Abnormal vaginal bleeding has many possible causes. If pregnant, abnormal bleeding of this type can be the sign of a problem with the pregnancy. Spotting to minimal bleeding is generally normal, but any bleeding during pregnancy should be evaluated by the doctor. Ovulation can cause mid-cycle bleeding as can the hormone imbalance polycystic ovary syndrome (PCOS). Medicines, such as birth control pills, sometimes cause abnormal vaginal bleeding.
Abnormal bleeding can the result of a number of different things, and thus diagnosis may be approached in a number of different ways. A woman with irregular menstrual periods requires a physical examination with a special emphasis on the thyroid, breast, and pelvic area. A Pap smear might also be done to rule out cervical cancer. A blood count may be done to rule out a low blood count (anemia) resulting from excessive blood loss. Additional blood hormone tests are done if the doctor suspects polycystic ovary, or if excessive hair growth is present. Endometrial sampling helps to rule out cancer or precancer in the uterus, or it can confirm a suspicion that a woman is not ovulating.
Treatment for irregular vaginal bleeding depends on the underlying cause. After a battery of tests determine the cause, the doctor will discuss with the patient whether treatment is necessary and if so, what the options are. Sometimes, the cause of excessive bleeding is not apparent after completion of testing (dysfunctional uterine bleeding). In these cases, oral contraceptives can improve cycle control and lessen bleeding. Medications for the treatment of irregular vaginal bleeding depend on the cause. On rare occasions, a hysterectomy might be necessary when hormonal medications cannot control excessive bleeding. However, unless the cause is precancerous or cancerous, this surgery should only be an option after other solutions have been tried.