Vaginal bleeding between periods

Hormonal Imbalance

• PCOS: Disrupts ovulation and can result in spotting
• Hypothyroidism: May lead to prolonged or heavy bleeding
• Hyperthyroidism: Often linked with irregular uterine bleeding
• Oral contraceptives: Spotting is common in the first few months of use
• Weight fluctuations: Being underweight, overweight, or rapid changes in weight affect hormone levels
• Hormone Replacement Therapy (HRT): Often causes bleeding or spotting during dose changes

Infections

• Vaginitis: Causes inflammation and may lead to spotting
• Cervicitis: Irritation of the cervix, often leads to intermenstrual bleeding
• PID: Involves the uterus and ovaries and can disrupt menstrual regularity
• Endometriosis: Endometrial tissue growing outside the uterus can result in pain and abnormal bleeding
• STIs (e.g., Gonorrhea, Chlamydia): Can contribute to spotting

Pregnancy-Related Issues

• Miscarriage: Often causes bleeding or spotting
• Ectopic pregnancy: Abnormal implantation leads to bleeding and pain
• Placental abruption: Early separation of the placenta from the uterus can cause bleeding
• Placenta previa: Placenta covers the cervix, causing vaginal bleeding
• Preterm labor: Labor before 37 weeks may begin with spotting or bleeding

Benign Uterine Conditions

• Fibroids: May cause irregular bleeding due to increased blood supply
• Uterine polyps: Non-cancerous growths that can lead to spotting
• Adenomyosis: Causes heavy bleeding due to abnormal tissue placement
• Cervical polyps: Generally harmless but can cause bleeding

Cancerous or Precancerous Changes

• Cervical cancer: Postcoital bleeding is often the first sign
• Endometrial hyperplasia: Excessive thickening of the uterine lining
• Vaginal cancer: Can result in bleeding, especially after intercourse
• Uterine sarcoma: A rare malignancy that can present with vaginal bleeding

Medical Disorders

• Celiac disease: May be associated with menstrual irregularities and spotting
• Von Willebrand Disease (VWD): A blood clotting disorder that increases bleeding risk

Medications

• Anticoagulants and aspirin: Known to cause breakthrough bleeding
• Tamoxifen: Used in breast cancer treatment and may cause abnormal discharge or bleeding

Other Contributing Factors

• Vaginal dryness: May lead to tissue irritation and spotting
• Trauma: Injury from sexual activity or objects can damage the vaginal lining
• Psychological stress: Elevated cortisol can disrupt menstrual hormones and lead to spotting

Medical History

The doctor begins by gathering a thorough medical history, focusing on menstrual patterns, reproductive and sexual health, related symptoms, and lifestyle factors to help determine the cause of bleeding between periods.

Physical Examination

A general physical check-up is conducted to evaluate vital signs and look for indicators of anemia, hormonal imbalances, or clotting disorders. A pelvic examination is also performed to identify any abnormalities that may be causing irregular bleeding.

Laboratory Tests

• Complete Blood Count (CBC): Assesses red blood cell levels and helps detect possible underlying conditions.
• Blood Pregnancy Test (hCG Beta Total Maternal): Measures hCG hormone levels to identify pregnancy-related issues such as miscarriage.
• Thyroid Function Tests: Used to check for thyroid hormone imbalances that could be disrupting menstrual cycles.
• Urinalysis: Determines the presence of hCG in the urine to confirm or rule out pregnancy.
• Progesterone and Estrogen Levels: Assesses hormonal balance, since fluctuations in these hormones can lead to abnormal bleeding.
• Coagulation Profile: Evaluates the blood’s clotting ability, as clotting disorders may be a cause of unexpected bleeding.
• Pap Smear: Screens for cervical cancer by collecting cells from the cervix to detect abnormalities that may lead to irregular bleeding.

Imaging Techniques

• Transvaginal Ultrasound: A probe is inserted into the vagina to capture detailed images of the reproductive organs and is commonly the first test performed for abnormal bleeding.
• Pelvic Ultrasound (Lower Abdomen): Uses sound waves to view the uterus and detect polyps or fibroids.
• Magnetic Resonance Imaging (MRI): A non-invasive method that creates high-resolution 3D images of the uterus and surrounding structures.
• Hysteroscopy: Involves inserting a thin tube with a camera into the uterus through the vagina to inspect the uterine lining and address abnormalities.
• Saline Infusion Sonography: A saline solution is introduced into the uterus to improve ultrasound clarity, allowing better visualization of small abnormalities.

Endometrial Biopsy

This test is often the initial step for evaluating abnormal bleeding in women aged 45 and older. It’s especially useful for those at risk of endometrial hyperplasia or cancer.

While it’s not always possible to prevent intermenstrual bleeding, certain steps may help reduce the risk:

Maintain Hormonal Balance

Achieve a healthy weight and avoid processed foods to support hormonal equilibrium and reduce the likelihood of irregular bleeding.

Limit Strenuous Physical Activity

Engaging in excessive or high-impact exercises may place strain on the pelvic region and cause spotting in some individuals.

