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Brown vaginal discharge: possible causes, testing, treatment, and when to see a doctor
By Slava Fuzayloff | Published on June 4, 2023
Every woman gets some sort of brown vaginal discharge in her lifetime. Usually this isn't a cause for concern and happens before or after a menstrual period.
However, if the discharge is accompanied by other symptoms or is unusual (in amount, consistency, timing, or color),it could be a sign of health condition.
In this article, will discuss the most common causes of brown vaginal discharge, testing options, and treatment modalities.
Let's begin!
Normal vaginal discharge
It's normal for females to have daily vaginal discharge [1] American Academy of Family Physicians. Vaginal Discharge. https://familydoctor.org/condition/vaginal-discharge/ . This discharge is produced by vaginal cells and normal bacteria that reside on the vaginal surface. Discharge, or cervical mucus, helps to maintain a healthy vagina and naturally changes in different phases of the menstrual cycle.
It's normal to have one half to one teaspoon (2-5 ml) of vaginal discharge daily. The discharge is usually white or clear and odorless with a mucus-like consistency.
Every female's normal vaginal discharge is personal to her. What's normal varies significantly from one woman to another [2] Vaginal itching and discharge - adult and adolescent https://medlineplus.gov/ency/article/003158.htm . It's important for every female to know what's normal for her so she'll recognize any changes that might be abnormal.
Any sudden change in vaginal discharge could mean that something is wrong.
How brown vaginal discharge getsits brown color
The color of the brown vaginal discharge that females sometimes get comes from blood being exposed to oxygen in the air [6] Signs and symptoms of endometrial cancer. (2016). https://www.cancer.org/cancer/types/endometrial-cancer/detection-diagnosis-staging/signs-and-symptoms.html . It's a natural process called oxidation that changes the color to brown.
The uterus and vagina are usually blood-rich organs, especially before and after a regular period, so it's common to have a small amount of blood spill in the area.When oxidized blood mixes with vaginal fluid, the result is a brownish vaginal discharge.
Different shades of brown
The shade of brown this vaginal discharge will be depends on the amount of blood present and the amount of time it's been exposed to the air (oxygen) before being expelled.
✓ The more blood, the darker the color
✓ The longer the exposure, the darker the color.
Light brown vaginal discharge
A light brown discharge is a sign of light bleeding or spotting and most commonly occurs at the beginning or end of a normal period or along with other condition that causes light bleeding.
Dark brown vaginal discharge
A dark brown color is a sign of the significant bleeding. This most commonly is seen during a menstrual period or other condition that causes significant blood loss.
Causes of brown vaginal discharge
When brown discharge is not a disease and is caused by normal monthly hormone fluctuations
When brown vaginal discharge is a normal menstrual cycle
The light bleeding that a period starts and ends with is exposed to oxygen while being expelled slowly from uterus to vagina and then to outside the body; this turns normal vaginal fluid brown. It usually lasts for 1-2 day sat the beginning and end of the monthly menstrual cycle.
Other signs of the menstrual cycle:
✓ Cramps
✓ Bloating
✓ Fatigue
✓ Breast soreness
✓ Pimple breakouts
✓ Mood swings
Brown vaginal discharge with mid-cycle spotting or ovulation
A small amount of brown discharge can be seen during ovulation (which is when an egg is released from the ovaries) or in the middle of the cycle. A female's normally high estrogen level suddenly drops during ovulation, triggering spotting or very light bleeding.
Brown vaginal discharge with ovulation will last 1-2 days.
Other signs and symptoms of ovulation:
✓ Increase in the amount of vaginal discharge
✓ Lower abdominal discomfort
✓ Higher resting body temperature
Brown vaginal discharge due to the birth control pill or intrauterine device (IUD)
✓ An IUD may cause slight spotting and subsequent brownish vaginal discharge after insertion for a short time. The minor bleeding is usually due to minimal trauma with IUD insertion.
✓ Birth control pills may cause hormonal changes and affect the menstrual period for some time, which can lead to spotting, breakthrough bleeding, and brown vaginal discharge. This can last for a few months until the body adjusts to the hormonal changes that accompany the pill. Taking birth control pills inconsistently occasionally causes temporary spotting and brown discharge as well.
When brown discharge is caused by minor trauma
Any minor trauma to the vagina or uterus that can cause minor bleeding or spotting can lead to brownish vaginal discharge.
