Vaginal bleeding between periods Information | Mount Sinai

Bleeding between periods; Intermenstrual bleeding; Spotting; Metrorrhagia

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

Related topics include:

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

External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries, and cervix.

Normal menstrual flow lasts about 5 days and produces a total blood loss of 60 to 250 mL and occurs every 28 days. There are several causes of abnormal vaginal bleeding and a careful exam by a health care provider is frequently the best way to sort out the source of the bleeding.

The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

Considerations

Normal menstrual flow lasts about 5 days. It produces a total blood loss of 30 to 80 mL (about 2 to 8 tablespoons), and occurs normally every 21 to 35 days.

Vaginal bleeding that occurs between periods or after menopause can be caused by various problems. Most are benign and can be easily treated. Sometimes, vaginal bleeding may be due to cancer or pre-cancer. Therefore, any unusual bleeding should be evaluated right away. The risk for 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 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 most often the best way to find the source of the bleeding. This exam can be done even while you are bleeding.

Causes

Causes may include:

• Uterine fibroids or cervical or uterine polyps
• Changes in hormone levels
• Inflammation or infection of the cervix (cervicitis) or uterus (endometritis)
• Injury or disease of the vaginal opening (caused by intercourse, trauma, 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
• Using hormonal birth control irregularly (such as stopping and starting or skipping birth control pills, patches, or estrogen rings) 
• Underactive thyroid (low thyroid function)
• Use of blood thinners (anticoagulants)
• Cancer or pre-cancer of the cervix, uterus, or (very rarely) fallopian tube
• Pelvic exam, cervical biopsy, endometrial biopsy, or other procedures

Home Care

Contact a provider right away if bleeding is very heavy.

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.

If possible, aspirin should be avoided, as it may prolong bleeding. However, NSAIDS such as ibuprofen can be used to minimize bleeding and cramping.

When to Contact a Medical Professional

Call your provider if:

• You are pregnant.
• There is any unexplained bleeding between periods.
• There is any bleeding after menopause.
• There is heavy bleeding with periods.
• Abnormal bleeding is accompanied by other symptoms, such as pelvic pain, fatigue, dizziness.

What to Expect at Your Office Visit

The provider will perform a physical exam and ask questions about your medical history. The physical exam will include a pelvic exam.

Questions about the bleeding may include:

• When does the bleeding occur and how long does it last?
• How heavy is the bleeding?
• Do you have cramps too?
• Are there things that make the bleeding worse?
• Is there anything that prevents it or relieves it?
• Do you have any other symptoms such as abdominal pain, bruising, pain when urinating, or blood in urine or stools?

Tests that may be done include:

• Blood tests to check thyroid and ovarian function
• Cervical cultures to check for a sexually transmitted infection
• Colposcopy and cervical biopsy
• Endometrial (uterine) biopsy
• Pap smear
• Pelvic ultrasound
• Saline infusion sonohysterogram
• Hysterosonogram
• Hysteroscopy
• Pregnancy test

Most causes of intermenstrual bleeding are easily treatable. The problem can most often be diagnosed without too much discomfort. Therefore, it is important not to delay in having this problem evaluated by your provider.

Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 17.

Ellenson LH, Pirog EC. The female genital tract. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Philadelphia, PA: Elsevier; 2020:chap 22.

Ryntz T, Lobo RA. Abnormal uterine bleeding: etiology and management of acute and chronic excessive bleeding. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 26.

Singh V, Mishra B, Sinha S, Agrawal S, Thakur P. Role of saline infusion sonohysterography in infertility evaluation. J Hum Reprod Sci. 2018;11(3):236-241. PMID: 30568352 pubmed.ncbi.nlm.nih.gov/30568352/.

Last reviewed on: 4/14/2021

Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Vaginal bleeding – irregular – Better Health Channel

Summary

Read the full fact sheet

• Irregular vaginal bleeding is any bleeding from a woman’s vaginal area and usually refers to bleeding that is not part of a regular period.
• If you suffer from ongoing bleeding problems, see your local doctor for a full assessment to make sure there is no underlying disorder causing the problem.
• In many women, the cause of the bleeding is not found.

During each monthly cycle, the lining of the womb (uterus) gets thicker in readiness for pregnancy. A menstrual period occurs when a pregnancy has not taken place. The lining of the uterus is shed and the loss is 50 per cent blood, which can vary from bright red to dark brown. After each period, the whole cycle starts again.

Irregular vaginal bleeding is any bleeding from a woman’s vaginal area and usually refers to bleeding that is not part of a regular period. The range of causes includes infection and hormonal changes. If you suffer from ongoing bleeding problems, see your local doctor for a full assessment to make sure there is no underlying disorder causing the problem.

