Vaginal bleeding between periods

Alternative names:

bleeding between periods; periods, menstrual - bleeding between; intermenstrual bleeding; spotting

Definition:

Intermenstrual bleeding is uterine bleeding that occurs between menstrual periods.

Considerations:

Normal menstrual flow lasts about 5 days, produces a total blood loss of 60 to 250 ml (about 2 to 8 Tablespoons), and occurs normally every 28 days.

Bleeding may be something to worry about for women over 50 (post-menopausal) or younger than 11 (premenarchal). 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/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:

• stress
• 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
• abortion (spontaneous or induced)
• fluctuation in hormone levels
• stopping and starting birth control pills or estrogens
• low thyroid function
• IUD use can cause occasional spotting (if bleeding is slight, it can be ignored)
• drugs such as anticoagulants
• cervical conization or cauterization procedures

Note: There may be other causes of bleeding between periods. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on the age of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints.

Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director, Utah Health Informatics and adam.com editorial