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Bleeding between periods (causes)

Healthy women could experience vaginal bleeding only during normal monthly menstrual periods. Any other bleeding between periods (sometimes called “intermenstrual bleeding”) should be considered as a symptom of several abnormal health conditions. Some conditions could be minor without any reason for concern, but sometimes bleeding between periods may be a symptom of serious diseases which need immediate medical intervention. Sometimes bleeding can occur after sexual activities – it called “postcoital bleeding”.

Any vaginal bleeding unrelated to normal menstrual period should be considered as abnormal. Bleeding between periods could have different intensity – it can be light like reddish spotting or brown discharge (loosing small amount of blood) or it can be heavy (real bleeding) requiring permanent attention and changing sanitary pads every one to two hours.

According to health experts, several things could trigger bleeding between periods including hormonal disturbances, vaginal infections or infections of whole reproductive tract, hormonal contraception or contraceptive devices, trauma or injuries, benign tumors or cancer. If bleeding between periods happened only once, it could be triggered by stress or strict diet or new medication. But if you experience irregular vaginal bleeding second time, it would be recommended to visit your doctor as soon as possible (especially if you are in menopause!).

Some bleeding causes could be easily identified and treated but others can indicate serious health conditions which would require longer diagnosis, treatment and follow up. Often bleeding between periods linked to problems related to reproductive system (vagina, cervix, uterus, ovaries).

Bleeding between periods causes

Bleeding triggered by hormonal dysfunctions

Bleeding between periods

Female hormones usually fluctuate at certain personal rhythms according to menstrual cycle regime. Hormone fluctuations controlled by pituitary glands (brain). Estrogen and progesterone are two main hormones that regulate menstrual cycle. Any imbalance between hormones could trigger ovarian dysfunctions, menstrual disturbances and bleeding.

Unfortunately women hormones are very sensitive and can be changed easily under “pressure” of different factors like stress, depression, strict diet, medication, travel, diseases, etc. Especially female hormones are sensitive during puberty and menopause. This is why bleeding between periods could occur often in teenagers and perimenopausal women.

Short (hours) light bleeding in the middle of menstrual cycle shouldn’t be confused with abnormal bleeding between periods. Some women could experience mid-cycle bleeding which coincides with ovulation (called “ovulation bleeding”). It usually caused by temporary mid-cycle drop in levels of female hormone oestrogen (normal for ovulation period).

Most common causes of bleeding between periods are polycystic ovary syndrome (PCOS), hyperthyroidism, hypothyroidism and ovarian dysfunctions.

Sometimes after fertility hormonal treatment women could experience temporary bleeding correlated with used hormonal medications.

Menopause is the most dangerous period for irregular bleeding – it can be alarming for many women. Menopause bleeding could be a sigh of cancerous transformations.

Contraception related bleedings

During first three months of certain types of contraception (mainly hormonal contraception) women could experience some side effects including irregular bleeding. Commonly bleeding could occur during use of following methods of contraception:

  • Birth control pills (combined oral contraceptives);
  • Intrauterine devices (mainly hormone containing IUDs),
  • Contraceptive patches (Xulane, Evra, Ortho Evra);
  • Contraceptive implants (Implanon, Norplant);
  • Contraceptive injections (DepoProvera, Noristerat);
  • Emergency contraception (Morning after pills, Plan B).

Bleeding during hormonal contraception is not uncommon because contraceptive synthetic hormones change normal balance of female hormones, eliminate ovulation and change internal uterine lining. Bleeding could also occur if you miss pills or forgot date of next patch, next implant and next injection.

If you experience bleeding during contraception, better to visit your doctor or change type of contraception.

Bleeding triggered by infections

Different types of vaginal infection can cause inflammation of reproductive organs (cervix, uterus, Fallopian tubes and ovaries) and irregular bleeding between periods. Women could experience bleeding because of:

  • sexually transmitted infections (Chlamydia, gonorrhea, trichomoniasis);
  • cervicitis and vaginitis (vaginal and cervical inflammation),
  • endometritis (inflammation of endometrium, inner lining of uterus);
  • pelvic inflammatory disease (PID);
  • intensive vaginal douching.

Pregnancy related bleeding

Pregnancy complications could be responsible for unexpected bloody spotting or on-going reddish discharge or vaginal bleeding. Women could experience vaginal bleeding during miscarriage (spontaneous abortion) or ectopic pregnancy (tubal pregnancy).

Miscarriage is spontaneous interruption of pregnancy development. Most common symptom of spontaneous abortion is vaginal bleeding which can vary from light spotting to heavy bleeding with blood clots. Bleeding during miscarriage often combined with cramping and pelvic pain.

Most common symptoms of ectopic (tubal) pregnancy are missed period, abdominal or pelvic pain, vaginal bleeding or pinkish discharge, dizziness or loss of consciousness and fast heartbeat (over 100 beats per minute).

Bleeding triggered by benign tumors

Vaginal bleeding can be triggered by benign tumors such as polyps, fibroids or adenomyosis (a type of unusual tissue growth in the uterus).

Polyps are abnormal growths of tissue that can appear in any organ that has blood vessels. Commonly polyps in women found on cervix and in uterus. In some cases cervical polyps rarely cause symptoms but sometimes they cause heavy menstrual period and irregular bleeding between periods (especially after intercourse or douching). Uterine polyps are the overgrowth of endometrial tissue. Typical symptoms of uterine polyps include heavy menstrual period and irregular bleeding combined with back pain and infertility.

Fibroids are more common after 35-40. The growth of fibroids depends on estrogen levels. While some fibroids don’t cause any symptoms, others could trigger bleeding, menstrual cramps, bloating or fullness in the belly, pelvic pain and bladder pressure.

Bleeding between periods cause by cancer

Less commonly bleeding between periods could occur during different types of cancer in reproductive system:

  • Cervical cancer,
  • Endometrial cancer,
  • Ovarian cancer,
  • Uterine sarcoma,
  • Vaginal cancer.

Bleeding between periods – Diagnosis and treatment

Detailed diagnosis and adequate treatment should be done by qualified experts. Self-treatment can be dangerous.

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