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It’s natural to be alarmed when blood shows up unexpectedly. It could be due to an irregular cycle, or it could be something more serious that requires medical attention. The average amount of blood loss during a period is 30-40ml. Menstrual bleeding is considered to be heavy when it is around 60-80ml or more in each cycle. However, menstrual flow differs among individual women, so you are actually the best gauge of what is supposed to be normal or abnormal. Here are 10 possible reasons for abnormal vaginal bleeding:

You could be pregnant

Spotting (spots of blood) during the first trimester of pregnancy is quite common. According to the American Pregnancy Association, 20% of women spot during the first 12 weeks. Spotting in the early stages of pregnancy will appear lighter than your usual period. Your obstetrician and gynaecologist (ob-gyn) will check whether you might be pregnant. If you are already pregnant, abnormal bleeding could be a warning sign of pregnancy complications, such as an ectopic pregnancy or a miscarriage. You should see your ob-gyn immediately if this occurs.

You may have a sexually-transmitted disease (STD)

Bleeding after sex is usually a tell-tale sign of an STD like gonorrhoea, chlamydia, trichomoniasis or human papillomavirus (HPV). These infections cause inflammation of the cervix, which can lead to bleeding. Other symptoms of STDs include vaginal itching, pain or burning sensation while urinating, abnormal discharge, blisters or rashes on the vaginal area. Often, however, STDs may be present without any symptoms.

If you have any reason to suspect an STD, it’s important to see your doctor or ob-gyn for a proper diagnosis and treatment. It may be embarrassing, but it’s better than suffering the consequences of an untreated STD.

It’s your medications

Some medications such as anticoagulants (blood thinners) that prevent blood from clotting may result in abnormal bleeding or unusually heavy periods. You should also be cautious about taking supplements. Some supplements, like ginkgo biloba, also have blood-thinning properties and could affect your menstrual flow.

Birth control methods that contain oestrogen and progestin may cause irregular bleeding. One common method is the intrauterine device (IUD), which is a coil inserted into the uterus. The copper IUD can cause heavier and longer periods, while the levonorgestrel-releasing IUD can cause some random bleeding (although your period will, conversely, become lighter).

Sometimes, it could also be due to the fact that the IUD has moved within the uterus – this will also cause discomfort. Another type of birth control method, the etonogestrel/ethinyl oestradiol vaginal ring, can also cause some irregular bleeding due to its effect on hormone levels. Don’t be afraid to ask your ob-gyn about it.

You have a thyroid problem

Thyroid problems are far more common among women than in men. The thyroid is a gland that produces the thyroid hormones, which are crucial in regulating the body’s metabolism, as well as the use of other hormones in the body. Therefore, if the thyroid gland is not producing enough hormones, there will be a cascading effect on the rest of your hormones, which can lead to bleeding.

You suffered some trauma

Sexual intercourse can cause some trauma if it was a little rough or there wasn’t enough vaginal lubrication. This can cause a little tear just outside the opening to your vagina, which can lead to some minor bleeding. If the injury heals by itself, there should be no need for medical attention. However, you should talk to your partner to prevent this from occurring again.

You have polycystic ovary syndrome (PCOS)

PCOS is a condition where a woman has excessive levels of the hormone testosterone. Testosterone can disrupt the function of oestrogen and cause problems to the menstrual cycle. Women with PCOS suffer from bleeding symptoms like heavy periods, and skipped or irregular periods.

You have a growth (benign or malignant)

If the thyroid gland is not producing enough hormones, there will be a cascading effect on the rest of your hormones, which can lead to bleeding. Photo: TNS

Abnormal bleeding could be a sign of a polyp or lesion in the genitals or reproductive system, such as ovarian cysts, cervicitis, endometritis, fibroids or other conditions like vaginal infections. In the worst case scenario, abnormal bleeding could be due to pre-cancer or cancer of the vagina, cervix, uterus or ovaries. See your ob-gyn to get it properly checked out. You should also ask your doctor about HPV vaccination, which can prevent a significant proportion of HPV infections that cause cervical cancer.

You are undergoing menopause

Menopause is characterised by dramatic hormonal changes in a woman’s body. During the transition period to menopause, women may experience abnormal bleeding.

You have a bleeding disorder

If you have a bleeding disorder (often an inherited disease), such as haemophilia, you would be aware that you are at high risk of excessive bleeding. Unfortunately, prolonged vaginal bleeding is also one of the possible consequences of bleeding disorders. The 10 possible causes listed in this article are meant to give you an idea that abnormal vaginal bleeding can be due to many reasons.

However, you should not use this list to diagnose yourself. It is important to seek proper medical advice, either from your general practitioner (GP) or your ob-gyn. When you see your doctor, you will probably be asked about your menstrual cycle, sexual activity, birth control methods (if any), medications or supplements you are taking, history of problems with clotting or bleeding disorders, and history of operations and gynaecological procedures.

Your doctor may perform a physical examination, including a pelvic examination, to examine your vagina, cervix and uterus. Other possible tests that may be required are blood tests, ultrasounds or a biopsy, if your symptoms and medical history indicate the need. As women, we have a habit of dismissing our own health concerns to focus on those around us. We need to start looking at our own health. Thus, don’t let any abnormal vaginal bleeding go undiagnosed and untreated. See a doctor today.