Vaginal bleeding between periods

Symptoms Of Vaginal Bleeding Between Periods 

Bleeding or spotting between periods can be associated with the following signs and symptoms:

• Heavy periods (menorrhagia)

• Irregular periods

• Periods for more than 7 days 

• Menstrual cycles longer than 35 days or shorter than 21 days

• Bleeding after intercourse

• Bleeding while being pregnant

• Bleeding after menopause

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Causes Of Vaginal Bleeding Between Periods 

Bleeding between periods can be caused by an array of causes.

PALM-COEIN is an acronym provided by the International Federation of Obstetrics and Gynecology (FIGO) to classify the underlying causes of abnormal uterine bleeding. 

• P: Polyp (small, abnormal growth)

• A: Adenomyosis (a condition where the tissue lining the uterus grows into the uterus)

• L: Leiomyoma (known as a fibroid, is a noncancerous growth of the uterus)

• M: Malignancy (cancer) and hyperplasia (excessive tissue growth)

• C: Coagulopathy (impaired blood clotting)

• O: Ovulatory dysfunction (a condition where the ovaries do not release eggs regularly)

• E: Endometrial disorders (medical conditions affecting the lining of the uterus)

• I: Iatrogenic (health problems caused accidentally by medical treatment)

• N: Not otherwise classified
  
  

A woman with one or more of these listed conditions can have abnormal vaginal bleeding. The various risk factors associated with these factors are described elaborately in the next section.

Risk Factors Of Vaginal Bleeding Between Periods 

1. Hormonal changes

• Polycystic ovary syndrome (PCOS): It is a common cause of menstrual irregularities, including spotting between periods. 

• Hypothyroidism: An underactive thyroid gland can interrupt regular menstrual cycles and increase the risk of abnormal vaginal bleeding, 

• Hyperthyroidism: An overactive thyroid gland is a common risk factor for abnormal uterine bleeding among reproductive-age women.  

• Use of Oral Contraceptive Pills: The most common effect of taking oral contraceptive pills during the first few months of use is spotting or bleeding between periods (breakthrough bleeding). 

• Being underweight or Obese: Weight affects the body's hormonal balance. Thus, being overweight or underweight or sudden changes in weight can trigger irregular bleeding.

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• Hormone Replacement Therapy (HRT): During the initial stages of HRT or when the dose is adjusted, breakthrough bleeding and spotting are very common.

2. Infections

• Vaginitis: It is an inflammation of the vagina that can result in discharge, itching, pain, and spotting between periods. 

• Cervicitis: It refers to irritation or infection of the cervix. Bleeding between periods is a common symptom of cervicitis.

• Pelvic inflammatory disease (PID): It is an infection of the upper reproductive organs, including the uterus, fallopian tubes, and ovaries. It can lead to irregular menstrual periods.

• Endometriosis: It is an infection in which the tissue that lines the inside of the uterus or womb called the endometrium starts growing outside the uterine cavity. This can lead to pain, heavy bleeding between periods, and infertility.

• Sexually transmitted infections (STIs): STIs like Gonorrhea and Chlamydia can cause bleeding between periods.

Sexually transmitted infections (STIs) can also affect fertility in women. Read more about infertility in women.
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3. Pregnancy complications

• Miscarriage: It refers to loss of pregnancy before the 20th week. It can cause vaginal bleeding or spotting. 

• Ectopic pregnancy: A pregnancy that occurs when a fertilized egg grows outside of the uterus. The first warning signs of ectopic pregnancy are vaginal bleeding and pelvic pain. 

• Placental abruption: This occurs when the placenta separates from the inner wall of the uterus before birth which can cause light, intermittent vaginal bleeding.

• Placenta previa: It is a condition during pregnancy where the placenta blocks all or part of the baby's exit from the vagina. The most common symptom of this condition is vaginal bleeding. 

• Premature labor: Labor that begins early, before 37 weeks of pregnancy can also cause abnormal vaginal bleeding.

