strengthens both the upper and lower body and can improve balance and coordination. (32)

Enjoy the Great Outdoors:  Whether you go for an after-dinner bike ride around your neighborhood, take a weekend afternoon hike or take an outdoor yoga or tai chi class, research now shows that exercising outdoors is not only good for your body, but also your mind. (33)

Of course, exercising outdoors has the added benefit of increasing vitamin D levels. In fact, according to researchers, 30 minutes of summer sun in a bathing suit can initiate the release of 50,000 IU of vitamin D into your system. The health benefits of vitamin D are well-documented and include improving bone health, facilitating hormone production, enhancing the immune system,  and protecting against certain types of cancer. Plus it is essential for both concentration and mood. (34, 35, 36, 37, 38)


Precautions

Whenever you experience any vaginal bleeding or brown discharge that is abnormal for you, talk to your doctor. In addition, if vaginal bleeding meets any of the following benchmarks, seek medical attention as soon as possible: (39)

  • Girls under the age of 8 or girls with no other signs of puberty
  • Menopausal women
  • Postmenopausal women not taking hormone therapy
  • Postmenopausal women taking cyclic hormone therapy
  • Postmenopausal women taking continuous hormone therapy

And, if you are pregnant — and you notice vaginal bleeding — see your doctor immediately. If vaginal bleeding occurs while you are pregnant, it can be a sign of a complication such as an ectopic pregnancy or a miscarriage. (40)


Key Points About Vaginal Bleeding

  • Abnormal vaginal bleeding is any bleeding that occurs outside of your normal menstrual cycle.
  • Spotting, brown discharge and excessive bleeding can occur at any stage of life, from childhood to after menopause.
  • Abnormal vaginal bleeding can be caused by a wide range of conditions including STDs, certain types of cancers, hormonal imbalances, trauma and certain types of medications.
  • Conventional treatment depends on the root cause of the bleeding, and diagnosis will likely require blood tests and a variety of imaging studies.
  • If you are pregnant and experience vaginal bleeding, seek emergency medical attention immediately.

6 Natural Tips for Women’s Reproductive & Sexual Health

  1. Have annual pelvic examinations and see your gynecologist whenever you experience any changes in your menstrual cycle or suspect an STD.
  2. Practice safe sex by properly using condoms, but understand that condoms have a failure rate of between 18 and 21 percent.
  3. Use contraception if you are not trying to get pregnant.
  4. Eat healthy foods and follow a candida diet if you are prone to vaginal yeast infections.
  5. Exercise at least 150 minutes weekly and shake up your routine with swimming, tennis, dancing, jumping rope and outdoor activities.
  6. Try these supplements:
  • Probiotics — 50,000 CFUs daily for gut and vaginal health.
  • Sea Buckthorn oil — 1,000 milligrams daily to relieve vaginal dryness.
  • Omega-3 Fatty Acids — 1 to 2 grams daily to relieve severe PMS symptoms.

Read Next: Worse Than PMS: Understanding PMDD (+ 10 Natural Ways to Help Relieve PMDD Symptoms


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