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Vaginal Bleeding Between Periods

Alternate Names

  • intermenstrual bleeding
  • spotting
  • metrorrhagia

Definition

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.

Risks

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.

Prevention

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.

Diagnosed

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.

Long Term Effects

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.

Other Risks

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.

Treatments

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.

Side Effects

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.

After Treatment

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.

Monitor

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.

Sources

Danforth's Obstetrics and Gynecology, 1999, Scott et al.

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