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Bleeding between periods; Intermenstrual bleeding; Spotting; Metrorrhagia
This article discusses vaginal bleeding that occurs between a woman's monthly menstrual periods. Such bleeding may be called "intermenstrual bleeding."
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Normal menstrual flow lasts about 4 days (plus or minus 2 - 3 days). It produces a total blood loss of 30 - 80 ml (about 2 - 8 tablespoons), and occurs normally every 28 days (plus or minus 7 days).
Vaginal bleeding that occurs between periods or after menopause can be caused by various problems. Most are benign and treatable. Sometimes vaginal bleeding may be due to cancer or precancer. So any unusual bleeding should be evaluated promptly. The risk of 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 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.
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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