What causes bleeding between periods?

There are many different causes of bleeding between periods. Some may not be anything to worry about, but seek medical advice if you’re concerned.

Hormonal contraceptives

Irregular bleeding, such as bleeding between periods, is common during the first few months of starting hormonal contraception, such as the:

• combined oral contraceptive pill
• progestogen-only contraceptive pill
• contraceptive patch (transdermal patch)
• contraceptive implant or injection
• intrauterine system (IUS)

If you’re concerned about bleeding or it lasts longer than a few months, you should seek medical advice.

You may also bleed between periods if you:

• miss any combined pills
• miss any progestogen-only pills
• have a problem with your patch or vaginal ring
• are on the pill and are also sick or have diarrhoea

Other causes

Some other causes of bleeding between periods include:   

• taking the emergency contraceptive pill
• injury to the vagina – for example, from having penetrative sex
• recently having an abortion – seek medical advice if you’re bleeding heavily
• sexually transmitted infections (STIs) such as chlamydia – it’s a good idea to get tested if you’ve recently had unprotected sex with a new partner
• recently having a miscarriage
• reproductive hormones not working normally – this is common in women approaching the menopause or in women with polycystic ovary syndrome (PCOS)
• stress
• vaginal dryness
• harmless changes to the neck of the womb (cervix) – this may be called cervical ectropion or cervical erosion
• cervical cancer – if you’re aged 25 to 64, you should be having regular cervical screening tests to detect any changes to your cervix; even if you’re up-to-date with screening tests, you should see a GP about irregular bleeding, particularly bleeding after sex, to eliminate the possibility of cervical cancer
• womb (uterus or uterine) cancer – this is more common in post-menopausal women and most cases of endometrial cancer are diagnosed in women over the age of 50; see a GP if you’re over 40 and have bleeding between periods to eliminate the possibility of uterine cancer
• vaginal cancer or vulval cancer
• cervical or endometrial polyps – non-cancerous (benign) growths in the womb or the lining of the cervix
• fibroids

When to seek medical advice

If you’re concerned about bleeding between periods, you should:

• see a GP
• visit a sexual health or genitourinary medicine (GUM) clinic

A healthcare professional will talk to you about your symptoms. Depending on your situation, they may suggest doing some tests, such as:

• tests for STIs, which may include an examination of your genitals
• a pregnancy test
• a cervical screening test, if you’re aged 25 to 64 and not up-to-date with these
• a pelvic ultrasound scan

To diagnose some conditions, you may need an examination, such as:

• a speculum examination – a smooth, tube-shaped tool (a speculum) is inserted into your vagina to examine your vagina and cervix
• an internal examination of your vagina with gloved fingers (bimanual examination)

Find out the answers to more questions about women’s health

Further information

• Heavy periods
• Period pain
• Stopped or missed periods
• Find services: sexual health

Page last reviewed: 5 November 2019
Next review due: 5 November 2022

Vaginal Bleeding Between Periods: Causes, Prevention & Diagnosis

You may experience bleeding between periods due to stress, medication changes, and certain health conditions.

Abnormal vaginal bleeding between periods is also called intermenstrual bleeding, spotting, and metrorrhagia. When bleeding occurs between normal periods, there are many possible causes.

While some causes may be easy to treat, others can indicate a serious underlying condition. Whether you notice spotting or heavier bleeding between periods, it’s important to see your doctor for testing, diagnosis, and treatment options. Potential causes of bleeding between periods include:

• a growth in your uterus or cervix
• stress
• a change in medication
• a miscarriage
• vaginal dryness
• a hormone imbalance
• cancer

Bleeding between periods isn’t a normal part of the menstrual cycle.

The average cycle lasts 21 to 35 days. Normal vaginal bleeding, also known as your period, can happen for a few days to a week. Any bleeding outside of this is considered abnormal and can be caused by a variety of factors. These include:

1.

