Vaginal Bleeding Between Periods

Alternate Names
intermenstrual bleeding
spotting
metrorrhagia

Definition of Vaginal Bleeding Between Periods

Vaginal bleeding between periods is when a woman has uterine bleeding after she has finished one menstrual period and before she begins the next. This occurs in many women at some point in their lives.

What is going on in the body?

The normal menstrual flow occurs about every 28 days, and lasts between 3 and 5 days. Bleeding in between periods can occur for many reasons. The bleeding may be harmless or serious, and in either case can cause much anxiety in affected women.

What are the signs and symptoms of the condition?

When a woman has bleeding between periods, the healthcare professional will need further information. He or she may ask:

• what the woman's normal cycle is like
• when the irregular bleeding started
• how much bleeding has occurred
• the description of the blood, such as whether it was bright red or whether there were clots
• when the woman's last normal period was
• whether or not the woman is sexually active and the type of birth control she uses
• whether or not irregular bleeding has occurred before
• whether any pain or cramps are associated with the bleeding
• when the woman's last Pap smear was
• whether or not the woman has ever had a sexually transmitted infection
• whether there have been any injuries to the pelvic area
• what medications are being taken
• any other symptoms, such as weight loss, nausea, fever, or abnormal bleeding or bruising in other parts of the body

Other questions may be asked, depending on the history and physical findings.

What are the causes and risks of the condition?

Bleeding from other areas, such as the bladder or bowels, may make a woman think she is having bleeding from the vagina.

True vaginal bleeding has many different causes, including:

• hormone imbalances, such as polycystic ovary syndrome or hypothyroidism
• early pregnancy or an early miscarriage or a pregnancy in the fallopian tube (ectopic pregnancy)
• benign masses such as polyps or fibroids
• cancer, such as endometrial cancer, or cancer of the cervix
• trauma to the vagina, such as from tampons or sexual intercourse
• inflammation in the female organs, such as cervicitis or pelvic inflammatory disease, both often due to sexually transmitted infections
• endometriosis or adenomyosis
• oral birth control pills, especially when they are stopped and started again
• certain medications, such as anticoagulants or aspirin

Other causes are also possible. In some cases, no cause can be found.

What can be done to prevent the condition?

Prevention is related to the cause. For instance, practicing safer sex can reduce, but not eliminate, bleeding due to sexually transmitted diseases (STDs). Regular Pap smears can find precancerous changes of the cervix and allow for treatment. A woman who is on oral birth control pills should take them as prescribed.

Too much aspirin should be avoided, if possible, because it may cause bleeding. Many cases cannot be prevented, but can be treated.

How is the condition diagnosed?

In many cases, the diagnosis is obvious from the history and physical exam. A pregnancy test, other blood and urine tests, and x-rays may be helpful, depending on the suspected cause. Occasionally, a laparoscopy may be necessary to explore the woman's female organs for the source of the pain.

What are the long-term effects of the condition?

Long-term effects are primarily related to the underlying cause. For instance, pelvic inflammatory disease may result in infertility, the inability to have children. Trauma to the vagina may heal and cause no long-term effects. Cancer may result in death.

What are the risks to others?

Bleeding between periods is not contagious and usually poses no risks to others. If the cause of bleeding is an infection, the infection may be contagious and passed on to sexual partners.

What are the treatments for the condition?

Hormonal treatments such as progesterone are often given if the bleeding is resulting from abnormal regulation of the menstrual cycle. Other treatments are directed at other causes. For instance, an infection may need to be treated with antibiotics. Women with cancer may need surgery, chemotherapy, or radiation therapy. A women with adenomyosis may need a hysterectomy, or surgery to remove the uterus.

What are the side effects of the treatments?

Side effects depend on the treatments used. All medications have possible side effects. For instance, progesterone drugs can cause headache and nausea. Antibiotics can cause allergic reactions and stomach upset. Surgery can be complicated by bleeding, infection, or a reaction to any anesthetic or pain medications used.

What happens after treatment for the condition?

This depends on the cause. If the cause is an infection that is treated with antibiotics, no further treatment or monitoring may be needed. If the cause is cancer, close monitoring and treatment may be needed for life.

How is the condition monitored?

Monitoring depends on the underlying cause of the bleeding. For instance, a woman found to have an early pregnancy might need frequent monitoring to determine whether or not she has lost the pregnancy. Most women who bleed in early pregnancy go on to have a normal baby.