Metrorrhagia

Alternative names

Abnormal uterine bleeding; Bleeding between periods; Intermenstrual bleeding; Spotting; Vaginal bleeding between periods

Definition

Intermenstrual bleeding is uterine bleeding that occurs between menstrual periods.

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 may be something to worry about for women over age 50 (postmenopausal). The risk of malignancy 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

• Uterine fibroids or polyps
  
• Injury or disease of the vaginal opening (caused by intercourse, infection, polyp, genital warts, ulcer, or varicose veins)
  
• Vaginal injury from insertion of foreign objects, from malignancy, or from infection
  
• Dry vaginal walls resulting from lack of estrogen after menopause
  
• Pregnancy complicated by abortion (spontaneous or induced)
  
• Pregnancy complicated by ectopic pregnancy
  
• Fluctuation in hormone levels
  
• Stopping and starting birth control pills or estrogens
  
• Low thyroid function
  
• IUD use (may cause occasional spotting)
  
• Drugs such as anticoagulants
  
• Cervical conization or cauterization procedures
  
• Stress
  

Home Care

Bed rest is recommended if bleeding is heavy.

The number of pads or tampons used over time should be recorded (so that the amount of bleeding can be determined).

Because aspirin may prolong bleeding, it should be avoided if possible.

Call your health care provider if

• You are pregnant