Hormonal imbalance

Estrogen and progesterone are the two hormones that regulate your cycle. You may have spotting if they get out of balance. The following can all affect your hormone balance:

• dysfunctional ovaries
• thyroid gland problems
• starting or stopping birth control pills

As well, some women spot during ovulation as a result of hormonal changes.

When starting any type of hormonal contraceptive, abnormal bleeding is common during the first three months, according to the National Health Services of the United Kingdom. These contraceptives include:

• birth control pills
• intrauterine device
• contraceptive patch
• contraceptive implant or injection

2. Pregnancy complications

Complications during pregnancy can cause spotting. Both a miscarriage and an ectopic pregnancy can cause bleeding. An ectopic pregnancy occurs when a fertilized egg implants itself in the fallopian tube instead of the uterus.

Spotting during pregnancy may not mean you’re having a miscarriage. However, if you’re pregnant and experience any vaginal bleeding, you should contact your doctor immediately.

3. Uterine fibroids

Uterine fibroids are noncancerous growths that form in the uterus. They aren’t uncommon in women who’ve given birth.

4. Infection

Vaginal bleeding between periods may indicate an infection of your reproductive organs. Infection can cause inflammation and bleeding. Causes include:

• sexually transmitted infection
• vaginal douching
• intercourse
• pelvic inflammatory disease, which is marked by inflammation of the reproductive organs that leads to scarring

5. Cancer

Less commonly, a cancer of any of these organs can cause bleeding:

• cervix
• vagina
• uterus
• ovaries

6. Rare causes

Other possible causes of vaginal bleeding are rare and include:

• insertion of an object into the vagina
• extreme stress
• diabetes
• thyroid disorders
• significant weight gain or loss

You should consult your doctor any time you have abnormal vaginal bleeding. The cause of the bleeding could be serious and should be determined. See your doctor right away if you’re pregnant and have vaginal bleeding.

If you have other serious symptoms in addition to bleeding, you may need emergency medical attention. These include:

• pain
• fatigue
• dizziness
• fever

Diagnosis

When you see your doctor about bleeding between periods, be prepared to answer questions about your symptoms.

It’s helpful to keep a record of your cycle. Take note of when your periods begin and end, the heaviness and duration of your flow, and when and how much you bleed between periods. Your doctor will want to know about any other symptoms that you’ve experienced and any medications you’re taking.

Your doctor will also likely give you a physical exam, including a pelvic exam.

Diagnostic tests can help your doctor find the cause of the bleeding. Your doctor may draw blood to check hormone levels. You may need to have cultures taken or tissue removed from your cervix or the lining of your uterus for testing, which is called a biopsy. Your doctor may also want to perform an ultrasound.

Treatment

There is no specific treatment for vaginal bleeding between periods. Treatment will vary based on what’s causing your abnormal vaginal bleeding.

In some cases, this kind of abnormal bleeding will resolve on its own. However, for some women, the underlying cause requires treatment. Ignoring the problem and failing to see a doctor can lead to a worsening of the problem. If the cause of the bleeding is an infection, cancer, or another serious disorder, the consequences could be life-threatening.

You may not be able to prevent bleeding between periods depending on the cause. However, in some cases, preventive measures can help.

Maintain a healthy lifestyle and a normal weight because being overweight can lead to abnormal periods.

If you take birth control pills, do so as directed to avoid a hormonal imbalance. Exercise moderately to maintain health and reduce stress.

To manage pain, use ibuprofen (Advil) or naproxen (Aleve, Naprosyn), which can actually help reduce bleeding. Avoid taking aspirin (Bufferin), which may increase your risk of bleeding.