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4. Noncancerous growths and other uterine conditions

• Uterine fibroids: They are non-cancerous growths that develop from the muscle tissue of the uterus. Fibroids may stimulate the growth of blood vessels, which can contribute to spotting between periods.

• Uterine polyps: These refer to the overgrowth of cells in the lining of the uterus. Polyps are usually not cancerous, but some can develop into precancerous polyps.

• Adenomyosis: It occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus.

• Cervical polyps: They are benign growths, usually protruding from the surface of the cervical canal. 

5. Cancers and precancerous conditions

• Cervical cancer: In many cases, vaginal bleeding is the first noticeable symptom of cervical cancer. It usually occurs after having intercourse. 

• Endometrial hyperplasia: It is a precancerous condition in which there is an irregular thickening of the uterine lining, causing heavy or abnormal bleeding. 

• Vaginal cancer: Vaginal cancer may cause signs and symptoms such as unusual vaginal bleeding after intercourse. 

• Uterine sarcoma: It is a cancer that starts in the muscle and supporting tissues of the uterus (womb) that can lead to unusual bleeding from the vagina. 

6. Medical conditions

• Celiac disease: It is a chronic digestive and immune disorder that damages the small intestine. Many studies have found that celiac disease can lead to spotting between periods. 

• Von Willebrand disease (VWD): It is a blood disorder in which the blood does not clot properly. VWD is a common cause of heavy menstrual bleeding and abnormal bleeding between periods. 

7. Certain Medications 

• Blood thinners and aspirin: Studies have reported that women taking blood thinners and aspirin have irregular, infrequent, and bleeding between periods. 

• Tamoxifen: This drug is prescribed for women undergoing treatment of breast cancer. It may lead to side effects like bloody discharge or unusual vaginal discharge.

8. Other factors

• Vaginal dryness: Friction and irritation in the vaginal tissue, may lead to small tears and spotting between periods.

• Injury to the vagina: This can happen during sexual activity or the use of certain products, which can lead to bleeding between periods by damaging the delicate vaginal tissue.

• Stress: Stress can elevate cortisol levels, impacting sex hormone production and potentially causing spotting.

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Diagnosis Of Vaginal Bleeding Between Periods 

1. Medical history 

A comprehensive and detailed medical history, including menstrual, reproductive, sexual, associated symptoms, and social factors, is taken by the doctor for identifying the cause of vaginal bleeding between periods.

2. Physical examination 

During a general examination, the doctor assesses vital signs, checks for signs of anemia, endocrine disorders, and clotting disorders, and conducts a pelvic examination to identify potential causes of abnormal uterine bleeding.

3. Lab tests 

• Complete Blood Count (CBC): It helps in identifying low red blood cell count and potential underlying causes. 

• Blood pregnancy test (HCG Beta Total Maternal): This blood test measures hCG levels in pregnant women's blood, helping in identifying hormonal changes and potential causes of bleeding, including miscarriage or early pregnancy-related issues.

• Thyroid tests: These tests diagnose any imbalance in thyroid hormones, a potential cause for bleeding between periods. 

• Urine analysis: Spotting can also be a sign of early pregnancy. Urine analysis checks whether human chorionic gonadotropin hormone (HCG or hCG) is present in the urine or not. 

• Progesterone and Estrogen test: These hormones regulate the menstrual cycle and their imbalance can cause irregular bleeding. 

• Coagulation panel: This test measures the blood's ability to clot, and how long it takes to clot. A woman having problems with clotting can also have vaginal bleeding between periods. 

• Pap smear: Also called a Pap test, this procedure is used to test for cervical cancer in women. This test involves collecting cells from the cervix and can help in detecting abnormal cells in the cervix before they become cancerous and cause vaginal bleeding amongst other symptoms.

4. Imaging tests 

• Transvaginal ultrasound: It involves inserting a small ultrasound probe into the vagina to produce detailed images of the pelvic organs. This is a first-line imaging test for the evaluation of abnormal uterine bleeding. 

• Lower abdomen ultrasound: This imaging test uses sound waves to visualize the inside of the uterus to detect any fibroids or polyps.

