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Vaginal bleeding between periods

• Overview
• Treatment

Definition:

Intermenstrual bleeding is bleeding from the uterus that occurs between menstrual periods.

Alternative Names:

Bleeding between periods; Intermenstrual bleeding; Spotting; Metrorrhagia

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)
• 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

• Review Date: 5/23/2006
• Reviewed By: Audra Robertson, MD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network

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