Women’s uterine bleeding – causes and treatments

The reasons why a woman may experience bleeding from the uterus, vagina or other part of the genital tract, prevailing in different age groups, are different. Regardless of age, their danger lies in the occurrence of anemia (anemia), if the blood loss is large enough, and bleeding occurs regularly. If a woman is not pregnant and is not in labor, then the following types of bleeding can be distinguished, the source of which is the uterus:

• Dysfunctional bleeding in girls – occurs at a young age, a little after menarche, due to hormonal failure in the ovaries
• Dysfunctional bleeding in women of reproductive age – require increased attention of the doctor, as they can serve as a harbinger of infertility.
• Climacteric bleeding – occur due to hormonal changes in the female body and may indicate in favor of the proliferative process, both benign and malignant. More often still benign: the occurrence of polyps, myomatous nodes due to hyperestrogenemia (an excess of the female sex hormone estrogen)
• Postmenopausal bleeding – occurs some time after the onset of menopause, in which there was no blood discharge from the genital tract. They can be a symptom that speaks of the process of tumor formation in the organs of the female reproductive apparatus.
• Postcoital bleeding is a special type of uterine bleeding that occurs after intercourse. It can be based on different reasons, both formidable and not dangerous to the health of a woman.

According to the moment at which bleeding from the genital organs was detected, they can be classified into menorrhagia: this is the name of bleeding that coincides with menstruation, but at the same time, the volume of blood lost is clearly higher than normal; as well as metrorrhagia: such bleeding does not coincide with the onset of the menstrual cycle, but is noted by a woman before or after critical days.

It should also be noted three conditions that require immediate, urgent, speedy seeking medical help

• A) Bleeding from the genital tract during pregnancy. It is important to note that such bleeding can rapidly pick up speed and lead to serious complications for both the fetus and the expectant mother.
• B) Bleeding that does not stop for a long time, which is accompanied by symptoms of anemia. The latter include pallor of the skin, lowering blood pressure, dizziness when trying to stand up or even sit down, persistent headaches, a rare and weakened pulse on the radial arteries (on the wrist), fainting.
• C) Internal bleeding. It should be considered if the bright symptoms of anemia are combined with the absence of visually recognizable blood discharge from the genital tract, especially if the patient also has a feeling of severe pain in the abdomen, and its anterior wall is very dense to the touch, board-like.

Uterine bleeding in women in the reproductive period

Many women have to suddenly notice vaginal bleeding between periods, or too much increase in the latter. If spotting, in a small amount of discharge occurs at the time of ovulation (the release of an egg from a ruptured ovarian follicle), as a rule, on the 14-18th day of the cycle, depending on its duration in a particular woman (28-32 days), then this should be considered normal . However, severe sudden bleeding should alert the woman, as it may indicate a gynecological pathology. If metrorrhagia that suddenly arises intensifies or simply does not end for a long time, then you need to consult a doctor who will stop the bleeding, and also prescribe the necessary examinations to understand the causes of its occurrence.

In addition to ovulation, the cause of uterine bleeding that occurs between two adjacent periods can be a sharp change in the amount of the female sex hormone estrogen in the blood, which is produced by the ovaries, any pathological process in which can cause the above manifestation. In addition, such metrorrhagia may be based on the end or start of the use of hormonal contraceptives, a significant decrease in the level of thyroid hormones, the use of emergency contraceptives, as well as other drugs that somehow include estrogen. In addition, bleeding between periods may be due to an infectious, tumoral process of the genital organs or their trauma, miscarriage, the consequences of recent gynecological manipulations.

Treatment of the bleeding described above is given according to the underlying cause. If metrorrhagia was caused by a gynecological disease, then the right treatment for this disease will also serve to stop bleeding.

Uterine bleeding in young girls

Bleeding from the genital tract that occurs in girls aged 12-18 years is called pubertal or juvenile. If such bleeding is severe, then there may be a threat to the health and life of a teenage girl, and therefore it is necessary to quickly consult a doctor who can prescribe adequate treatment so that these bleeding do not pass into the reproductive period, in which, in this case, risk of infertility for this patient.
Quite often, juvenile metrorrhagia occurs in the winter-spring period due to a lack of vitamins and trace elements in the girl’s body. Often, stress, infectious processes or unhealthy diet can also be the main cause.
Most often in the pubertal period, bleeding in girls occurs after a delay in menstruation (several weeks), and lasts more than seven days, either increasing in intensity or decreasing, which can eventually lead to large blood loss and anemia. Such a process needs to be stopped, and therefore it is necessary to contact an obstetrician-gynecologist immediately.

