Spotting again?! I went through a season where I was spotting between my periods. What a nuisance! Since women are encouraged to let their health care provider know when something is unusual with their menstrual cycle, I did contact my doctor- eventually. Everything was fine.

While bleeding between periods generally doesn’t indicate a problem, there are times when it is one. It is helpful for women to know about unusual bleeding patterns, their causes, and the fixes so that women not worried and can act when needed. 

What is Intermenstrual Bleeding?

Spotting between periods is also called intermenstrual bleeding. Intermenstrual bleeding is “bleeding that occurs at any time between normal menses.” Metrorrhagia is a term that is no longer recommended. The “metro” part of that word means measure and the “-rrhagia” part means abnormal flow. The term metrorrhagia is inaccurate because some women experience menstrual spotting that happens as a harmless and normal part of their menstrual cycle. 

Menstruation is a cyclic process that occurs in most women between the ages of 12 and 50 usually it happens without any difficulty. There is some normal sense of inconvenience accompanying the period, the variation in the interval between menstrual cycles, and the duration of each menstrual cycle. The amount of blood loss, the lack of discomfort or presence of discomfort, and the subjective psycho emotional experience of menstruation between different women is so great that it makes it hard to divine define what a “normal” menstruation is, since there is a wide range of normal variation. Spotting tends to be a deviation from the norm. 

What is spotting? This kind of bleeding can range from being a light tinge of blood in a discharge to being a heavy flow that feels like a normal period.

Possible Causes

Birth control that is based on hormonal contraceptives like birth control pills; contraceptive implant, injection, or patch; or an intrauterine device can cause spotting- also known as breakthrough bleeding- during the first three months of using them. 

Polycystic ovary syndrome (PCOS) happens when the eggs in the ovaries become surrounded by fluid-filled sacs, making it hard to be released like they normally would. PCOS can cause irregular bleeding patterns.

Uterine fibroids are noncancerous tumors that sometimes grow in the lining or muscle of a woman’s uterus that can lead to spotting and bleeding after the period.

Uterine polyps are an overgrowth of cells around a small blood vessel inside the uterus or on the cervix that can lead to spotting. 

Spotting that occurs at the end of the reproductive years, in perimenopause or menopause, may be related to hormones. Menopause is sometimes called “The Change.” As a woman ages, her hormone levels begin to change, which can result in a thickening of her uterus. This can result in more frequent episodes of irregular bleeding or a prolonged absence of bleeding. The change to no periods doesn’t happen automatically- it takes time. Also, if a woman is  taking hormone replacement therapy (HRT) to manage your symptoms of menopause, this can lead to spotting.

Some health conditions like von Willebrand disease, hypothyroidism, chronic kidney disease, or liver disease may also cause irregular bleeding. 

In the first semester of pregnancy, there may be some minor bleeding- and it could happen after sex, a Pap smear, or a pelvic exam. 

Cesarean scar defect in women who have had multiple cesarean births can result in bleeding that starts just after the end of their regular menstruation.

Pelvic infections, including sexually transmitted infections (STId), can cause bleeding between periods. 

Gynecologic cancers or precancers — cervical, ovarian, uterine, vaginal and vulvar — are rare causes of bleeding between periods. This is more likely if the woman has had abnormal pap smears or if there are other risk factors. 

Possible Risks

There is a condition called metrorrhagia that predisposes women to anemia. 

Other irregular menstrual cycles can be associated with PCOS, polycystic ovarian syndrome, that can predispose a woman to diabetes, and consequently heart disease. 

Women with long or highly irregular menstrual cycles have a slightly increased risk of developing Type 2 Diabetes Mellitus that is not explained by obesity.

Action Step

Bleeding concerns that last more than a few months should be evaluated by a health care professional to see if there is an underlying condition that needs to be addressed. 

May God bless you on your wellness journey!

Joni

P.S. What experience do you have with spotting between periods?