Vaginal bleeding between periods Health Article

Definition

Intermenstrual bleeding is bleeding from the uterus that occurs between menstrual periods.

Alternative Names

Bleeding between periods; Intermenstrual bleeding; Spotting; Metrorrhagia

Considerations

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

Vaginal bleeding that occurs between periods or after menopause sometimes may be due to cancer or precancer, and should be evaluated promptly. The risk of cancer increases with age.

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

• Cancer of the cervix, uterus, or (very rarely) fallopian tube
• Cervical or endometrial biopsy or other procedures
• Changes in hormone levels
• 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
• Uterine fibroids or polyps
• 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)

Home Care

Immediately contact a health care provider 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.

Because aspirin may prolong bleeding, it should be avoided, if possible.

Call your health care provider if

Call your health care provider if:

• You are pregnant
• There is any unexplained bleeding between periods
• There is any bleeding after menopause
• Abnormal bleeding is accompanied by other symptoms