From the Guidelines
If you're experiencing frequent vaginal bleeding, you should consult with a healthcare provider as soon as possible for proper evaluation and diagnosis, as this symptom can have many causes ranging from hormonal imbalances to structural issues or, rarely, more serious conditions. While waiting for your appointment, keep track of your bleeding patterns (frequency, duration, heaviness), any associated symptoms like pain or fatigue, and use appropriate menstrual products to manage the flow.
Key Considerations
- The patient's goals, including continued method use or method discontinuation, should be explored 1.
- If the patient wants to continue use, provide reassurance and advise the patient that they may contact their provider at any time to discuss bleeding irregularities or other side effects 1.
- Treatment options may include NSAIDs, hormonal treatment, or antifibrinolytic agents, depending on the patient's preferences, treatment goals, and medical history 1.
- Underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, should be considered and treated if found 1.
Treatment Options
- NSAIDs, such as ibuprofen, may be used for short-term treatment (5–7 days) 1.
- Hormonal treatment, such as low-dose COCs or estrogen, may be used for short-term treatment (10–20 days) 1.
- Antifibrinolytic agents, such as tranexamic acid, may be used for short-term treatment (5 days) 1.
- Iron supplements, such as ferrous sulfate, may be needed if anemia has developed 1.
Next Steps
- Consult with a healthcare provider to determine the underlying cause of the frequent vaginal bleeding and to discuss treatment options 1.
- Keep track of bleeding patterns and associated symptoms to provide accurate information to the healthcare provider.
- Use appropriate menstrual products to manage the flow and prevent complications.
From the Research
Evaluation and Management of Frequent Vaginal Bleeding
Frequent vaginal bleeding can be caused by various factors, including hormonal contraception, uterine pathologies, coagulopathy, ovulation dysfunction, or iatrogenic factors 2. To manage frequent vaginal bleeding, it is essential to evaluate the underlying cause and the woman's preference and fertility wishes.
Assessment of Frequent Vaginal Bleeding
The assessment of frequent vaginal bleeding should entail a menstrual and gynaecological history and a bleeding score to distinguish those women who require additional haematological investigations 2. A pelvic examination and ultrasound scan can help rule out the presence of any underlying pathology 3.
Treatment Options for Frequent Vaginal Bleeding
Treatment options for frequent vaginal bleeding depend on the underlying cause and may include:
- Hormonal treatments, such as levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives 2, 4
- Haemostatic therapies, such as tranexamic acid and DDAVP (1-deamino-8-D-arginine) 2
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 5, 4
- Supplemental estrogen 5, 4
- Changing to an OCP with a higher estrogen content or to a different formulation 5
- Adding norethisterone acetate to progesterone-only pills 6
- Endometrial ablation or hysterectomy in severe cases 2
Key Considerations
- Clinicians should counsel individuals about the potential for abnormal bleeding at initiation of the contraceptive method 4
- Pregnancy and the misuse of OCPs are frequent causes of abnormal uterine bleeding 5
- Bleeding is common during the first three months of OCP use; counseling and reassurance are adequate during this time period 5
- If bleeding persists beyond three months, it can be treated with supplemental estrogen and/or an NSAID 5