For example, minor trauma could occur during a routine PAP smear, IUD insertion, or vigorous or prolonged sexual activity.
Minor trauma-induced vaginal discharge usually lasts for a day or two.
When brown discharge is caused by infection: STDs and non-STDs
Many infections that affect the vagina—both STDs and non-STDs—can cause brown vaginal discharge
[2, 4]
Vaginal itching and discharge - adult and adolescent
https://medlineplus.gov/ency/article/003158.htm
Vaginitis: current microbiologic and clinical concepts
https://pubmed.ncbi.nlm.nih.gov/3510698/
. This is the first thing that need to be ruled out in sexually active females.
STDs
Chlamydia, gonorrhea, and trichomoniasis are three common STDs that can lead to brown vaginal discharge.
Chlamydia
Chlamydia is a common sexually transmitted infection (STI) caused by bacteria. It can cause minor spotting, which can lead to brown vaginal discharge.
Other chlamydia signs and symptoms:
✓ Painful urination
✓ Vaginal discharge
✓ Bleeding with intercourse and between periods
✓ Painful sex
Gonorrhea
Gonorrhea is sexually transmitted bacteria that mainly affect the cervical area of the vagina.Very occasionally (much less often than chlamydia), it can be a cause of brown vaginal discharge.
Other gonorrhea signs and symptoms:
✓ Painful urination
✓ Vaginal discharge
✓ Bleeding with intercourse and between periods
✓ Abdominal and pelvic pain
Trichomoniasis
Brownish discharge can be a result of trichomoniasis, which is a sexually transmitted infection caused by live parasites.
Other common trichomoniasis signs and symptoms:
✓ A significant amount of thin, gray, smelly, vaginal discharge
✓ Pain with urination or sex
✓ Redness and itch of the genitals
✓ Lower abdominal discomfort
Pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID) can sometimes result in brown discharge [9] Vaginal Discharge. (2007). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099568/ . This happens when sexually transmitted bacteria (primarily chlamydia and gonorrhea) spread from the vagina into the uterus, fallopian tubes, and ovaries. It usually takes some time for a regular STD to progress to PID.
PID might not have symptoms, or symptoms may be very mild. Here are the most common symptoms of PID when they are present:
✓ Lower abdominal and pelvic pain
✓ Unusual or heavy vaginal discharge
✓ Pain with sex and urination
✓ Fever and chills
Non-STDs
Bacterial vaginosis (BV) and yeast infection (candidiasis) are two common non-STDs that can cause vaginitis and lead to brown vaginal discharge. Both conditions are caused by a change in the pH of the vagina.
Bacterial vaginosis (BV)
Bacterial vaginosis is caused by overgrowth of normal vaginal bacteria, whichupsets the vagina's natural balance.
Other symptoms of BV:
✓ Thin, gray vaginal discharge
✓ Foul smell (described as "fishy")
✓ Vaginal itch
✓ Vaginal burn
✓ Burning with urination
Yeast infection
Yeast infection is caused by overgrowth of a yeast called candida (a type of fungus). Candida usually stays in balance within the body, but it grows rapidly when it is out of balance, occasionally causing brownish discharge.
Other symptoms of vaginal yeast infection:
✓ Redness and swelling of the vulva and vagina
✓ Intense itch
✓ Thick white discharge with a cottage cheese appearance
✓ Burning of the area with urination and intercourse
A foreign body in the vagina
Any object found in the vagina is considered a foreign body. The most common foreign bodies in adults are forgotten tampons(not removed for days) and pieces of condom (after a condom breaks).
Brown vaginal discharge (due to minor bleeding) from foreign body retention is common.
Other symptoms of brown vaginal discharge:
✓ Vaginal itch
✓ Vaginal bleeding
✓ Foul smell from the vagina
✓ Pain with urination
✓ Pelvic pain or pressure
When brown discharge is a sign of a medical condition
Here we will discuss medical conditions that can present with brown vaginal discharge.
Ovarian cyst
Ovarian cysts are sacs filled with fluid on the surface of an ovary. Most of the time, ovarian cysts are asymptomatic and cause no discomfort. But sometimes they twist and rupture, causing discomfort or even serious symptoms.
Large ovarian cysts can present with irregular, brown vaginal discharge due to bleeding.
