- Vaginal bleeding before puberty OR abnormal bleeding after puberty
- Heavy menstrual bleeding after puberty
- Light breakthrough bleeding or spotting in between menstrual cycles after puberty
- Newborn Vaginal Bleeding. Baby girls can have vaginal bleeding at any time from 2-10 days of life. This is normal and called false menses. The cause is the sudden drop-off in the mother's estrogen (a hormone) after birth. The blood-tinged discharge can last 3 or 4 days.
- Before Puberty. Vaginal bleeding (other than newborn) is not normal. Bleeding in this age group needs an exam.
- First Menstrual Period. If over 8 and has signs of puberty, this most likely is her first period. Signs of puberty are breast changes or pubic hair. Most girls do not have their first period until 2 years after puberty begins. Some girls do start during the first stage of puberty.
- After Puberty. Vaginal bleeding is abnormal if it occurs between regular periods. Heavy bleeding is also not normal. Bleeding that is severe or lasts over 7 days should be seen. Bleeding along with signs of severe anemia (such as pale skin, weakness) should also be seen. Teens may have abnormal bleeding during the year after their periods start. This can be normal. It usually doesn't need an urgent exam unless it's heavy or severe.
- Sexually Transmitted Infections (STIs). May cause spotting or blood-tinged discharge.
- Birth Control. Some birth control medicines can cause breakthrough or abnormal bleeding. This most often occurs for the first few months on the medicines.
- Pregnancy. Vaginal bleeding can be a sign of pregnancy. Teens that are having sex should keep this in mind. In early pregnancy, vaginal bleeding can be a sign of serious problems. Causes include miscarriage or an ectopic pregnancy. If in doubt, always do a pregnancy test.
Excessive Menstrual Bleeding
Menstrual bleeding can be defined as too much with any of the below:
- More than 7 days (1 week) of bleeding (8 days is prolonged)
- More than 6 well-soaked pads or tampons per day
- Periods happen more often than every 21 days
- Any bleeding or spotting between regular periods
- If bleeding is felt to be more than normal, the teen should be seen.
Vaginal Bleeding Severity is defined as:
- Spotting: pinkish/brownish mucous discharge, less than 1 pad total per day
- Mild: less than 1 pad per hour; like menstrual bleeding
- Moderate: 1-2 pads/hour; small blood clots (pea, grape, small coin)
- Severe: soaking more than 2 pads/hour. Bleeding not contained by pads with large amount of red blood from vagina. Can also have large blood clots (golf ball, large coin).