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)
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.
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