Other symptoms of symptomatic (remember, most cysts are asymptomatic) ovarian cysts:
✓ Pelvic pain on and off
✓ Fullness and pressure in the stomach
✓ Bloating
Polycystic ovarian syndrome (PCOS)
Polycystic ovarian syndrome (PCOS) is a common hormonal condition affecting one in nine females of reproductive age (15-45 years old). Its cause is unknown (but it might be insulin resistance or genetics).
An imbalance of reproductive hormones, such as high production of androgens, results in irregular or missed periods.
Brown vaginal discharge instead of the monthly period is one of the symptoms of PCOS. [10] Pelvic Inflammatory Disease. (2020). https://www.ncbi.nlm.nih.gov/books/NBK499959/
Other symptoms of PCOS:
✓ Excess hair
✓ Acnes
✓ Dark skin patches
✓ Obesity
✓ Ovarian cyst
✓ Infertility
Endometriosis
Endometriosis is a painful disorder in which endometrial tissue that normally lines the surface of the uterus grows outside the uterus. The areas most commonly affected are the ovaries, fallopian tubes, and colon.
One of the symptoms of endometriosis is brown vaginal discharge due to the bleeding caused by the condition.
Other common symptoms of endometriosis:
✓ Pain during period
✓ Pain with sex
✓ Pain with bowel movements and urination
Cervical cancer
Cervical cancer is caused by a certain type of human papilloma virus (HPV).Very infrequently, cervical cancer can present with brown vaginal discharge.
Other symptoms of cervical cancer:
✓ Heavy and prolonged period
✓ Bloody vaginal discharge that can be foul smelling
✓ Painful sex
✓ Weight loss
When brown discharge is pregnancy related
Sometimes brown vaginal discharge can be a sign of pregnancy or a pregnancy-related medical condition. [7] Why does blood turn brown when it touches the air? (2006). scienceline.ucsb.edu/getkey.php?key=1329
Implantation
Implantation is the process of a fertilized egg attaching to the uterine lining.This occurs one to two weeks after conception. It can cause minor bleeding that can present as brown vaginal discharge due to the blood oxidation process.
Other signs of early pregnancy:
✓ Nausea and vomiting
✓ Achy breasts
✓ Bloating
Pregnancy
It's normal to have more vaginal discharge during pregnancy. The amount of discharge increases even more toward the end of the pregnancy, and it gets thicker.
About 30% of females experience brownish vaginal discharge with pregnancy, especially during the first three months (first trimester) of pregnancy.
Ectopic pregnancy
Ectopic pregnancy occurs when a fertilized egg, instead of attaching, to the uterus cavity, implants somewhere else in the body, usually in a fallopian tube. This is a serious medical condition and might require immediate intervention.
Light bleeding with early ectopic pregnancy can turn vaginal discharge brown.
Other signs of ectopic pregnancy:
✓ Abdominal pain
✓ Nausea and vomiting
✓ Vaginal spotting and bleeding
✓ Lightheadedness
When brown discharge is age related
Perimenopause is the time when the body naturally transitions to menopause, marking the end of a woman's reproductive years.
Women begin perimenopause at different ages, but usually from the late thirties to early forties.
Due to an uneven rise and fall of estrogen (the main female hormone),the menstrual cycle might become longer or shorter. Sometimes this results in brown vaginal discharge instead of a normal bright-red period flow.
Other symptoms of perimenopause:
✓ Mood swings
✓ Hot flashes
✓ Vaginal dryness
Diagnosing brown vaginal discharge
To establish the correct diagnosis for brown vaginal discharge, a detailed history of the discharge taken by a doctor and proper testing are necessary.
[3, 4]
Bishop GB. Vaginal Discharge.
https://www.ncbi.nlm.nih.gov/books/NBK281/
Vaginitis: current microbiologic and clinical concepts
https://pubmed.ncbi.nlm.nih.gov/3510698/
For infectious causes, testing can be done via a vaginal swab or urine test. A vaginal swab is the preferred method.
Chlamydia is diagnosed via a vaginal swab (preferred) or urine test.
Gonorrhea is diagnosed via a vaginal swab(preferred) or urine test.
Trichomoniasis is diagnosed via a vaginal swab(preferred) or urine test.
PID is diagnosed via a combination of a vaginal swab and doctor's physical examination of the abdomen and pelvis.
Yeast infection is diagnosed via a vaginal swab.
Bacterial vaginosis is diagnosed via a vaginal swab.
