Abnormal vaginal bleeding in Warsaw - gynaecological diagnostics
Abnormal vaginal bleeding can occur between periods, after intercourse, during pregnancy, after menopause or as an exceptionally heavy and prolonged period. Its causes include hormonal disorders, uterine fibroids, polyps, infections, cervical lesions and diseases of the endometrium. Even slight, recurring spotting may require diagnostics.
At OpenMed Warsaw Wola we provide gynaecological consultations and diagnostics of the causes of abnormal bleeding. Depending on the symptoms, the doctor may perform a gynaecological examination and a transvaginal ultrasound, assess the cervix and plan appropriate laboratory tests and further management.
Abnormal vaginal bleeding - when should you see a gynaecologist?
Vaginal bleeding is not always related to a period. The blood may come from the uterine cavity, the cervix, the vagina or the vulva. In women who menstruate, regular bleeding is a natural part of the cycle, but a change in its frequency, duration or heaviness may point to abnormalities that need to be assessed.
It is worth seeing a gynaecologist in particular when you have:
- spotting or bleeding between periods,
- periods lasting longer than 8 days,
- exceptionally heavy bleeding that requires changing a pad or tampon every 1-2 hours,
- irregular bleeding appearing at unpredictable intervals,
- bleeding after sexual intercourse,
- bleeding after menopause, even a single episode,
- recurring spotting while using hormonal contraception,
- bleeding combined with lower abdominal pain, unusual discharge or an unpleasant smell,
- bleeding that appears after several months without a period.
It is worth distinguishing spotting from bleeding. Spotting means a small amount of blood that may only be visible on underwear or toilet paper. Bleeding is usually heavier and may require the use of sanitary products. Both symptoms can have similar causes and may need a gynaecological assessment.
The timing of the symptoms also matters. Brief spotting in the middle of the cycle may accompany ovulation, but a similar symptom can be related to an endometrial polyp, an infection or hormonal disorders. The timing of the bleeding alone is not enough to identify its cause.
At OpenMed you can book a gynaecological visit, during which the doctor will assess your symptoms and decide whether additional tests are needed.
When does vaginal bleeding need urgent medical help?
Some bleeding requires immediate help, especially when the blood loss is large, there are signs of circulatory problems or a pregnancy complication is suspected.
Urgent help at a hospital emergency department or calling an ambulance on 112 is needed in particular for bleeding accompanied by:
- fainting, loss of consciousness or severe dizziness,
- sudden weakness, paleness, cold sweats or a racing heart,
- very heavy blood loss, e.g. soaking through one large pad per hour for several hours in a row,
- severe, sudden lower abdominal pain, especially on one side,
- shoulder pain, feeling faint or severe abdominal pain when pregnancy is possible,
- shortness of breath, marked weakness or difficulty staying upright.
Do not wait until you have used a certain number of pads if your general condition is getting worse quickly.
Bleeding with a positive pregnancy test or a suspected pregnancy needs special attention. It may occur with a miscarriage or an ectopic pregnancy, and in later weeks also with placental complications. Such symptoms require an urgent obstetric assessment, and heavy bleeding or pain - hospital care.
Fever, worsening lower abdominal pain and bleeding may also accompany a serious infection of the pelvic organs.
An outpatient gynaecological consultation is intended for patients whose general condition is stable. If warning signs appear, do not put off getting help until a planned visit.
Doctors diagnosing abnormal vaginal bleeding at OpenMed
Finding the cause of bleeding requires taking into account the age of the patient, the course of the menstrual cycle, the contraception used, past illnesses and test results. OpenMed gynaecologists see patients with irregular periods, spotting between periods, bleeding after intercourse and symptoms that may point to diseases of the uterus, ovaries and cervix. During the visit the doctor can carry out a gynaecological examination, perform an ultrasound and decide whether further hormonal, microbiological or histopathological diagnostics are needed.
What are the most common causes of vaginal bleeding?
Abnormal bleeding can result from anatomical changes in the reproductive organs as well as from hormonal disorders, systemic diseases or the effects of medicines.
In gynaecology, the causes of abnormal uterine bleeding in women who are not pregnant are classified, among other systems, according to PALM-COEIN. It covers structural lesions such as polyps and fibroids, as well as causes that are not related to a visible anatomical change.
The most important causes include:
- Uterine fibroids - benign tumours of the uterine muscle that can cause heavy, prolonged periods and spotting. Submucosal fibroids, which deform the uterine cavity, are particularly significant. You can find more information on the page about diagnosis and treatment of uterine fibroids.