A wide range of ‘normal’ menstrual periods

Periods differ from woman to woman and from month to month. A period can last from three to 10 days, and occur every three to six weeks. This pattern can vary with age, stress, diet, exercise and inherited factors. The flow can also vary. Around 40ml (two tablespoons) of fluid is lost, which the body quickly replaces.

It is common for women to suffer some cramping pain with their period. This is felt just below the navel and may spread into the legs or lower back. It can be felt as a dull ache or sharp twinge. During a period it is also common to feel bloated and heavy, get more pimples, feel tense and emotional, and have sore breasts and greasier hair.

A range of causes

In many women, the cause of the irregular bleeding is not found. For others, the cause depends on their age and the site of bleeding. Once pregnancy has been ruled out, some of the known causes include:

• Hormonal changes
• Contraception such as the pill, injection or IUD (intrauterine device)
• Infection in the vagina or uterus
• Fibroids or polyps inside the uterus
• Trauma to the vagina
• Some medications such as anticoagulants or anti-epilepsy drugs
• Underlying health problems such as bleeding or thyroid disorders
• Cancer in the lining of the uterus, the cervix or vagina (rare).

Diagnosis methods

For some women, medical history and physical examination are enough for the doctor to be able to diagnose the cause of the irregular bleeding. For other women, a range of tests may be offered including:

• Cervical smear and swabs
• Pregnancy test
• Blood tests
• Ultrasound
• Dilation and curettage (D&C), which involves gently widening the cervix and scraping away the uterine lining.

Treatment options

Treatment depends on the cause but may include:

• Anti-inflammatory drugs
• Antibiotics
• Change of contraception
• Hormone therapy
• Anti-bleeding agents such as tranexamic acid
• Surgery to remove fibroids, polyps or cancers
• Treatment for any underlying health problem.

Taking care of yourself at home

If you have irregular bleeding, some general home care suggestions include:

• Get plenty of sleep
• Eat a well-balanced diet
• Do some gentle exercise
• Keep a diary of your symptoms to show your doctor.

Pain relief suggestions

If you suffer from pain with your bleeding, suggestions include:

• Rest. Curl your knees up to your chest and lie on your side.
• Place a warm pack, such as a hot water bottle or wheat bag, over your abdomen.
• Take a warm bath.
• Wear loose clothing.
• Exercise.
• Rub or massage where it hurts.
• Take painkillers such as paracetamol, but avoid aspirin.
• Try relaxation techniques.
• Consider increasing your intake of magnesium or vitamin B1.

For more detailed information, related resources, articles and podcasts, visit Jean Hailes for Women’s HealthExternal Link.

Where to get help

• Your GP (doctor)
• Gynaecologist
• Sexual Health VictoriaExternal Link Tel. 1800 013 952

This page has been produced in consultation with and approved
by:

Non-period bleeding: definition and causes

Updated

February 12, 2022

|

Published

19 December 2019

Reviewed by an expert

How Flo Verifies Facts

All information published on Flo Health follows strict editorial standards for medical accuracy, validity, and timeliness. For more information on how we ensure the reliability of published information, please see our Fact Checking Principles.

The term “spotting” is commonly used to refer to scanty bleeding between periods. They can appear a week before or just before menstruation, as well as after sex.
However, how to distinguish brownish discharge before menstruation from menstrual bleeding? What are the most common causes of such discharge? Let’s figure it out.

What is spotting?

Bloody discharge is the release of a small amount of blood from the vagina between periods. For many women, this is quite a common occurrence and, as a rule, is not a cause for concern. Nevertheless, it is useful to know what causes such discharge and in which cases you should pay special attention to them.

In general, spotting is not dangerous and does not require medical attention. But in some cases, examination or treatment may be necessary.

Spotting and periods: the differences

Notice something that looks like spotting on the day you should have your period? It may not be spotting, but the start of your period.

Sometimes it is difficult to distinguish between spotting and menstruation. However, there are some differences between menstrual bleeding and spotting.

Menstrual blood varies in color from red to dark brown. By the end of menstruation, it can become almost black. If the bleeding is heavy and the blood is scarlet (bright red with an orange tinge), you should consult a doctor.

Spotting is light and short bleeding (1-2 days), not as heavy as menstruation. Such bleeding should not be accompanied by severe pain or clots. The color of blood varies from light brown to pink.

Bleeding may appear at any time, but menstruation is cyclical.

Bleeding often occurs in the middle of the cycle, and then it is usually associated with ovulation. However, sometimes spotting signals some other change in your body. A variant of the norm can also be spotting shortly after menstruation.

Is spotting normal?

Spotting is quite common, but it can be a cause for concern for many women. Unexpected stains on your underwear can be surprising and even frustrating, especially if you have a regular cycle.

However, don’t worry in advance. Remember: in most cases, spotting does not indicate anything serious and does not require examination and treatment. If they bother you or are accompanied by alarming symptoms, seek the advice of a specialist.

