One of the most common presentations in gynecology is irregular bleeding.

• This may be bleeding that does not come when anticipated — either too early or too late.
• It may be bleeding that is presenting several times per month or not for two or three months.
• There may be bleeding that occurs after intercourse or is associated with pain.

During this time of increased stress, we are here to help guide you into figuring out what may be contributing to your irregular bleeding.

Is it a pregnancy?

What is most important for women that are at risk for pregnancy is to check a home urine pregnancy test. Once pregnancy is excluded, we look for clues in a woman’s history that may help guide our work up. The most common reasons for irregular bleeding include structural, hormonal, genetic or infectious disease.

Let’s break these down…

Could it be structural?

The most common structural problems include fibroids (muscle growths) and polyps (tissue growths). Typically, a pelvic exam and/or an ultrasound will determine if you have any of these conditions. These can be managed with medications and/or surgery.

Are my hormones having a field day?

Hormonal causes for bleeding may include infrequent ovulation, increased stress, weight loss or gain and thyroid disorders. Individuals using hormonal contraception may experience irregular bleeding as well. Hormonal causes for bleeding are due to your body not having the “normal” rise and fall of estrogen and progesterone which are responsible for timed, regular bleeding episodes.

Does this run in my family?

Genetic causes for bleeding could include bleeding or clotting disorders. These are not very common, but a thorough family history and blood work may be needed if you are at an increased risk. Young women experiencing very heavy periods, awaiting surgery or needing a blood transfusion should have this testing performed.

Do I have an infection?

Infectious causes for bleeding include sexually transmitted infections (STIs), urinary tract infections or other non-sexually associated infections. Your provider may recommend STI screening and a pelvic exam to include such conditions.

What’s next if the reason isn’t obvious?

Sometimes it can be difficult to determine the exact cause of irregular bleeding, but a history, physical exam and blood work can help guide your provider and exclude other health conditions.

Could it happen after menopause?

In certain cases, irregular bleeding may be due to cancer. If you are a woman who has gone through menopause and is experiencing vaginal bleeding, you should contact your provider and be evaluated. Up to 5-10% of women who have postmenopausal bleeding may have uterine cancer. Cervical cancers and ovarian cancers may present with vaginal bleeding as well. Your GYN provider will perform a pelvic exam and may order an ultrasound or CT scan depending on your condition. Thankfully, most women with postmenopausal bleeding do not have cancer. Rather, they have a common condition called vaginal atrophy, which is caused by thinning of tissues due to lack of hormones.

Who can I call if irregular bleeding is happening to me?

Irregular bleeding episodes can cause a lot of stress and anxiety. GYN providers at WakeMed would be happy to help assist you and evaluate what may be the cause of your condition.

Learn more about WakeMed Obstetrics and Gynecology, and schedule your appointment at a location convenient to you.

About the Author

Dr. Chantel Roedner has received several awards for excellence in teaching and surgery including the Golden Tar Heel teaching award, Gynecology Excellence in Surgery Award, OBGYN Resident of the Year, Midwifery Chief Resident award and Association of Professors in Gynecology and Obstetrics Excellence in Teaching award. She is welcoming new patients at the Brier Creek and North Raleigh locations.