By Andrea Rodrigo BSc, MSc (embryologist).
Last Update: 04/21/2015

Metrorrhagia, commonly known as intermenstrual bleeding or bleeding between periods, is characterized by the appearance of minor bleeding before or after menstruation.

This bleeding presents different characteristics when compared with menstrual bleeding, but both come from the uterus. It is a very common problem, especially in teenagers and perimenopausal women. In fact, it is the second cause of gynaecological visits after vaginal and cervical infections.

It is common for hormonal contraceptives to cause irregular bleedings, especially during the first cycles. Do not be alarmed by this because the irregularities normally disappear over time. In these cases, contraceptives should be correctly taken in order to avoid disorders and untimely bleedings.

Causes of intermenstrual bleeding

There are several reasons why a woman can bleed between periods. The most common ones are mentioned hereafter:

  • Uterine cancer or cancer in other areas of the female reproductive system.
  • Uterine fibroids, i.e. presence of noncancerous (benign) tumours.
  • Endometrial hyperplasia: it is due to the excessive proliferation of endometrial cells, usually as a result of abnormally high levels of estrogen or decreased levels of progesterone.
  • Endometriosis.
  • Cervicitis: inflammation or infection of the cervix.
  • Miscarriage or threatened miscarriage. The woman may bleed without knowing she is pregnant.
  • Hormonal changes: variations in estrogen levels either due to internal problems (hypothyroidism) or due to contraceptives.

  • Ectopic or tubal pregnancy.
  • Vaginal lesions or diseases: changes in the vaginal opening caused by intercourse, infections, genital warts, polyps, ulcers, insertion of foreign objects, etc.
  • Coagulation problems and anticoagulant drug or Aspirin abuse.
  • Intrauterine device (IUD) use.
  • Stress or certain emotional situations that can cause ovulatory dysfunctions.

Spotting or ovulation bleeding

Spottings are small bleedings that occur between periods due to ovulation. It’s a sign ovulation is happening.

Some women bleed slightly during ovulation due to a estrogen increase. Furthermore, this small spotting can be accompanied by pain similar to that suffered during menstruation.

Diagnosis and treatment

First, it is important to determine that the bleeding comes from the vagina and not from another area, such as the rectal or urinary tract. In order to do this, a tampon is placed in the vaginal cavity to confirm the origin of the bleeding. However, in cases of regular intermenstrual vaginal bleedings, you should consult a gynaecologist.

The doctor will check the patient’s clinical history and analyze the type and frequency of the bleeding. A physical study, blood tests, a pregnancy test, and a Pap test to determine the cause of the bleeding, and the best treatment will also be performed.

According to the cause of the bleeding, one treatment or another will be chosen:

  • Medication to treat hormonal imbalances or infections.
  • Contraceptives. Changing the contraceptive for another one with a higher or lower estrogen and/or progesterone level.
  • Surgery to treat endometriosis, polyps, or fibroids. Dilatation and curettage may be the treatment chosen to remove the remains of a miscarriage that might be the cause of the bleeding.

Surgery, chemotherapy, and/or radiotherapy are the treatments of choice in case of cancer.

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Authors and contributors

 Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information