Dr. Tariq Jagnarine
Fam Med, Endocrinology/ Diabetes
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 spotting is noticed or bleeding becomes heavier between periods, it’s important to see a doctor for testing, diagnosis, and treatment options.
CAUSES OF VAGINAL BLEEDING BETWEEN PERIODS
Bleeding between periods isn’t a normal part of the menstrual cycle. The average cycle lasts from 21 to 35 days. Normal vaginal bleeding, also known as a period, can happen for a few days to as long as 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. Women 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 because of hormonal changes.
When starting any type of hormonal contraceptive, abnormal bleeding is common during the first three months. 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 a miscarriage. However, if any vaginal bleeding is experienced while pregnant, contact a doctor immediately.
3. Uterine fibroids
Uterine fibroids are noncancerous growths that are formed 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, can lead to scarring
5. Cancer
Less commonly, 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
WHEN TO SEEK MEDICAL HELP
Consult a doctor any time you have abnormal vaginal bleeding. The cause of the bleeding could be serious, and should be determined. See a doctor right away if pregnant and have vaginal bleeding. If having other serious symptoms in addition to bleeding, you may need emergency medical attention. These include pain, fatigue, dizziness, and fever.
DIAGNOSIS
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 would want to know about any other symptoms that you’ve experienced and any medications you’re taking.
A doctor would also likely give you a physical exam, including a pelvic exam. Diagnostic tests can help a doctor find the cause of the bleeding. The 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. The doctor may also want to perform an ultrasound.
TREATMENT
There is no specific treatment for vaginal bleeding between periods. Treatment would vary based on what’s causing your abnormal vaginal bleeding.
CONSEQUENCES OF IGNORING VAGINAL BLEEDING BETWEEN PERIODS
In some cases, this kind of abnormal bleeding would resolve on its own. However, for some women, the underlying cause requires treatment. Ignoring the problem and failing to see a doctor could 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.
PREVENTING VAGINAL BLEEDING BETWEEN PERIODS
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 taking birth control pills, do so as directed, in order to avoid a hormonal imbalance. Exercise moderately to maintain health and reduce stress.
• To manage pain, use ibuprofen naproxen, which can help reduce bleeding. Avoid taking aspirin, which may increase the risk of bleeding.