- Endometrial and cervical polyps - local overgrowths of the mucous membrane that can cause spotting between periods or bleeding after intercourse.
- Ovulation disorders - irregular maturation of ovarian follicles and lack of ovulation can lead to unpredictable shedding of the endometrium.
- Polycystic ovary syndrome (PCOS) - can cause long gaps between periods followed by heavy bleeding. In such cases PCOS diagnostics are important.
- Adenomyosis - the presence of endometrium-like tissue in the uterine muscle, often associated with painful and heavy periods.
- Infections and inflammation - inflammation of the cervix, vagina or pelvic organs can cause contact bleeding, spotting and pain.
- Endometrial hyperplasia - excessive growth of the lining of the uterus, which may be related to long-term exposure to oestrogens without the balancing effect of progesterone.
- Precancerous and cancerous lesions - abnormal bleeding can be one of the symptoms of endometrial cancer or cervical cancer.
- Clotting disorders and systemic diseases - e.g. von Willebrand disease or some thyroid function disorders.
- Medicines and contraception - bleeding can occur while using hormonal preparations, intrauterine devices or anticoagulants.
Not all abnormal bleeding comes from the uterine cavity. The source of the blood can also be lesions of the vulva, vagina or cervix, which is why establishing the exact site of the bleeding is important in diagnostics.
Spotting between periods, heavy and irregular bleeding
Abnormal uterine bleeding is referred to as AUB (abnormal uterine bleeding). It may concern the length of the cycle, the regularity of periods, how long they last and the amount of blood lost.
Intermenstrual spotting occurs between regular periods. Sometimes it is related to ovulation and lasts 1-2 days. However, if it recurs in subsequent cycles, lasts for several days or appears at unpredictable times, it is worth checking whether it is caused by changes in the uterine cavity, hormonal disorders or cervical disease.
Heavy periods may show up as the need to change sanitary products every 1-2 hours, leaking through clothes, passing large clots and limiting daily activities. In diagnostics, not only the amount of blood matters, but also the effect of periods on wellbeing, work and everyday functioning.
Periods lasting more than 8 days are considered prolonged. Regular but very heavy bleeding can occur, for example, with submucosal fibroids or adenomyosis.
Irregular bleeding may appear a dozen or so days after the previous period or after a gap of many weeks. This pattern is typical of some ovulation disorders, for example during puberty, around menopause or with PCOS.
Long-lasting, heavy periods can lead to iron deficiency and anaemia. Their symptoms include chronic tiredness, paleness, palpitations, poorer concentration and breathlessness on exertion.
Bleeding after intercourse - what can cause it?
Bleeding after intercourse, known as postcoital or contact bleeding, can occur immediately after sex or within the following hours. It usually takes the form of light spotting, although sometimes it is heavier.
One possible cause is micro-injuries of the vaginal lining related to friction, dryness or insufficient lubrication. They are more common after menopause, during breastfeeding and when oestrogen levels are low.
Bleeding after intercourse can also be caused by:
- a cervical polyp,
- cervical ectropion,
- inflammation of the cervix,
- Chlamydia trachomatis or Neisseria gonorrhoeae infections,
- precancerous and cancerous lesions of the cervix,
- inflammation and injuries of the vagina.
With recurring contact bleeding, the doctor may recommend an assessment of the cervix with a speculum, appropriate tests for infections and cervical screening, if indicated.
When a sexually transmitted infection is suspected, STI and STD tests can help, including PCR/NAAT molecular tests.
If the appearance of the cervix raises doubts or earlier tests showed abnormalities, the doctor may refer the patient for colposcopy. The examination allows the cervical epithelium to be viewed under magnification and, where justified, a biopsy to be taken for histopathological examination.
A normal cytology result does not rule out all causes of contact bleeding. This is why recurring bleeding after intercourse needs to be assessed even when earlier screening tests showed no abnormalities.
Vaginal bleeding in pregnancy - when is a consultation needed?
Bleeding during pregnancy always requires contacting medical staff and deciding how it should be assessed. It does not have to mean pregnancy loss, but it can be a symptom of a complication that needs urgent management.
In the first trimester of pregnancy, light spotting can occur, among other things, with changes in the cervix or a subchorionic haematoma. More serious causes include miscarriage and ectopic pregnancy.
An ectopic pregnancy most often develops in the fallopian tube. It can cause spotting, pain on one side of the lower abdomen and worsening symptoms. If the tube ruptures, internal bleeding may occur, which is a direct threat to life.