• Magnetic resonance imaging (MRI): This is a non-invasive imaging technology that produces three-dimensional detailed anatomical images of the uterus.

• Hysteroscopy: It is a procedure used to examine the inside of the womb (uterus). A hysteroscope, which is a narrow telescope with a light and camera at the end and is passed through the vagina. This procedure allows one to look inside the uterus to diagnose and treat the causes of abnormal bleeding.

• Saline infusion sonography: In this test, saline is infused into the uterus for a clearer ultrasound image. It gives a better picture of the inside of the uterus, and small abnormalities can be detected easily.
  
  

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5. Endometrial biopsy

An endometrial biopsy is considered the first-line test in women with abnormal uterine bleeding who are 45 years or older. This test is usually performed on women who are at high risk for hyperplasia or malignancy.

Prevention Of Vaginal Bleeding Between Periods 

Though all cases of bleeding between periods cannot be prevented, here are some preventive measures that can help:

1. Regulate your hormones

Prevent hormonal imbalances by focusing on a balanced diet and maintaining a healthy weight. Replace processed, packaged junk food with nutritious options. 

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2. Avoid heavy exercises

Intense workouts and heavy physical exercises can cause exertion in the pelvic area, which can result in spotting in some women.

3. Include iron in the diet

Iron is essential for maintaining healthy blood cells and preventing excessive bleeding. When the body lacks iron, it may lead to conditions like anemia, which can increase the risk of abnormal bleeding.

Consume food containing a rich source of iron such as bananas, beans, and spinach.

You can also take iron supplements after consulting your doctor to cover any gaps in your diet.
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4. Manage stress effectively 

Stress can result in spotting and other menstrual changes. Therefore, stress management is an important preventive measure for bleeding between periods.

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5. Practice safe sex 

This can reduce the risk of certain sexually transmitted infections (STIs) that can cause vaginal bleeding between periods. 

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Specialist To Visit

A gynecologist can help in detecting the underlying medical condition and management of vaginal bleeding between periods as they specialize in diagnosing and treating diseases of the female reproductive system.

When to see a doctor?

• When you have more than one period in a month

• When your periods last longer than 7-9 days

• When you feel light-headed or dizzy during the day

• When you experience spotting after menopause

• When you experience spotting during pregnancy

• When you have extreme lower abdominal pain and cramping.

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Treatment Of Vaginal Bleeding Between Periods 

The treatment is based on what’s causing the vaginal bleeding between periods. It includes:

1. Lifestyle modifications

• Maintain a healthy weight through diet and exercise

• Stay hydrated and eat a balanced diet

• Incorporate iron-rich foods in your diet

• Avoid consumption of alcohol and tobacco

• Limit caffeine intake

• Manage stress by practicing relaxation techniques

• Follow a regular sleep schedule

• Avoid excessive physical strain

2. Medications

Birth control pills: These are used to regulate hormonal imbalances causing irregular bleeding. Estrogen and progesterone (combination birth control pill) is the most commonly used drug.

• Progesterone: It is effective in preventing or treating excessive bleeding, especially in women with irregular ovulation. Examples include:

• Medroxyprogesterone acetate

• Norethindrone acetate

• Gonadotropin-releasing agonists: These are effective in the long-term treatment of women with abnormal uterine bleeding. A few examples of GnRH agonists are: 

• Goserelin

• Leuprorelin

• Leuprolide

• Tranexamic acid: It is an effective treatment for irregular uterine bleeding as it prevents excessive bleeding, particularly in cases of hormonal imbalance or heavy menstrual flow. 

• Non-steroidal anti-inflammatory drugs: They are given to reduce blood loss and cramping. Commonly used drugs are:

• Ibuprofen

• Naproxen 

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3. Intrauterine device (IUD)

Progestin-releasing IUDs are recommended for abnormal uterine bleeding. They reduce menstrual blood loss, alleviate pain, and may even stop periods altogether.

