Bleeding or spotting between periods, called intermenstrual bleeding or metrorrhagia, can be an unsettling experience that can actually occur at any time. Whether it is the first time you have experienced bleeding or spotting between periods, or it has happened before, it is crucial to know why it has happened and what you should do for that.

What Are the Causes of Bleeding Between Periods?

Bleeding between periods is not a normal part of the menstrual cycle, though it happens to many women over their lifetime. There are a number of causes for this bleeding or spotting and they are:

• Intrauterine device. This form of birth control inserted into the uterus can cause bleeding between periods.
• Hormonal imbalance. If there is an imbalance of estrogen or progesterone, this can cause spotting between periods. Conditions such as dysfunctional ovaries and thyroid problems can cause hormonal imbalances, so can the starting or stopping birth control pills.
• Infections. Infections of the reproductive system can cause inflammation and bleeding between periods. Infections can be due to sexually transmitted diseases or pelvic inflammatory diseases.
• Uterine fibroids or polyps. Common among women who have had children, fibroids are non-cancerous tumors that can form in the uterus and cause bleeding between periods.
• Cancer. Though less common, reproductive cancers such as vaginal, ovarian, cervical, and uterine cancers can cause bleeding.
• Other rare causes. Other possible causes, though rare, that can cause bleeding between periods are diabetes, extreme stress or anxiety or an object in the vagina.

When Should You Seek Medical Help?

You should contact your healthcare professional anytime you experience bleeding between periods so that the cause can be determined immediately as some causes can be serious. You should also see your doctor right away if you experience bleeding during pregnancy. Seek medical attention immediately if you experience any of the following symptoms along with bleeding between periods:

• Abdominal pain
• Dizziness
• Fatigue
• Fever

How Is Bleeding Between Periods Diagnosed?

Most causes of bleeding between periods are not very serious, but you should contact your doctor to determine the exact cause. Once you have contacted your doctor about bleeding between periods, he will most likely ask you to keep a diary chronicling the days you bleed and how light or heavy the bleeding is. You will have a physical exam and the doctor will perform blood tests and other diagnostic methods to get the cause. These include:

• Common Tests. These tests include complete blood count, prolactin, and thyroid stimulating hormone test.
• Ultrasound. This uses sound waves to get a picture of the pelvis, including the uterus and ovaries. It can be done through the abdomen or with a probe into the vagina.
• Endometrial biopsy. A sample of the tissue from the uterus is taken to be examined in a lab for any abnormalities.
• Sonohysterogram. This is an ultrasound done after fluid has been injected into the uterus through a tube and it gives a visual of the lining of the uterus.
• Hysteroscopy. A small tube with a camera is inserted through the vagina and cervix into the uterus, so the doctor can see if there are any abnormalities.

How Is Bleeding Between Periods Treated?

The treatment of bleeding between periods depends on the causes and the doctor will determine if treatment is necessary. If there is no serious cause for the bleeding and it doesn’t impact the woman’s daily activities, treatment may not be necessary.

• If there are underlying conditions, such as thyroid problems, problems with blood clotting, or problems with the liver or kidneys, treatment will be directed to correcting those problems.
• If the cause is an infection, antibiotics are prescribed.
• In many cases, oral contraceptives will be prescribed. They can help make the menstrual cycle regular when there is no apparent cause for the bleeding between periods or if menopause has begun to cause some of the symptoms such as hot flashes.
• Progesterone medications are typically prescribed in the event of precancerous changes in the uterine lining or if ovulation has stopped.
• Surgery can be performed to remove polyps or other benign growths from the uterus or to treat endometriosis.
• Dilation and curettage (removal of the lining of the uterus) may be performed if the bleeding is excessive.
• In some cases of excessive bleeding, a hysterectomy may be performed.