Diagnostics in early pregnancy may include a transvaginal ultrasound and a blood β-hCG test. If the location of the pregnancy is not yet visible on ultrasound, the doctor may recommend a repeat ultrasound and a follow-up β-hCG test, often after about 48 hours, depending on the clinical situation.
In the second and third trimester, bleeding may be related to placental abnormalities, including placenta praevia or placental abruption. Such situations may require urgent diagnostics in an obstetric hospital.
Towards the end of pregnancy, a small amount of blood mixed with mucus may accompany changes in the cervix before labour, but this symptom should also be assessed in the context of the stage of pregnancy and any other symptoms.
Patients using pregnancy care should report any new bleeding and spotting to their doctor. With severe pain, heavy bleeding, fainting or other warning signs, go directly to hospital.
Bleeding after menopause - why does it need diagnostics?
Menopause is usually diagnosed after 12 consecutive months without a period, if the absence of bleeding is not due to another cause.
Any vaginal bleeding that appears after menopause requires diagnostics, even if it is light, lasts only one day or has happened only once.
Possible causes include:
- atrophy and thinning of the vaginal epithelium related to oestrogen deficiency,
- atrophy of the lining of the uterus,
- endometrial or cervical polyps,
- endometrial hyperplasia,
- bleeding related to menopausal hormone therapy,
- endometrial cancer or other cancerous lesions.
Many cases of postmenopausal bleeding have a benign cause. However, it is important to rule out atypical hyperplasia and cancer of the lining of the uterus.
One of the basic tests is a transvaginal ultrasound with assessment of the endometrium, the mucous membrane lining the uterine cavity. The doctor assesses its thickness, uniformity and borders, as well as the possible presence of polyps or other lesions.
Age, obesity, diabetes, previous ovulation disorders, the use of hormonal medicines and a family history of cancer also matter when assessing the endometrium.
In some cases it is necessary to take a sample of the endometrium for histopathological examination or to perform a hysteroscopy. A normal or thin endometrium on ultrasound alone should not automatically end diagnostics, especially with recurring bleeding or additional risk factors.
Bleeding after menopause should not be treated as a natural return of periods. It requires a gynaecological consultation as soon as possible.
What does a gynaecological consultation for bleeding look like?
The visit starts with a detailed medical history. The doctor asks when the bleeding started, how heavy it is, how regular the menstrual cycle is and about any accompanying symptoms.
The following information matters, among other things:
- the date of the last period and the usual length of the cycle,
- how many days the current bleeding has lasted,
- the number of pads or tampons used,
- the presence of clots and their approximate size,
- the possibility of pregnancy,
- lower abdominal pain or bleeding after intercourse,
- the contraception used and medicines taken,
- previous gynaecological diagnoses and procedures.
Then, if the condition of the patient and the indications allow it, a gynaecological examination is performed. The doctor can assess the external genitals, the vagina and the cervix using a speculum to establish where the blood is coming from and whether any local lesions are visible.
A bimanual examination makes it possible to assess the size and mobility of the uterus, tenderness of the adnexa and the presence of any palpable abnormalities.
Depending on the situation, the consultation can be extended with a gynaecological ultrasound or further tests can be planned. Based on the information gathered, the doctor decides whether the patient needs treatment, observation, a check-up at a set time or referral to a centre that performs more advanced procedures.
Not all bleeding requires the same set of tests. For example, in a young patient with irregular periods the key may be assessing ovulation disorders, whereas in a woman after menopause the priority is diagnostics of the endometrium.
Which tests are used to diagnose vaginal bleeding?
The choice of tests depends on the type of bleeding, the age of the patient, the result of the gynaecological examination and the suspected cause.
A transvaginal gynaecological ultrasound makes it possible to assess the uterus, the endometrium, the ovaries and the adnexal area. During the examination, fibroids, some polyps, signs of adenomyosis or other anatomical abnormalities can be seen.
At OpenMed a gynaecological ultrasound is available, which is an important part of diagnosing menstrual disorders and bleeding.
Depending on the indications, the doctor may also recommend:
- A complete blood count - checks the haemoglobin level and shows whether there is anaemia related to blood loss.
- Ferritin - helps assess iron stores, which may be low even before obvious anaemia develops.
- A pregnancy test or β-hCG test - important in patients of reproductive age who may be pregnant.
- TSH and selected hormone tests - when the clinical picture suggests thyroid or ovulation disorders.
- Clotting tests - especially with very heavy periods since puberty, easy bruising or a family history of bleeding.
