Sunday, May 19, 2013

Vaginal bleeding between periods

Table of Contents

Definition

This article discusses vaginal bleeding that occurs between a woman's monthly menstrual periods. Such bleeding may be called "intermenstrual bleeding."

See also:

  • Dysfunctional uterine bleeding
  • Heavy, prolonged, or irregular menstrual periods

Alternative Names

Bleeding between periods; Intermenstrual bleeding; Spotting; Metrorrhagia


Considerations

Normal menstrual flow lasts about 4 days (plus or minus 2 - 3 days). It produces a total blood loss of 30 - 80 ml (about 2 - 8 tablespoons), and occurs normally every 28 days (plus or minus 7 days).

Vaginal bleeding that occurs between periods or after menopause can be caused by various problems. Most are benign and treatable. Sometimes vaginal bleeding may be due to cancer or precancer. So any unusual bleeding should be evaluated promptly. The risk of cancer increases to about 10% in women with postmenopausal bleeding.

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, or 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.


Common Causes
  • Uterine fibroids or cervical or uterine polyps
  • Changes in hormone levels
  • Inflammation or infection of the cervix (cervicitis)
  • Injury or disease of the vaginal opening (caused by intercourse, infection, polyp, genital warts, ulcer, or varicose veins)
  • IUD use (may cause occasional spotting)
  • Ectopic pregnancy
  • Miscarriage
  • Other pregnancy complications
  • Vaginal dryness due to lack of estrogen after menopause
  • Stress
  • Stopping and starting birth control pills or estrogens
  • Underactive thyroid (low thyroid function)
  • Use of blood thinners (anticoagulants)
  • Cancer or precancer of the cervix, uterus, or (very rarely) fallopian tube
  • Cervical or endometrial biopsy or other procedures

Review Date: 03/22/2011
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)