Intermenstrual Bleeding
Intermenstrual bleeding, also known as spotting or breakthrough bleeding, refers to any vaginal bleeding that occurs between regular menstrual periods. While light spotting can be normal in some situations, persistent or heavy bleeding between periods may indicate underlying conditions requiring medical attention.
⚠️ Seek Emergency Care For:
- Heavy bleeding soaking pad/tampon hourly
- Severe pelvic or abdominal pain
- Signs of pregnancy with bleeding
- Dizziness or fainting from blood loss
- Fever with abnormal bleeding
- Bleeding after menopause
- Severe cramping with bleeding
- Signs of shock (rapid pulse, pale skin)
Definition and Overview
This type of bleeding can range from light spotting that only appears on toilet paper to heavier bleeding requiring sanitary protection. The timing, amount, and associated symptoms provide important clues about the cause. Common causes include hormonal fluctuations, contraceptive use, infections, and structural abnormalities of the reproductive system.
While occasional light spotting may not be concerning, especially around ovulation or when starting new hormonal contraception, any new or persistent intermenstrual bleeding should be evaluated. This is particularly important for women over 40 or those with risk factors for gynecological cancers.
Common Causes
Hormonal Causes
- Birth control pills
- IUD (especially first months)
- Emergency contraception
- Ovulation bleeding
- Thyroid disorders
- PCOS
Reproductive Issues
- Uterine fibroids
- Endometrial polyps
- Endometriosis
- Cervical polyps
- Adenomyosis
- Cervical ectropion
Infections
- Sexually transmitted infections
- Pelvic inflammatory disease
- Cervicitis
- Endometritis
- Vaginal infections
- UTIs
Serious Conditions
- Cervical cancer
- Endometrial cancer
- Ovarian cancer
- Pregnancy complications
- Ectopic pregnancy
- Miscarriage
Associated Symptoms
Intermenstrual Bleeding often occurs with other symptoms:
- Pelvic pain: May indicate underlying issue
- Abnormal discharge: Suggests infection
- Painful intercourse: Dyspareunia
- Irregular periods: Cycle changes
- Fatigue: From blood loss
- Bloating: Hormonal effects
- Mood changes: Hormonal fluctuations
- Weight changes: May affect hormones
When It's Serious
Warning Signs
- New bleeding after menopause
- Heavy or prolonged bleeding
- Bleeding after intercourse
- Age over 40 with new symptoms
- Family history of gynecologic cancer
- Persistent bleeding despite treatment
- Associated pelvic pain
- Abnormal pap smear history
Diagnostic Approach
Medical Evaluation
- Menstrual history
- Contraceptive use
- Sexual history
- Physical examination
- Pelvic exam
- Pregnancy test
Common Tests
- Transvaginal ultrasound: Uterine evaluation
- Endometrial biopsy: If indicated
- Pap smear: Cervical screening
- Blood tests: Hormones, CBC
- STI testing: If risk factors
- Hysteroscopy: Direct visualization
Home Care Tips
Tracking
- Keep bleeding diary
- Note timing and amount
- Track associated symptoms
- Monitor pad/tampon use
- Record sexual activity
- Note stress levels
- Document medications
- Track cycle changes
Management
- Use appropriate protection
- Stay hydrated
- Iron-rich foods
- Rest as needed
- Avoid aspirin
- Manage stress
- Take medications as directed
- Follow up with doctor
Prevention
- Regular check-ups: Annual gynecological exams
- Consistent contraception: Take as directed
- Healthy weight: Affects hormones
- Stress management: Impacts cycles
- Quit smoking: Affects hormones
- Treat infections: Promptly
- Know your normal: Track cycles
- Safe sex: Prevent STIs