At the same time, both sudden and severe bleeding, and prolonged and sluggish bleeding can lead to anemia. The symptoms of anemia are similar regardless of the cause that caused it: pallor of the skin, weakness, dizziness when trying to sit or stand up, a drop in blood pressure, short-term loss of consciousness.

In case of self-cessation of metrorrhagia in a girl, you still need to see a doctor, since the goal of treatment, in this case, will be to prevent anemia and a terrible complication – hemorrhagic shock.

Climacteric uterine bleeding

It is impossible to ignore the discharge of blood from the genital tract during menopause, as it can be a symptom of a pathological process, even uterine cancer. For many women, menopause is quite difficult. Along with uterine bleeding, jumps in blood pressure, mental disorders, and metabolic disorders can occur.

Usually the cause of climacteric bleeding from the genital tract is a massive hormonal restructuring in the woman’s body, but they can also indicate tumor growth.
Menopausal bleeding can be classified into:

• Premenopausal metrorrhagia
• Postmenopausal metrorrhagia

In the premenopausal period, bleeding from the genital tract most often occurs due to improper production of sex hormones due to disorders associated with the ovulation process, which in turn leads to changes in the change in the functional layer of the endometrium (epithelial lining of the uterus). Such bleeding can be repeated for several years with different strength and frequency. Anemia in this case is rare, in comparison with adolescent girls, however, if it occurs, it can be combined with uterine fibroids or with more complex and dangerous pathological processes in the female body.

Bleeding that occurs in the postmenopausal period is the most dangerous, as it requires an immediate diagnostic search to exclude malignant neoplasms. Such metrorrhagia is an indication for diagnostic hysteroscopy (curettage of the uterine cavity and cervical canal).

Postcoital bleeding

If bleeding occurs in a woman immediately after intercourse, then it is called postcoital (coitus-coitus. Sin.: penetration, copulation, copulation, sexual intercourse). Such discharge of blood from the genital tract can be caused by a number of reasons:

• Mechanical injury of the genital tract
• Sexually transmitted diseases (often chlamydia)
• Inflammatory diseases of the genital tract (vaginitis – in the vagina, cervicitis – in the cervix, etc. )
• Erosions and polyposis (requiring surgical treatment)
• Due to certain drugs, including hormones
• Dysplastic changes (replacement of the epithelium with the wrong one for this section of the genital tract) up to the tumor process

If bleeding is accompanied by a sharp pain syndrome and occurs suddenly during or after copulation, then you need to call an ambulance, because the situation can be life-threatening. In this case, you need to pay attention to the symptoms in case a woman has internal bleeding, which may be accompanied by acute pain in the abdomen, groin, lower back, weakness, dizziness, fainting, profuse sweating (“breaks through cold sweat”).

Timely visit to a doctor usually contributes to a speedy recovery.

Metrorrhagia after medical abortion

Bleeding after medical abortion usually stops in most women with therapy. And the cycle is completely normalized within 1-2 months. However, if, due to metrorrhagia after an abortion, two sanitary pads are completely soaked within one hour, then the bleeding should already be considered severe and requiring immediate intervention by a gynecologist.

Treatment of bleeding from the genital tract

The goals of treating metrorrhagia are usually limited to stopping the actual bleeding and replenishing the lost blood volume, finding and eliminating the already found cause of metrorrhagia, preventing the recurrence of bleeding and treating its consequences (anemia, hemorrhagic shock).

Uterine bleeding should be treated according to its cause. Often, the bleeding itself stops when its cause is eliminated surgically or conservatively.
Therapy should be cumulative: hormonal, symptomatic, restorative (helps restore the female body). The treatment is usually based on hormonal therapy and symptomatic – drugs that increase blood clotting and uterine contraction.
In addition to a conservative approach, a surgical approach is often used: this happens if the bleeding is strong enough and / or prolonged. Such treatment usually begins with a diagnostic hysteroscopy.

