By Adeola, ND

Bleeding in-between periods

The menstrual cycle is typically between 21 and 35 days. A menstrual period typically lasts up to 7 days.

Bleeding between periods, also known as intermenstrual bleeding, is vaginal bleeding that occurs outside of normal menstruation. It can be light spotting or heavier bleeding with more blood loss, and it may happen once or more often. This type of bleeding has a variety of causes and may present differently depending on the underlying cause. Understanding the possible reasons for intermenstrual bleeding is crucial for managing this condition effectively.

Types of Intermenstrual Bleeding

Intermenstrual bleeding can be categorized based on its characteristics and timing. The main types include:

1. Spotting: Light bleeding that occurs between periods, often appearing as pink or brownish discharge.

2. Breakthrough Bleeding: More substantial bleeding that can occur in women taking hormonal contraceptives, especially during the initial months of use.

3. Mid-cycle Bleeding: Occurs around ovulation, usually due to hormonal changes in the menstrual cycle.

4. Postcoital bleeding: Vaginal bleeding or spotting that occurs after sexual intercourse which can occur as a result of vaginal dryness, inflammation, infection or cervical problems.

Causes of Intermenstrual Bleeding

Several factors can lead to intermenstrual bleeding, ranging from benign to more serious conditions:

1. Hormonal Imbalance: Fluctuations in hormones, such as estrogen and progesterone, can cause unexpected bleeding. This is common during puberty, perimenopause, or when starting or changing birth control methods.

2. Stress: When the body experiences significant stress, whether emotional or physical, it can disrupt the delicate balance of hormones that regulate the menstrual cycle.

3. Lifestyle changes: Changes in eating habits, sleep patterns, and physical activity levels can also contribute to menstrual irregularities.

4. Contraceptives: Hormonal contraceptives like birth control pills, IUDs, and implants can cause spotting or breakthrough bleeding, especially during the first few months of use.

5. Uterine Fibroids and Polyps: Non-cancerous growths in the uterus can cause irregular bleeding. Fibroids are common, especially in women over 30.

6. Infections: Pelvic inflammatory disease (PID) or sexually transmitted infections (STIs) can cause inflammation and bleeding.

7. Endometriosis: A condition where the tissue similar to the lining inside the uterus grows outside of it, causing pain and bleeding.

8. Pregnancy Complications: Miscarriages, ectopic pregnancies, or implantation bleeding can cause bleeding that at first may seem to be between periods.

9. Cancer: Cervical, uterine, or ovarian cancer can present with irregular bleeding, though this is less common. 

10. Other health conditions: Blood clotting disorders, like von Willebrand disease, hypothyroidism, liver disease, or chronic kidney disease can all contribute to changes in bleeding patterns.

11. Polycystic ovary syndrome (PCOS):  This is a condition where the ovaries do not release eggs properly. The ovaries become enlarged and contain multiple fluid-filled sacs that encircle the eggs. Additionally, the body produces an excess of male hormones, known as androgens. This hormonal imbalance can result in irregular periods, spotting, or sometimes the absence of periods altogether.

12. Other causes: These may include injury or disease of the vaginal opening, or IUD perforation.

Some tests to help diagnose the cause of your vaginal bleeding may include the following:

• a vaginal swab to test for sexually transmitted infections (STIs)

• a pelvic exam and PAP smear test for infection and abnormal cells in your cervix

• blood tests

• a pregnancy test

• an ultrasound scan, which may include a pelvic or transvaginal ultrasound

3W provides many of these services and most of all we listen to your story. We would be happy to support you in navigating your intermenstrual bleeding concerns! Our goal is to provide the care and education our patients need in a safe setting at a minimal cost.

Conclusion

Intermenstrual bleeding can be a symptom of various conditions, ranging from hormonal imbalances to more serious health issues. Identifying the type and cause of bleeding is essential for effective treatment. Women experiencing intermenstrual bleeding should seek medical advice to determine the underlying cause and appropriate treatment options. With proper diagnosis and management, most cases of intermenstrual bleeding can be effectively treated, improving the quality of life for those affected.

References

1. American College of Obstetricians and Gynecologists (ACOG) https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding

2. Healthline https://www.healthline.com/health/vaginal-bleeding-between-periods

3. HealthDirect.Gov.Au Bleeding between periods

4. 3W Medical Blog https://www.3wmedical.org/medical-blog