Overview of bleeding or spotting between periods
- Alternative names
The following terms may be used to describe spotting or bleeding that occurs between periods:
- inter-menstrual bleeding
- metrorrhagia
- dysfunctional bleeding
- irregular menstrual periods
- spotting between periods
- bleeding between periods
- irregular vaginal bleeding
- abnormal uterine bleeding, and so on
These are just but a few of the names which people use to describe the bleeding that occurs either earlier or later than expected - bleeding that is unexpected. Therefore, if you hear any of them, know that they are referring to the same thing.
It is however important to note that the terms: dysfunctional bleeding, irregular menstrual periods, irregular vaginal bleeding and abnormal uterine bleeding, are broader. Although they also describe this condition (bleeding between periods), they can also refer to heavy or prolonged bleeding. They usually are used in cases where vaginal bleeding is "not ordinary" or rather "not-as-usual".
Here, we are only going to focus on bleeding that occurs in between periods.
- Understanding a normal vaginal bleeding
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).
Spotting or bleeding that occurs in between the 28(+/- 7) days is abnormal, and it is what we are referring to.
Is spotting or bleeding between periods a serious condition?
Yes and No. It is usually a symptom of an underlying condition. Some of the causes of bleeding that occurs in between periods are serious and require immediate medical attention, while others are not.
The seriousness of an underlying condition, causing abnormal uterine bleeding, can only be determined by a doctor. Therefore, the appropriate response should always be to seek immediate medical attention, especially where such bleeding is accompanied by symptoms such as fatigue, pain and dizziness.
However, it is important to note that most of the causes of vaginal bleeding between periods are treatable. This includes those that are regarded as serious medical conditions. However, chances of recovery and the treatment options available to you will depend on how fast you seek medical attention.
Diagnosing abnormal vaginal bleeding
Confirmation that it is a vaginal bleeding
Once you notice what appears to be an abnormal bleeding, you should immediately confirm that it is actually a vaginal bleeding. This is important as it will help your doctor to come up with an appropriate diagnosis. In case there are any steps that need to be taken to reduce the risks that you are exposed to, confirming the source of the bleeding will also play an important part.
To confirm the source of the bleeding, what you need is a tampon. You need to gently insert it into your vagina. If there is blood on the tampon, then it means that it is a vaginal bleeding. The source may therefore be the uterus, cervix or the vagina. If there is none, then it may mean that the spotting or bleeding you are experiencing is either from the rectum or is in the urine.
Examination of an abnormal bleeding by your healthcare provider
A healthcare provider has the knowledge and the best tools at his or her disposal. He or she should therefore be your first stop, even if you are still bleeding.
A doctor will likely run several tests, ask you some questions and thereafter prescribe a treatment. If there are any precautions that you should take, he or she is usually better placed to inform you.
The 21 causes of vaginal bleeding in-between periods
- Uterine fibroids
- Ovarian cysts
- Cervical polyps
- Uterine polyps
- Changes in hormone levels
- Inflammation or infection of the cervix (cervicitis)
- Injury caused by sexual intercourse
- An ulcer in the vaginal region
- Varicose veins around the vaginal opening
- Genital warts
- 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
Can ovarian cysts cause bleeding between periods?
Yes they can. When ovarian cysts rupture, the fluid that is released via the vagina can cause an abnormal bleeding. The color and type of discharge will however vary from woman to woman, depending on the type of cyst in a given woman's ovaries.
What to do when you notice an abnormal uterine bleeding
Immediately contact a health care provider if bleeding is very heavy or if it is accompanied by other symptoms. It is always good to get an exhaustive medical checkup. And it never hurts to be cautious where your health is concerned. It however does not mean that you should always panic once you experience spotting or bleeding between periods.
Keep track of the number of pads or tampons used over time so that the amount of bleeding can be determined. Uterine blood loss can be estimated by keeping track of how frequently a pad or tampon is soaked and how often one needs to be changed. this will help a doctor when it comes to diagnosing the type of bleeding and the likely cause of the vaginal spotting or bleeding.
Avoid taking aspirin. this is because it may prolong bleeding, something that will definitely make your condition worse.
- If bleeding happens when you are pregnant
- If there is no obvious explanation for your bleeding between periods
- If the bleeding happens after menopause
- If you experience heavy bleeding with periods
- If the abnormal uterine bleeding is accompanied by other symptoms, such as pain, fatigue, dizziness
Keep track of the number of pads or tampons used over time so that the amount of bleeding can be determined. Uterine blood loss can be estimated by keeping track of how frequently a pad or tampon is soaked and how often one needs to be changed. this will help a doctor when it comes to diagnosing the type of bleeding and the likely cause of the vaginal spotting or bleeding.
Avoid taking aspirin. this is because it may prolong bleeding, something that will definitely make your condition worse.
When to contact a medical professional immediately
- If bleeding happens when you are pregnant
- If there is no obvious explanation for your bleeding between periods
- If the bleeding happens after menopause
- If you experience heavy bleeding with periods
- If the abnormal uterine bleeding is accompanied by other symptoms, such as pain, fatigue, dizziness
What to expect at your office visit
The doctor will perform a physical exam and ask questions about your medical history. The physical examination with include an emphasis on the pelvic area.
Questions may include:
When did this bleeding between periods begin?
Does it occur consistently, such as every month?
When (during the course of a menstrual cycle) does this bleeding begin?
How long does the in-between bleeding last?
Does it occur consistently, such as every month?
When (during the course of a menstrual cycle) does this bleeding begin?
How long does the in-between bleeding last?
Quality
Is the bleeding heavy?
How many tampons or pads are required?
Do cramps accompany the bleeding?
Aggravating factors
What makes it worse?
Does increased physical activity make the bleeding worse?
Does intercourse bring on the bleeding?
Is increased stress associated with the bleeding?
Relieving factors
Does anything relieve or prevent it?
Other symptoms
What other symptoms do you have?
Do you have abdominal pain or cramps?
Is there increased bruising elsewhere on the body?
Do you have any difficulty, pain, or burning with urination?
Is there bloody urine or blood in the stools?
Other important information
Are you pregnant?
Have you had a miscarriage or abortion?
Have you had a D and C?
Have you ever had an abnormal Pap smear?
What medications are you taking? Do you take hormones or supplements?
Are you using tampons? What kind? What size?
At what age did your periods start?
Have you had normal periods without bleeding between in the past?
Are you sexually active?
Do you have a history of sexually transmitted infection?
Are you using birth control? What kind?
Have you been injured?
Have you received any medical or surgical treatments?
Tests that may be done include:
- Blood tests to check thyroid and ovarian function
- Cervical cultures to check for a sexually transmitted infectin
- Colposcopy and cervical biopsy
- Endometrial (uterine) biopsy
- Pap smear
- Pelvic ultrasound
- Pregnancy test
Do you want to learn more about ovarian cysts? Go to the Ovarian Cyst Miracle official website, its a good place to start
Anything on your mind? Share it in the comments below
Don’t forget to click on the like button :) Thank you
References
Lobo RA. Abnormal uterine bleeding: ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding.
In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007:chap. 37.
Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008;35(2):219-234.