- Microbiological and molecular tests - when inflammation of the cervix or vagina or a sexually transmitted infection is suspected.
- Cervical tests - an appropriately chosen HPV test, cytology or colposcopy, if indicated.
When an infection is suspected, bacteriological tests may be useful, although not all infections can be detected with a standard culture.
If an endometrial polyp, a submucosal fibroid or lesions in the uterine cavity are suspected, a hysteroscopy may be necessary. It allows the inside of the uterus to be assessed directly and, in certain situations, a sample to be taken for histopathological examination.
Histopathological examination of the endometrium is particularly important when hyperplasia of the lining or cancerous lesions are suspected. The scope and method of sampling are decided by the doctor based on the clinical picture and current indications.
How is abnormal vaginal bleeding treated?
Treatment of bleeding depends on the cause identified, the amount of blood lost, the age of the patient and her plans for having children.
For hormonal disorders and abnormal uterine bleeding, the doctor may use medication. The options include progestogen preparations, selected methods of hormonal contraception and medicines that reduce the heaviness of bleeding.
Tranexamic acid reduces the breakdown of clots and can be used to treat heavy periods in suitably qualified patients. In certain cases non-steroidal anti-inflammatory drugs are also used, which can reduce menstrual blood loss and ease pain. However, they are not suitable for every patient.
One method of treating heavy bleeding is a levonorgestrel-releasing intrauterine device. It acts locally on the lining of the uterus, limiting its growth and reducing bleeding. Whether this option can be used depends, among other things, on the shape of the uterine cavity and ruling out contraindications. More information is available on the page about intrauterine devices (IUD).
When endometrial polyps or some submucosal fibroids are diagnosed, procedural treatment may be indicated, e.g. hysteroscopic removal of the lesion.
For uterine fibroids, the choice of management depends on their size, number, location and the severity of symptoms. Not all fibroids need to be removed. Some can be observed, while for other patients medication or surgery is indicated.
If the bleeding is caused by an infection, treatment is chosen according to the pathogen identified and the nature of the infection. With precancerous or cancerous lesions, management must follow the result of histopathological diagnostics and the recommendations of the appropriate specialist centre.
A separate part of therapy is treating iron deficiency and anaemia, if they have developed as a result of long-term bleeding.
The aim of management is not only to reduce the bleeding itself, but above all to identify and properly treat its cause. At OpenMed the patient can discuss possible treatment options with a gynaecologist and plan further care.
How to prepare for a gynaecological visit for bleeding?
You do not need to do an extensive set of hormone tests on your own before the consultation. It can be much more useful to prepare information about the course of the bleeding and any treatment so far.
Before the visit it is worth:
- writing down the date of your last period and the day the abnormal bleeding started,
- noting the number of pads or tampons used per day,
- working out whether the bleeding is continuous or comes and goes,
- preparing a list of medicines you take, including hormonal contraception and anticoagulants,
- bringing earlier ultrasound, cytology and blood test results and records of gynaecological treatment,
- telling the doctor about a possible pregnancy, previous miscarriages, births and procedures.
With irregular periods, a calendar covering the last 3-6 cycles is helpful. You can mark the dates of bleeding, how heavy it was and any pain.
There is no need to put off the consultation just because you are bleeding. In many situations a gynaecological examination and ultrasound can also be performed during a period or spotting. However, heavy bleeding can limit the assessment of some structures and may require an additional examination to be planned once it has stopped.
Before the examination, do not stop prescribed hormonal or anticoagulant medicines on your own. If you use vaginal preparations, tell the doctor, as they may matter when samples are taken for testing.
With very heavy bleeding, severe pain or weakness, do not prepare for a planned visit, but seek urgent medical help.
Diagnostics of vaginal bleeding at OpenMed Warsaw
At OpenMed Gynaecology and Obstetrics in the Wola district of Warsaw we see patients reporting abnormal bleeding, spotting between periods, heavy periods and other symptoms related to the reproductive system.
The clinic is located at ul. Wschowska 8, 01-239 Warsaw (Wola).
As part of the care available, patients can use gynaecological consultations, ultrasound diagnostics and appropriately chosen additional tests.
During the visit the doctor analyses the symptoms and existing medical records, carries out an examination and then discusses the possible causes of the symptoms and further management.
This is particularly important with recurring bleeding, when a single normal test result does not always explain the problem. In such cases it may be necessary to observe the following cycles, repeat the ultrasound or carry out additional diagnostics.