Ensure Adequate Iron Intake

Iron supports healthy blood cell production. Iron-rich foods like spinach, legumes, and bananas help prevent anemia, which can lead to heavier or irregular bleeding.

Manage Stress

Chronic stress can interfere with hormone levels, so managing stress is key to maintaining regular menstrual cycles.

Practice Safer Sex

Using protection during sexual activity helps lower the risk of infections that could trigger vaginal bleeding between cycles.

Specialist to Consult

A gynecologist should be consulted for evaluating and managing abnormal bleeding, as they are trained to diagnose and treat conditions affecting the female reproductive system.

When to Seek Medical Advice

• Experiencing two or more periods within a single month
• Menstrual bleeding that continues beyond 7–9 days
• Feeling faint or light-headed without an obvious cause
• Spotting after entering menopause
• Spotting while pregnant
• Severe abdominal cramping and pain accompanying bleeding

The course of treatment depends on the underlying reason for the bleeding. Approaches may include:

Lifestyle Changes

• Achieve and maintain a healthy body weight with proper nutrition and regular exercise
• Stay well-hydrated and consume a balanced diet
• Include iron-rich foods in daily meals
• Avoid alcohol and tobacco use
• Limit intake of caffeine
• Use stress-relief techniques like meditation or deep breathing
• Follow a consistent sleep routine
• Avoid excessive physical exertion

Medications

• Birth Control Pills: These help stabilize hormone levels and are commonly used to manage irregular bleeding. Combined estrogen-progesterone pills are most frequently prescribed.
• Progesterone Therapy: Beneficial for controlling heavy or irregular bleeding, particularly when ovulation is inconsistent. Examples include:
• Medroxyprogesterone acetate
• Norethindrone acetate
• Gonadotropin-Releasing Hormone (GnRH) Agonists: Used for long-term treatment of abnormal uterine bleeding. Examples include:
• Goserelin
• Leuprorelin
• Leuprolide
• Tranexamic Acid: Helps prevent excessive bleeding, especially in cases of hormonal imbalance or heavy menstrual flow.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These reduce menstrual bleeding and pain. Common options include:
• Ibuprofen
• Naproxen

Intrauterine Device (IUD)

A progestin-releasing IUD is often recommended for managing abnormal bleeding. It reduces blood flow, relieves discomfort, and may even halt menstruation altogether.

Surgical Options

Surgery might be necessary when abnormal bleeding is caused by benign uterine conditions such as fibroids, polyps, or endometrial thickening:

• Dilation and Curettage (D&C): Involves opening the cervix and scraping the uterine lining to remove abnormal tissue.
• Endometrial Ablation: A procedure that removes or destroys the uterine lining to manage persistent bleeding or heavy periods. In some cases, menstruation may stop permanently afterward.
• Myomectomy: Surgical removal of fibroids while preserving the uterus, allowing for future pregnancies.
• Hysterectomy: Complete removal of the uterus, eliminating the possibility of future pregnancies.
• Uterine Artery Embolization (UAE): A procedure that cuts off the blood supply to fibroids or other growths, helping control bleeding.

Short-Term Complications

• Severe Anemia: Significant blood loss can lower red blood cell levels, leading to fatigue and weakness.
• Low Blood Pressure (Hypotension): Heavy or frequent bleeding may cause a drop in blood pressure, especially in cases involving fibroids.

Long-Term Complications

• Infertility: Irregular menstrual cycles are a contributing factor in many infertility cases.
• Endometrial Cancer: Persistent abnormal bleeding may increase the risk of uterine lining cancer.

These complementary therapies can support overall well-being and may assist in symptom management:

Yoga:

Helps balance the body and mind, and may reduce menstrual discomfort and emotional symptoms like anxiety or mood swings.

Acupuncture:

A traditional Chinese technique that uses fine needles to stimulate specific points in the body. It may assist in regulating menstrual cycles, although evidence is limited and varies between individuals.

Some natural remedies may help ease minor symptoms, but always consult a healthcare provider before trying them:

• Ginger (Adrak): Known for anti-inflammatory properties, ginger may help reduce minor bleeding.
• Use: Steep a teaspoon of minced fresh ginger in boiling water for 10 minutes to make tea.
• Jaggery (Gur): Traditionally believed to help balance hormones and reduce spotting.
• Use: Consume a small piece directly or dissolve it in warm milk or water.
• Cinnamon (Dalchini): May help regulate blood flow and improve menstrual consistency.
• Use: Add to your diet or make tea by boiling a cinnamon stick in water.

Unexpected bleeding can cause emotional distress, impact relationships, and affect overall quality of life. Strategies to cope include:

1. Seek Timely Medical Help: If bleeding is frequent or heavy, consult a physician without delay to determine the cause.
2. Keep a Menstrual Log: Track the pattern, duration, and severity of bleeding to help healthcare providers assess your condition.
3. Watch for Other Symptoms: Monitor for additional signs like pain, unusual discharge, or cramping, which may offer clues about the underlying issue.
4. Stick to the Treatment Plan: Follow your doctor's advice, whether it involves medication, lifestyle changes, or surgical interventions.
5. Focus on General Wellness: A nutritious diet, routine exercise, and good sleep habits contribute to better reproductive health.