Bleeding Between Periods

Abnormal vaginal bleeding between periods is also called intermenstrual bleeding, spotting, and metrorrhagia. When bleeding occurs between normal periods, there are many possible causes, including hormonal changes, injury, or an underlying disease.

While some causes may be easily treatable, others may indicate a serious underlying disease. Whether you notice spotting or heavy bleeding periods, it is important to see your doctor for testing, diagnosis, and treatment options.

Normal periods  

Normal menstrual bleeding lasts about five to seven days. While menstruation usually occurs on average every 28 days, between 21 and 35 days between menstruations is considered normal. About 14 days after the start of the period, ovulation takes place, and an egg is released from the ovary. Spotting may occur during ovulation, which is normal. The lining of the uterus is ready for implantation of the fertilized egg, and spotting may occur at the time of implantation if pregnancy occurs and begins.

Types

Different types of bleeding that can occur between menstrual periods include:

• Spotting: In this case, there is only a red tint on the toilet paper or one or two drops of blood on the underwear. Medically, spotting is only considered if it is not during menstruation and does not require the use of pads or tampons.
• Light bleeding: This type of bleeding occurs just before or after menstruation and is not technically spotting; It is part of the period.
• Breakthrough bleeding: Bleeding is sudden when bleeding occurs between menstrual periods.
• Abnormal bleeding: Abnormal bleeding describes any heavy bleeding outside the menstrual cycle and is not due to hormonal contraceptive pills. It is often called abnormal uterine bleeding or abnormal vaginal bleeding.

Causes of bleeding between periods 

The medical term for intermenstrual bleeding is metrorrhagia. They are also known as spotting or sudden bleeding. Menstruation is when women bleed every month, usually between 2 and 7 days. The menstrual cycle refers to the time interval between the first day of a period and the first day of the next day. This cycle usually lasts between 25 and 30 days but can be longer or shorter.  Menstruation is different for each woman. Any bleeding outside of this period is considered abnormal.

Hormonal imbalance 

Estrogen and progesterone are two hormones that regulate the menstrual cycle. If they are out of balance, spotting may occur. The following can affect hormonal balance:

• Thyroid gland problems
• Starting or stopping birth control pills
• Dysfunctional ovaries

Abnormal bleeding is common during the first trimester when starting any hormonal contraceptive. These contraceptives include:

• Birth control pills
• Intrauterine device
• Contraceptive patch
• Contraceptive implant or injection

Pregnancy complications

Complications of pregnancy can cause spotting. Both miscarriage and ectopic pregnancy can cause bleeding. An ectopic pregnancy occurs when a fertilized egg implants in the fallopian tube instead of the uterus. Spotting during pregnancy may not mean miscarriage. However, if you are pregnant and have vaginal bleeding, you should contact your doctor immediately.

Infection

Vaginal bleeding between periods may indicate a genital infection. Infection can cause inflammation and bleeding. The causes are:

• Sexually transmitted infection
• Vaginal douching
• Intercourse
• Pelvic inflammatory disease

Cancer

In most cases, intermenstrual bleeding is not a cause for concern. However, vaginal bleeding between periods is a possible symptom of certain types of cancer. Cervical cancer can affect women of all ages. The disease is more common in sexually active women between the ages of 30 and 45. Bleeding between periods or after sex is usually the first sign of cervical cancer. Other early symptoms include pain or discomfort during sex or a foul-smelling vaginal discharge.

Uterine cancer affects most women who have reached menopause. That is, they no longer menstruate. For this reason, any postmenopausal vaginal bleeding should be abnormal. If women have not reached menopause, bleeding may occur between menstrual periods. Sometimes the bleeding is more severe than usual. Less common symptoms include pain during sex or pain in the abdomen. Cancer can rarely cause bleeding in any of these organs:

• Cervix
• Vagina
• Uterus
• Ovaries

Injury  

If the skin or tissue of the vagina is damaged, it may bleed. The most common way for this to happen is during intercourse. If the vagina is dry, it is much more likely. The body produces a natural lubricant that prepares the vagina for penetrative sex. Vaginal dryness can be caused by many factors, including lack of arousal, changes in hormone levels due to menopause, diabetes, or cancer treatment.

Menopause or perimenopause  

Menopause usually occurs between the ages of 45 and 55. It is defined as the time when a woman has not had a period for one year. Perimenopause is the period leading up to menopause. This can last up to 10 years because hormone levels in the body change. Hormone levels are often unstable in the perimenopause period. This can cause irregular periods, spotting, and heavy bleeding.

Polyps in the cervix or vagina

Polyps are small growths. They can form in the uterus or on the cervix, which is the structure between the vagina and the uterus. In some cases, polyps can cause bleeding and may need to be removed.

Polycystic ovary syndrome  

Polycystic ovary syndrome (PCOS) is a condition that can cause irregular menstruation as well as bleeding between periods. Other symptoms include fertility problems, weight gain, and oily or acne-prone skin.

Endometriosis or adenomyosis  

Chronic conditions that affect the uterus, such as endometriosis or adenomyosis, can cause bleeding or spotting between menstrual periods. This condition can also cause heavy or painful periods and cramps between periods.

When to see a doctor

A woman should seek medical advice if vaginal bleeding is heavy or persistent between periods. Knowing other symptoms associated with intermenstrual spotting can help your doctor diagnose an underlying medical problem. If a woman has recently started taking a hormonal contraceptive, the bleeding may go away after 3-6 months. If it does not go away, a woman should see a doctor. Sexually transmitted diseases are contagious and can cause long-term health problems. If a person suspects an STI that has caused vaginal bleeding, they should see a specialist for testing and treatment. Most sexually transmitted diseases can usually be treated with antibiotics.

Complications in bleeding Between Periods 

Vaginal bleeding between periods can cause anxiety or stress. It can also be painful or uncomfortable, depending on the cause. Anyone experiencing underlying health problems such as STIs should seek treatment as soon as possible. In severe cases, STIs can cause fertility problems. Early cancer detection increases a person’s chances of successful treatment and recovery.

Treatment in bleeding Between Periods 

Treatment depends on the underlying cause of the bleeding. Keeping track of when bleeding occurs, how long it takes, and how much blood is lost can help the doctor determine the cause.

A cervical cancer test, known as a screening or Pap smear, looks for anything abnormal in the cervical tissue. Small tears and bleeding can be caused by damage to the dry skin of the vagina. Using artificial lubricants and ensuring arousal before sexual intercourse can prevent damage to the vagina during sexual activity. There is no cure for PCOS, but symptoms can be managed. Treatment can include weight loss, the use of hormonal contraceptives, and the use of metabolic therapies.

The bottom line  

Many women experience spotting or bleeding between periods. There are many reasons why this happens. Most of them are not a cause for concern, but sometimes this type of bleeding can be a sign of a serious problem.

Regular cervical screening is essential to preventative health care that can help detect abnormal cells early. Taking hormonal contraceptives is one of the causes of spots. Other causes include pregnancy, sexually transmitted infections, and PCOS. The most serious causes include cancer and ectopic pregnancy.

You should talk to your healthcare provider if you experience vaginal bleeding, light or heavy. The cause may be something minor that can be easily remedied. If the bleeding is a sign of something serious, you may need more treatment.

If there is bleeding or spotting between periods, Dr. Arjan g Naim, MD, a specialist in gynecological diseases, can find the underlying cause and offer the best treatment.