Bloody discharge a week before menstruation: should I be worried?

If your period is due in about a week and you already notice spotting, don’t worry. It is unlikely that they are talking about some serious problem, so it is better to remain calm and try to objectively assess the situation.

To get started, check out our list of the most common causes of this discharge. This will give you an idea of ​​possible diagnoses and whether you need to seek medical attention and, if so, how urgently.

However, there are symptoms to watch out for:

• pain in the lower abdomen;
• fever;
• spotting or other vaginal bleeding after menopause;
• spotting that gets worse or more frequent with time.

If you have any of the following concerns, seek professional advice as soon as possible.

Possible Causes of Spotting

You already know that spotting is light bleeding from the genital tract between periods. They can manifest differently in different women or in the same woman at different times. Their color may also differ: fresh blood is bright red, older blood is brown or even black.

Let’s find out what are the most common causes of bleeding between periods.

• Hormonal contraceptives. If you start using hormonal contraceptives (pills, patches, injections, etc.), you may experience spotting in the first 3 months. Doctors call this breakthrough bleeding. It is associated with changes in the lining of the uterus that occur under the influence of the hormones you are taking. Barrier methods of contraception (condoms, etc.) do not provoke such secretions.
• Sexually transmitted infections (STIs), such as chlamydia. STIs are on the rise worldwide, partly because many of these infections are asymptomatic. In addition to spotting, STIs can cause abnormal vaginal discharge, abdominal pain accompanied by fever, pain with urination or sex. If you suspect you have an STI, you and your partner should be tested immediately.
• Myoma or polyps of the uterus. These are benign tumors that form in the lining or muscles of the uterus. Polyps are manifested by abundant irregular menstruation (vary in time and intensity), and can lead to difficulty conceiving. Uterine fibroids can make themselves felt by pain, constipation, difficulty urinating.
• Polycystic ovary syndrome (PCOS). Women with PCOS have elevated levels of male sex hormones (androgens), leading to irregular periods and bleeding between periods.
• Oncological diseases of the reproductive system. This includes uterine cancer. These tumors are more common after menopause, although they can also be diagnosed in younger women. If you are over 40 years old and have spotting between periods, you should consult your doctor for advice.
• Perimenopause. As menopause approaches, hormone levels in the body change, causing the lining of the uterus to sometimes become thicker. And this can lead to irregular periods, spotting and other symptoms.

In most cases, spotting is not a cause for concern and no medical intervention is required. But in rare cases, they can talk about a disease and require additional examination.

If you have any of the above concerns or are worried about bleeding for any other reason, be sure to see your doctor.

Bleeding while taking oral contraceptives

When taking oral contraceptives (OC), the so-called breakthrough bleeding between periods is quite normal.

The causes of bleeding in this case are individual and depend on the type of tablets.

If you have just started taking OCs, bleeding between periods may be due to the body adjusting to the changed hormonal background. Such bleeding is not dangerous and normally stops after a few months.

Skipping 1-2 tablets can also cause spotting, which is quite normal and should not be cause for concern. But keep in mind that a violation of the intake of OK can lead to an unplanned pregnancy.

Bloody discharge during ovulation

Some women may have a pinkish or blood-streaked discharge during ovulation. In general, this is considered the norm.

Hormonal changes may be the cause of this spotting. Before ovulation, estrogen levels drop, which sometimes leads to spotting.

Bloody discharge after sex

Some women may notice bloody discharge during or immediately after intercourse (postcoital bleeding).

Possible causes of bleeding after sex:

• friction and damage to the mucous membrane of the vagina and cervix during sex, which is caused by lack of lubrication;
• inflammation of the vagina and cervix;
• sexually transmitted infections;
• endometriosis;
• taking oral contraceptives, etc.

This is usually a one-time occurrence, does not pose a health risk and should not be cause for concern.

But if bleeding after sex happens regularly or is accompanied by pain, you should consult a doctor to determine the cause.

Links

http://www.mayoclinic.org/healthy-lifestyle/birth-control/expert-answers/seasonale-side-effects/faq-20058109

http://www.parenting.com/article/how-cervical -mucus-helps-predict-your-most-fertile-days

http://www.justmommies.com/articles/ovulation-spotting.shtml

History of updates

current version
(12 February 2022)

29 August 2018

Blood in the middle of the cycle in women

Normal bleeding should be in the menstrual phase of the cycle. Blood discharge during the intermenstrual period is a common symptom of gynecological diseases. Intermenstrual bleeding is called metrorrhagia. They can be minor or intense.

Periodically, menstrual irregularities occur in every woman and this is not always a sign of any violations. If the cycle is unstable, it is difficult to understand whether the bleeding from the vagina is associated with the onset of menstruation or not.