It should be remembered that a visit to a gynecologist should be an indisputable and indispensable component of the treatment of uterine bleeding. There should be no talk of self-treatment, because in the case when the cause of bleeding is serious enough, the latter can cost a woman’s health, and often life itself.

To prevent uterine bleeding, every woman should visit a gynecologist twice a year for an examination. In this case, early diagnosis of diseases associated with the genital tract will become possible, which will allow you to quickly and gently carry out therapeutic measures without waiting for dangerous bleeding.

symptoms, causes and first aid

Article contents

1. Signs
2. Causes
3. Types and classification
4. Complications
5. When you need medical help
6. Diagnostics
7. Treatment
8. Preventive measures

Internal bleeding is a condition where the outflow of blood occurs in the cavity formed by the outflow of blood, or the natural cavity of the body.

Symptoms of internal bleeding vary by location and severity, with the most likely signs being weakness and loss of consciousness, and drowsiness. Diagnosis consists of examination, X-ray, CT and MRI, ultrasound and endoscopy. The success of treatment depends on the removal of the source of bleeding. In a general sense, internal bleeding is the loss of blood in the conditions of its outflow into the internal cavities of the human body as a result of an exacerbation of chronic diseases or injury.

The danger lies in the massive nature of blood loss, the complexity of diagnosis and the neglect of the pathology. In these conditions, delay in seeking help threatens the life of the patient.

Pathology is treated in a wide range of medical areas – clinical traumatology, abdominal or thoracic surgery, vascular and neurosurgery.

Features

The primary signs of internal bleeding are:

• weakness;
• drowsiness;
• blanching of mucous membranes and skin;
• dizziness;
• cold sweat;
• thirst;
• blackouts in the eyes;
• changes in pulse and pressure – low-intensity blood loss is characterized by a slight increase in heart rate and a small decrease in pressure.

Sometimes there are no clinical symptoms of internal bleeding.

The average severity of blood loss is reflected by tachycardia and a drop in pressure, while the patient feels dry mouth, nausea and dizziness, adynamia and severe weakness. The patient may faint.

Signs of severe bleeding:

• pressure drop up to 80 mmHg and increased pulsation up to 110 or more beats per minute;
• irregular breathing and cold sweat;
• tremor in hands and dark circles before eyes;
• minimum amount of urine produced;
• paleness and blueness of the skin, lips.

Massive bleeding and its symptoms:

• pressure drop up to 60 mmHg and increased heart rate up to 140-160 beats per minute;
• breathing frequency;
• confusion and delirium;
• sharply pale bluish-gray skin tones;
• absent gaze, sunken eyes.

How to determine the internal bleeding of a fatal form? According to the following signs: coma, lack of pressure, pulse 10 beats. in minutes, convulsions and involuntary discharge of urine and feces begin, the pupils dilate, the skin becomes dry and cold. This state turns into agony and leads to death.

Internal bleeding of the stomach and into the esophagus is accompanied by vomiting of dark blood of the shade of coffee grounds. Tar-shaped stool indicates the flow of blood into the upper parts of the digestive system and the small intestine. Internal abdominal bleeding is accompanied by irritation of the peritoneum and dull sounds in a shallow place during palpation.

The outflow of blood into the lungs is accompanied by a cough with the release of foamy blood and its accumulation in the pleural cavity. Therefore, there is difficulty breathing and shortness of breath, as well as lack of air. Internal bleeding in women is the outflow of blood into the uterine or vaginal cavity.

The individual characteristics of each organism affect the severity of certain symptoms. Poorly expressed symptoms complicate the process of diagnosing and worsen treatment prognosis.

Causes

The causes of internal bleeding can be injuries and chronic diseases in the acute stage or advanced form. Post-traumatic internal bleeding into the abdominal cavity develops from blows or falls from a height, car accidents or blunt trauma.