Testing for noninfectious causes is more complex and depends on the condition. A detailed history and physical exam help the doctor order the right test.
Ovarian cyst
An ovarian cyst can be detected during physical examination and confirmed by ultrasound.
PCOS
PCOS is diagnosed with a combination of the patient's history (irregular menstrual cycle), blood work (high androgen level), and ultrasound (which can reveal multiple cysts in the ovaries).
Endometriosis
Endometriosis is diagnosed with a combination of physical exam (cysts and scars can be felt), ultrasound, MRI, or laparoscopy (surgery to look for sign of endometriosis).
Cervical cancer
A simple PAP smear test can detect abnormal cells in the cervix.Then an HPV DNA test can be done.
Perimenopause
Perimenopause is diagnosed based on taking a history that includes the person's age, menstrual history, and any other symptoms and body changes present.
Brown vaginal discharge treatment options
The treatment of brown vaginal discharge depends on the cause. To determine the discharge's cause, evaluation and testing by a specialist are necessary.
Here we will briefly discuss the treatment options for the most common causes of brown vaginal discharge.
Most infectious conditions are treated and cured with medication:
Chlamydia is treated and cured with seven days of Doxycycline.
Gonorrhea is treated and cured with one shot of Ceftriaxone.
Trichomoniasis is treated and cured with metronidazole, which can be taken in a one-time pill or over a seven-day period.
PID is treated and cured with a combination of oral and injection antibiotics. The treatment always includes treatment for chlamydia and gonorrhea.
Yeast infection is treated and cured with one-time oral Diflucan or with over-the-counter vaginal suppositories.
Bacterial vaginosis is treated and cured with topical or oral metronidazole.
The treatment for a medical condition that causes brown vaginal discharge is not as simple as treatment for infectious causes.
Ovarian cyst
Most ovarian cysts go away on their own. If not, birth control pills or even surgery might be necessary.
PCOS
Treatments for PCOS include birth control pills to regularize periods, a medication called metformin to prevent diabetes, statins to control high cholesterol, hormones to increase fertility, and procedures to remove excess hair.
Endometriosis
Treatment of endometriosis consists of hormones and excision surgery.
Cervical cancer
Treatment of cervical cancer depends on the stage and may include surgery, radiation, and/or chemotherapy.
Perimenopause
Systemic estrogen therapy is used to relieve perimenopausal hot flashes and night sweats.
When to see a doctor
Occasional brown discharge is okay to have. This is especially true if it's at the beginning or end of the menstrual period. But pay attention to any other symptoms you have in addition to brown vaginal discharge:
✓ Smell
✓ Vaginal itch
✓ Pain with urination
✓ Pain with sex
✓ Pelvic pain and lower abdominal pain
✓ Abnormal bleeding between periods
✓ Irregular or frequently missed periods
✓ Spotting after menopause
✓ Weight loss
Visit a medical doctor if you experience any of the above symptoms in addition to brown vaginal discharge, as they might indicate infection or another medical condition.
While usually brown discharge is nothing to worry about, it never hurts to seek your doctor's advice.
Source
-
American Academy of Family Physicians. Vaginal Discharge.
https://familydoctor.org/condition/vaginal-discharge/ -
Vaginal itching and discharge - adult and adolescent
https://medlineplus.gov/ency/article/003158.htm -
Bishop GB. Vaginal Discharge.
https://www.ncbi.nlm.nih.gov/books/NBK281/ -
Vaginitis: current microbiologic and clinical concepts
https://pubmed.ncbi.nlm.nih.gov/3510698/ -
National Health Service. Vaginal discharge.
https://www.nhs.uk/conditions/vaginal-discharge/ -
Signs and symptoms of endometrial cancer. (2016).
https://www.cancer.org/cancer/types/endometrial-cancer/detection-diagnosis-staging/signs-and-symptoms.html -
Why does blood turn brown when it touches the air? (2006).
scienceline.ucsb.edu/getkey.php?key=1329 -
Patterns and predictors of vaginal bleeding in the first trimester of pregnancy. (2011).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884141/ -
Vaginal Discharge. (2007).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099568/ -
Pelvic Inflammatory Disease. (2020).
https://www.ncbi.nlm.nih.gov/books/NBK499959/ -
Abnormal Uterine Bleeding: a Focus on Polycystic Ovary Syndrome. (2009).
https://journals.sagepub.com/doi/full/10.2217/WHE.09.20
