Characteristics of prospectively measured vaginal bleeding among women trying to conceive


Dr Rafael Mikolajczyk, Department of Public Health Medicine, School of Public Health, University of Bielefeld, PO-Box 100131, D-33501 Bielefeld, Germany.


Mikolajczyk RT, Louis GMB, Cooney MA, Lynch CD, Sundaram R. Characteristics of prospectively measured vaginal bleeding among women trying to conceive. Paediatric and Perinatal Epidemiology 2010; 24: 24–30.


Previous research has described variability in menstrual cycle lengths within and across women, though less attention has focused on characterising patterns of bleeding. While clinical definitions for menstrual bleeding are often given in standard textbooks, the validity of conventional definitions has not been empirically evaluated in epidemiological studies. The definition of menstrual bleeding may affect the analysis of time to pregnancy and pregnancy dating that relies upon the last menstrual period. We used daily records of vaginal bleeding from a prospective cohort study that included 74 women trying to become pregnant who reported 430 bleeding episodes. A longitudinal mixture model (PROC TRAJ) was used to classify patterns of bleeding.

Among the first 74 bleeding episodes, 15% comprised only days with spotting or light bleeding (possibly representing non-menstrual bleeding given the length of the cycle defined by these bleeding episodes). When all 430 bleeding episodes were analysed, four distinct bleeding patterns emerged: (1) episodic bleeding comprising 1–3 days of spotting (10%), (2) bleeding lasting 3–6 days (40%), (3) bleeding lasting 6–8 days (33%), and (4) bleeding lasting 8–12 days (17%). These findings suggest that non-menstrual bleeding may be relatively common. Considerable variation in menstrual bleeding patterns is evident, and as such is likely to impact fecundity-related endpoints or gestational age estimates that rely upon menstrual cycle dates. The association between bleeding patterns and female fecundity awaits future research.