Pulmonary hemorrhages appear from fractures of the ribs and damage to the vessels between them, as well as to the pleura. Bleeding into the cranial region occurs after traumatic brain injury. In this case, even the smallest amount of blood can be fatal. Blood flows into the joint cavity during fractures and bruises of the joints. It is most dangerous for its consequences in the absence of treatment.

Sometimes it occurs due to cracks in the walls of the esophagus due to alcohol or frequent overeating. Most bleeding of internal organs develops against the background of chronic diseases of the gastrointestinal tract:

• tumors of a malignant nature;
• stomach and intestinal ulcers;
• gastritis;
• varicose veins of the esophagus;
• cirrhosis of the liver and others.

Women’s bleeding occurs against the background of gynecological diseases – ectopic pregnancies and ovarian ruptures, after abortions, in case of placental abruption, rupture of the uterus and birth canal.

Types and classification

There are types of pathology according to the following criteria:

• causes of development – mechanical in injuries, arrosive in tumors and diapedetic in chronic diseases;
• volumes of blood loss – light, moderate, severe, massive, fatal;
• the nature of the damaged vessels – arterial, capillary, venous and mixed;
• localization – gastrointestinal, pleural, pericardial, articular and others;
• signs of bleeding – overt and covert;
• accumulations of blood – abdominal and interstitial;
• time of appearance – primary, early and late secondary.

Complications

Most cases of pathology require urgent surgical intervention, which eliminates the cause of bleeding and prevents the development of serious consequences.

Lethal outcome is the most dangerous complication of bleeding, it occurs due to the development of hemorrhagic shock against the background of circulatory disorders and acute form of vascular insufficiency. This means that the blood stops carrying oxygen, nutrients and metabolic products.

When you need medical help

Not all cases of the development of pathology can lead to mortal danger. However, a timely visit to a doctor will alleviate the symptoms of the disease and lead to a normal life for the patient. In addition, it is not possible to cure the pathology on its own due to the difficulty of determining the true causes.

Urgent care is required in the following cases:

• bleeding has not stopped 10 minutes after applying a tourniquet or pressure bandage;
• the outflow of blood occurs in a stream;
• presence of a deep wound in the abdomen and chest;
• the presence of symptoms such as severe weakness, pallor of the skin, blue extremities, tinnitus and cold sweat.

You can call the ambulance team of JSC “Medicina” (clinic of Academician Roitberg) by phone +7 (495) 775-73-60. The clinic is located at the address: Moscow, 2nd Tverskoy-Yamskoy pereulok, 10, next to the metro stations Novoslobodskaya, Chekhovskaya, Belorusskaya, Tverskaya.

Diagnostics

The presence of suspicion of bleeding into the internal cavities of the body requires a comprehensive diagnostic examination:

• detailed external examination – measurement of pressure and pulse, chest auscultation, percussion and palpation of the abdominal cavity;
• blood test;
• radiography;
• ultrasound;
• radiological methods.

An additional examination is due to specific reasons for the development of pathology:

• gastrointestinal tract – digital examination of the rectum, colonoscopy and others;
• lungs – bronchoscopy;
• bladder – cystoscopy;
• hidden closed cavities – X-ray with contrast, fluoroscopy, laparoscopy, echoencephalography, MRI and CT.

Treatment

Assistance with internal bleeding consists in the timely delivery of the patient to a specialized hospital. If pulmonary forms of bleeding are suspected, the patient should half-sit, and in other cases, lie down. The suspected source of bleeding is supplied with ice. It is impossible to apply heat within the framework or give laxatives and drugs, as well as resort to stimulation of cardiac activity.

Treatment of pathology is carried out exclusively within the framework of the hospital. The department of the hospital is selected according to the source of bleeding.

The primary task is to stop bleeding into the internal cavities, compensate for blood loss and increase blood microcirculation. For this purpose, a jet transfusion of a glucose solution, saline, blood or plasma itself, as well as blood and plasma substitutes, copes. In rare cases, bleeding can be stopped by cauterization of the site of bleeding.