Women’s Health: What type of bleeding is normal?

A healthy menstrual cycle isn’t the same for everyone, but there is a certain range that most people who menstruate fall within. Periods can typically be anywhere from 24 to 35 days apart and may last between 2 and 7 days. They can be the same length every month or slightly different month to month, and may or may not be accompanied by cramps or other symptoms.

Val Petrosian, M.D., F.A.C.O.G

The best way to know what is normal for you is to monitor your menstrual cycle month to month. As long as your cycle generally falls within this range, your typical experience is most likely healthy for you. If you are concerned about bleeding that you are experiencing, consult your gynecologist. However, a bleeding event may not warrant a visit to the doctor if:

  • you are of reproductive age
  • the bleeding is isolated (i.e., occurs once or twice a year)
  • you don’t perceive the amount of bleeding to be unusually heavy
  • the bleeding is followed by subsequent normal cycles

When is bleeding considered abnormal?
Bleeding is considered abnormal in the following situations:
1. Bleeding or spotting between periods
2. Heavy bleeding during your period (e.g., blood clots, changing a pad/tampon every 1-2 hours)
3. Bleeding or spotting after sex
4. Prolonged periods, lasting more than 7 days
5. Menstrual cycles that are less than 24 days or more than 38 days apart
6. Bleeding during pregnancy
7. Bleeding after menopause
All postmenopausal bleeding is considered abnormal and requires evaluation at your doctor’s office.

Abnormal bleeding may arise from anywhere along the genital tract. The details of your individual experience will help your doctor in identifying the source of the problem. For example, bleeding that occurs after intercourse may signify a presence of infection in the cervix.

There are a variety of conditions that can cause abnormal bleeding
If the bleeding is from the uterus, it may be caused by: polyps, fibroids, hyperplasia, pelvic inflammatory disease (PID), adenomyosis, endometriosis, ovulatory dysfunction such as polycystic ovarian syndrome (PCOS), or cancer.

If the bleeding is from the cervix, it may be caused by: ectropion (normal migration of cells), infection, polyp, or cancer.

If the bleeding is from the vagina, it may be caused by: infection, polyps, or adenosis.

If the bleeding is from the vulva, it may be caused by: skin tags, warts, sebaceous cysts, or cancer.

If the bleeding is from trauma, it may be caused by: sexual intercourse, sexual abuse, foreign body (including intrauterine device, IUD), or pelvic trauma (i.e. from an accident).

If the bleeding is from drugs, it may be caused by: contraceptives, postmenopausal hormonal therapy, blood thinners, steroids, or chemotherapy.

If the bleeding is from a systemic disease, it may be caused by: PCOS, thyroid dysfunction, blood disorder, smoking, emotional or physical stress, or excessive exercise.

Commonly, things like urinary tract infections (UTIs) and hemorrhoids may be perceived by a patient as vaginal bleeding. These are frequently encountered during pregnancy. Bleeding in pregnancy should always be reported to your doctor as soon as possible, regardless of the source.

Depending on the problem, abnormal bleeding may be treated with medications (e.g., contraceptives, hormonal supplements) or surgery (e.g., endometrial ablation, removal of polyps/fibroids).

Regular wellness visits are key to menstrual health
All people who menstruate should see a gynecologist every year. Remember, a Pap test is only a part of the visit. Your doctor will also give you a breast exam, test you for sexually transmitted infections, ask about your typical menstruation experience, and be available for any questions you may have about your reproductive health.

If you need to discuss abnormal bleeding or ready for your annual well woman visit, schedule an appointment with one of our obstetrics and gynecology specialists, Dr. Valery Petrosian. Call (914) 241-4900 to request an appointment in Mt. Kisco or Yorktown.

By Valery Petrosian, MD,Obstetrics and Gynecology, Westchester Healthmember of Westchester Health Physician Partners