Vaginal bleeding between periods


Definition

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

Related topics include:

Alternative Names

Bleeding between periods; Intermenstrual bleeding; Spotting; Metrorrhagia

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

This EM Should be displayed at the top of the article section "Causes"

Causes may include:

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 (non-steroidal anti-inflammatory drugs), such as ibuprofen can be used to minimize bleeding and cramping.

When to Contact a Medical Professional

Contact your provider if:

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:

Tests that may be done include:

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.

References

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 & Cotran Pathologic Basis of Disease. 10th ed. Philadelphia, PA: Elsevier; 2020:chap 22.

Klat EC. The female genital tract. In: Klatt E, ed. Robbins and Cotran Atlas of Pathology. 4th ed. Philadelphia, PA: Elsevier; 2021:chap 13.

Ryntz T, Lobo RA. Abnormal uterine bleeding: etiology and management of acute and chronic excessive bleeding. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022: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/.

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