4. Surgery

It could be an option if vaginal bleeding between periods is due to some noncancerous uterine growth such as a polyp, fibroid, or thickening in the endometrium. It includes:

• Dilation and curettage (D&C): It is a procedure to remove abnormal tissue from inside the uterus. The cervix is dilated (opened) so that the uterine lining (endometrium) can be scraped with a curette (spoon-shaped instrument). 

• Endometrial ablation: It is a procedure that destroys the lining of the uterus. This is recommended for bleeding between the menstrual periods, having a heavy flow, or having periods that last a long time. 

Note: In several cases, the periods will return to normal. However, in a few cases, the period stops completely. 

• Myomectomy: It is a surgery to remove uterine fibroids. Myomectomy leaves the uterus intact, so people can still become pregnant after the procedure.

• Hysterectomy: It is a surgical procedure that removes the uterus. A woman will no longer be able to get pregnant after a hysterectomy. 

• Uterine artery embolization (UAE): This procedure is used to stop vaginal spotting if it is due to underlying medical conditions like uterine fibroids, trauma, cancerous tumors, and childbirth.

Home Care For Vaginal Bleeding Between Periods

There are certain home remedies that can help with vaginal bleeding between periods. However, always consult your doctor before trying anything as they can interfere with your medications. These include:

• Ginger (Adrak): Ginger has anti-inflammatory and blood-thinning properties, which can mitigate minor bleeding issues.

How to use it?

Mince one teaspoon of fresh ginger boil water for about 10 minutes and make it into tea.

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• Jaggery (Gudh): Jaggery has lots of medicinal properties and regular consumption of jaggery may help regulate spotting between periods. 

How to use it?

You can take a small piece as it is or mix it in milk or water for easy consumption.

• Cinnamon (Dalchini): Cinnamon helps in regulating the blood flow to the uterus and may treat irregular periods. 

How to use it?

It can be added to your diet in various ways, such as sprinkling it on oatmeal or yogurt or making cinnamon tea by boiling a cinnamon stick in water.

Complications Of Vaginal Bleeding Between Periods

Complications of vaginal spotting between periods can be grouped into the following:

1. Acute complications 

• Severe anemia: Vaginal bleeding between periods can lead to excessive blood loss and anemia by reducing the number of circulating red blood cells.

• Hypotension (low blood pressure): A heavy period or spotting between periods can result in low blood pressure. Low blood pressure is also a cause of underlying health conditions like uterine fibroids. 

Chronic complications 

• Infertility: Irregular periods lead to a large percentage of infertility cases. 
  
  

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• Endometrial cancer: Long-term abnormal vaginal bleeding is associated with risk of endometrial cancer.

Alternative Therapies For Vaginal Bleeding Between Periods

Alternative therapies act as an adjunct to managing the condition or the symptoms. These include:

1. Yoga 

Yoga is great for balancing the mind and body. Various studies suggest that yoga helps reduce menstrual pain and emotional symptoms associated with menstruation and bleeding between periods, such as depression and anxiety. 

Yoga emphasizes the holistic improvement of the mind, body, and soul. Here are some of the health benefits of yoga!
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2. Acupuncture

Living With Vaginal Bleeding Between Periods

Experiencing irregular bleeding between periods can lead to anxiety, stress, mood swings, and strain on relationships, impacting mental health and overall well-being. 

1. Do not delay medical attention

If you experience irregular or heavy bleeding between periods, consult a doctor immediately. They can evaluate your condition and identify any underlying causes.

2. Maintain a menstrual calendar

A menstrual calendar can track the frequency, duration, and flow of bleeding episodes. This information can help your healthcare provider make an accurate diagnosis.

3. Be vigilant about other symptoms

Pay attention to accompanying symptoms like pain, cramping, or changes in vaginal discharge. These details can provide valuable insights into the cause of the bleeding.

4. Follow your doctor’s advice

Once your doctor diagnoses the underlying cause, follow their recommended treatment plan that may involve medication, lifestyle changes, or other interventions.

5. Take care of your overall health

A healthy lifestyle, including regular exercise and a balanced diet, can support your reproductive health.