OpenMed also provides access to gynaecological care for patients who need regular consultations and monitoring of diagnosed conditions.
How much does a gynaecological consultation at OpenMed cost?
The cost of diagnosing vaginal bleeding depends on the scope of the consultation and the additional tests needed.
The basis is a visit to a gynaecologist, during which the doctor takes a medical history, assesses the reported symptoms and sets out a further diagnostic plan.
Depending on the situation, the following may also be needed:
- a transvaginal gynaecological ultrasound,
- a complete blood count and ferritin test,
- hormone tests,
- a pregnancy test or β-hCG test,
- microbiological diagnostics,
- colposcopy or other specialist tests.
Not all of these tests have to be done during one visit. Which ones are chosen depends on the medical indications.
The current price of the consultation and individual tests can be checked in the OpenMed price list or confirmed with the registration desk on 22 100 45 20.
Abnormal vaginal bleeding - frequently asked questions
Slight, brief spotting can occur around ovulation or while using hormonal contraception. However, if it appears regularly, lasts several days or is accompanied by pain, its cause should be checked. Similar symptoms can be caused by polyps, infections and hormonal disorders.
A brown colour usually means blood that has had time to change before leaving the reproductive tract. Such spotting can occur before a period, after it ends or between cycles. The colour alone does not show whether the cause is benign. What matters is when it occurs, how heavy it is and any accompanying symptoms.
Small clots can appear during a heavier period. Larger clots, e.g. with a diameter of more than about 2-2.5 cm, especially with heavy bleeding, are a reason for a consultation. If the bleeding is very heavy or is accompanied by dizziness and weakness, urgent medical help is needed.
Yes, recurring contact bleeding can be one of the symptoms of cancerous lesions of the cervix, but much more often it has other causes, e.g. ectropion, polyps, infections or micro-injuries. However, the symptom should not be ignored. The doctor may recommend a cervical examination, HPV testing or colposcopy.
Two bleeds in one calendar month do not have to mean disease if they occur as part of a shorter but regular cycle. However, gaps between periods shorter than 24 days in an adult woman may point to abnormalities. It is worth distinguishing a real period from bleeding between periods.
No. Many fibroids cause no symptoms at all. The risk of heavy bleeding is higher, among others, with submucosal fibroids, which bulge into the uterine cavity. The size of a fibroid alone does not determine how severe the symptoms are - its location also matters.
After an IUD is inserted, temporary changes in bleeding can occur. A copper IUD can make periods heavier, while a hormonal one may at first cause irregular spotting, which often gradually decreases. New, heavy or long-lasting bleeding requires a check-up, especially when accompanied by pain or fever.
Severe stress can affect hormonal regulation and ovulation, leading to a delayed period or irregular cycles. However, it should not be considered the cause of bleeding without ruling out other problems, especially if the symptoms recur or are severe.
No. Ultrasound helps identify many anatomical lesions, but it does not detect all causes of bleeding. Some polyps can be difficult to see, and ovulation disorders, clotting disorders or infections require other diagnostic methods. With persistent symptoms the doctor may extend the tests despite a normal ultrasound picture.
No. Common causes are atrophic changes of the vaginal lining or the endometrium, as well as benign polyps. However, because bleeding can also be a symptom of endometrial cancer, every episode after menopause requires a gynaecological assessment, even if it was brief and stopped on its own.
Yes, in many cases a gynaecological examination and ultrasound can be performed during bleeding. There is no need to automatically reschedule the visit. However, heavy blood loss can make some procedures more difficult, so the doctor may recommend doing selected tests at another time.
No. Spotting in early pregnancy can also occur in a normally developing pregnancy. However, the appearance of the blood cannot rule out a miscarriage or an ectopic pregnancy. Any bleeding requires contacting medical staff, and with severe pain, fainting or heavy blood loss, immediate hospital help is necessary.
Bleeding can last from a few hours to many days, depending on the cause. Periods lasting more than 8 days are considered prolonged. Recurring spotting also requires diagnostics, even if each episode lasts only one day.
Yes. Long-term blood loss can lead to reduced iron stores and anaemia. A complete blood count and a ferritin test can help. Iron deficiency can also occur with a normal haemoglobin level, so the results should be assessed together with the symptoms and the pattern of bleeding.
In many cases bleeding can be significantly reduced with appropriately chosen medication or treatment of the cause. The options include hormonal methods, medicines that reduce blood loss and procedures to remove polyps or certain fibroids. Choosing treatment requires first assessing the cause and taking into account the individual situation of the patient.