Many women experience bleeding and spotting in between periods. Vaginal bleeding is abnormal if it occurs

• when you are not expecting your period
• when your menstrual flow is lighter or  heavier than normal
• when it happens at a time when it is not expected  such as before the age of 9 , when you’re pregnant or after menopause

What are the causes of abnormal bleeding

Abnormal vaginal bleeding  has many causes . However it doesnt necessarily indicate a serious condition.

• Bleeding could mean a problem with pregnancy. As a result pregnancy is always suspected when a woman of childbearing age starts bleeding.
  • spotting or minimal bleeding could be normal but any bleeding during pregnancy needs  to be evaluated
  • heavy vaginal  bleeding or bleeding that occurs before 12 weeks could be a sign of ectopic pregnancy or a miscarriage
  • heavy vaginal bleeding or bleeding that occurs that occurs after 12 weeks also means  a serious problem such as placenta previa
• Ovulation can result in mid cycle bleeding
• Stopping and starting birth control pills or estrogen
• use of blood thinners ( anticoagulants )
• pelvic organs infection  can also result in bleeding especially after douching or intercourse. Pelvic organs include vagina, cervix,uterus, fallopian tubes and ovaries. Sexually transmitted infections can also result in infection.
• Intrauterine device IUD also increases your risk of spotting or heavy bleeding.
• Pelvic Inflammatory Disease PID causes inflammation or infection of the uterus, fallopian tubes or ovaries which can cause abnormal bleeding

Other causes of abnormal bleeding between periods include the following :

• an object in the vaginal
• sexual abuse
• cancer of the cervix, ovaries, uterus or vagina
• uterine  fibroids or cervical or uterine polyps
• structural problems such as polyps or urethral prolapse
• diseases such as diabetes or hyperthyroidism
• cervical or endometrial biopsy or other procedures
• extreme emotional stress and excessive exercise

Heavy bleeding during the first few weeks after delivery or after an abortion may  occur .  This is because the uterus has not contracted  to the pre pregnancy size or because  fetal tissue remain in the uterus.

At age 40 and over, bleeding may indicate that you are entering perimenopause . If you’ve not had your period for 12 months , vaginal bleeding is always abnormal and you need to contact your doctor.

Treatment for abnormal bleeding depends on the cause. Contact your doctor if you have any abnormal  bleeding outside your period.