Physiological causes of intermenstrual bleeding.

Bleeding during ovulation

The normal menstrual cycle is 21-35 days. Hemorrhagic discharge is most often observed on days 10-16, which corresponds to the days of ovulation. A mature egg leaves the follicle, which is accompanied by slight spotting blood discharge, lasting 1-3 days. During this period, unexpressed pain in the lower abdomen and bloating may occur.

Bleeding when taking combined oral contraceptives (COCs) – breakthrough bleeding.

Scanty bleeding often occurs in the first 2-3 months of COC use, as hormonal changes take place during this period. After the body adapts to COCs, acyclic bleeding stops. If this does not happen, then you need to contact a gynecologist to select another drug.

Also, when taking COCs, acyclic bleeding is possible if the drug regimen is violated (missed doses, insufficient absorption of the drug from the gastrointestinal tract due to diarrhea, vomiting).

The same acyclic blood discharge is possible when using the Mirena intrauterine hormonal system, and meager short-term (3-4-5 days) acyclic blood discharge can accompany the entire period of use of this system. This situation does not require correction and is perceived by a woman as irregular menstruation.

Pathological causes of intermenstrual bleeding

Periodic bleeding between periods can be the result of various gynecological and non-gynecological diseases.

Of the gynecological causes, the following should be noted:

• Inflammatory diseases – inflammation of the uterus and appendages, inflammation of the vagina caused by sexually transmitted infections – a common cause of acyclic bleeding.
• Benign diseases of the uterus – uterine fibroids, adenomyosis, uterine cavity polyps, endometrial hyperplasia – can cause bleeding, both related to menstruation and not related.
• Malignant neoplasms of the reproductive system . Cancer of the cervix, cancer of the body of the uterus, cancer of the fallopian tube, ovaries, vagina are often accompanied by acyclic bleeding
• Mechanical damage to the mucous membrane of the vagina and cervix can cause both scant and heavy bleeding. Erosion and ectropion of the cervix are often injured during sexual contact, because. the mucosa in the area of ​​erosion and ectropion is distinguished by a very thin layer of cells, the integrity of which is easily broken when touched. The vaginal mucosa of perimenopausal and postmenopausal women thins and becomes dry due to a decrease in the amount of sex hormones, which also leads to trauma upon contact. Rough sexual intercourse at any age often leads to ruptures of the walls of the vagina, accompanied by bleeding of varying intensity, up to very heavy, profuse bleeding.
• A separate cause of bleeding not associated with menstruation should be noted pregnancy . Especially often, bloody discharge appears in the short term of pregnancy and may indicate a miscarriage that has begun. An ectopic pregnancy in the vast majority of cases is accompanied by scant bleeding.

Non-gynecological causes include:

• Endocrine diseases that affect the reproductive system, such as polycystic ovary disease caused by an imbalance of sex hormones produced by the adrenal glands, pituitary tumors, thyroid disorders, etc. Hormonal dysfunctions of the ovaries also cause diabetes and obesity.
• Blood diseases associated with a violation of its coagulation, can cause bleeding in any organs, including the genitals. As a rule, such bleeding, if they are not associated with menstruation, is very meager and prolonged, but at the same time, menstruation itself can turn into real bleeding.

Other causes of abnormal uterine bleeding

• Diets , accompanied by a change in metabolism, a decrease in the amount of vitamins and microelements entering the body, can cause dysfunction of the reproductive organs, and hence the menstrual cycle.
• Drug effect. Some drugs can cause uterine bleeding. The most commonly used drugs are anticoagulants and antiplatelet agents, often used in long-term courses for the prevention of thrombosis and other diseases of the cardiovascular system. Often used prophylactically, aspirin is also a drug that can cause bleeding. Non-steroidal anti-inflammatory drugs – so beloved by the people “painkillers” – with prolonged use also cause bleeding. Other drugs that increase the risk of bleeding include some antihistamines, calcium channel blockers, antidepressants, antipsychotics, etc.
• Living conditions . Chronic and acute stress, change of time zones, climatic zones, chronic lack of sleep, excessive physical activity and many other factors can cause abnormal blood discharge associated with dysregulation of the reproductive system, especially in young girls and women of the perimenopausal period, i.e. during periods of life characterized by unstable hormonal regulation. In these cases, as a rule, with the physical and mental harmonization of life, abnormal bleeding stops.

In conclusion it should be noted that it is possible to understand the cause of uterine bleeding only with a thorough examination by a gynecologist, and often with the involvement of other specialists. With any abnormal blood discharge from the genital tract, a woman should not take expectant tactics and not self-medicate, but immediately contact a gynecologist in order to avoid serious complications that have arisen due to diseases not detected in time.

Article reviewed by physician

Gral Irina Olegovna

Obstetrician-gynecologist of the highest category.
Experience 30 years.

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