Normal menstrual flow lasts about 4 days, produces a total blood loss of 30 to 80 ml (about 2 to 8 tablespoons), and occurs normally every 28 days (+/-7 days).

Vaginal bleeding may be something to worry about for women over age 50 (postmenopausal). The risk of malignancy increases with age.

Make sure that bleeding is coming from the vagina and is not from the rectum or in the urine. Inserting a tampon into the vagina will confirm the vagina/cervix/uterus as the source of bleeding.

A careful exam by your health care provider is frequently the best way to sort out the source of the bleeding. This exam can be accomplished even while you are bleeding. Do not delay getting an exam just because you are currently bleeding.

• Uterine fibroids or polyps
• Injury or disease of the vaginal opening (caused by intercourse, infection, polyp, genital warts, ulcer, or varicose veins)
• Vaginal injury from insertion of foreign objects, from malignancy, or from infection
• Dry vaginal walls resulting from lack of estrogen after menopause
• Pregnancy complicated by abortion (spontaneous or induced)
• Pregnancy complicated by ectopic pregnancy
• Fluctuation in hormone levels
• Stopping and starting birth control pills or estrogens
• Low thyroid function
• IUD use can cause occasional spotting (if bleeding is slight, it can be ignored)
• Drugs such as anticoagulants
• Cervical conization or cauterization procedures
• Stress