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Spotting - Vaginal Bleeding Between Periods


Overview, Causes, & Risk Factors

Vaginal bleeding between periods is when a woman has uterine bleeding after she has finished one menstrual period and before she begins the next. This occurs in many women at some point in their lives.

What is going on in the body?

The normal menstrual flow occurs about every 28 days, and lasts between 3 and 5 days. Bleeding in between periods can occur for many reasons. The bleeding may be harmless or serious. This bleeding can cause much anxiety in affected women.

What are the causes and risks of the condition?

Bleeding from other areas, such as the bladder or bowels, may make a woman think she is having bleeding from the vagina. True vaginal bleeding has many different causes, including:

  • hormone imbalances, such as polycystic ovary syndrome or hypothyroidism
  • early pregnancy or an early miscarriage
  • tumors or cancer, such as fibroids of the uterus, endometrial cancer, or cancer of the cervix
  • trauma to the vagina, such as from tampons or sexual intercourse
  • infections in the female organs, such as cervicitis or pelvic inflammatory disease, both often due to sexually transmitted diseases
  • endometriosis or adenomyosis
  • oral contraceptives when they are stopped and started again
  • certain medications, such as anticoagulants or aspirin
  • Other causes are also possible. In some cases, no cause can be found.


    Symptoms & Signs

    What are the signs and symptoms of the condition?

    When a woman has bleeding between periods, the healthcare provider will need further information. He or she may ask:

  • what the woman's normal cycle is like
  • when the irregular bleeding started
  • how much bleeding has occurred
  • the description of the blood, such as whether it was bright red or whether there were clots
  • when the woman's last normal period was
  • whether or not the woman is sexually active and the type of birth control she uses
  • whether or not irregular bleeding has occurred before
  • whether there was any pain or cramps associated with the bleeding
  • when the woman's last Pap smear was
  • whether or not the woman has ever had a sexually transmitted disease
  • whether there have been any injuries to the pelvic area
  • what medications are being taken
  • any other symptoms, such as weight loss, nausea, fever, or abnormal bleeding or bruising in other parts of the body
  • Further questions may also be asked to help determine the cause of the bleeding.


    Diagnosis & Tests

    How is the condition diagnosed?

    A history and physical exam are done first. In some cases, this is all that is needed to determine the cause. Blood and urine tests are commonly done, including a pregnancy test and a complete blood count or CBC, to make sure the woman has not lost too much blood. Further tests are often related to the suspected cause. Other blood tests or special x-ray tests may be ordered. Occasionally, a laparoscopy to explore the woman's female organs may be done in some cases.


    Prevention & Expectations

    What can be done to prevent the condition?

    Prevention is related to the cause. For instance, practicing safer sex can help avoid bleeding due to sexually transmitted diseases. Regular Pap smears can help prevent cancer of the cervix. A woman who is on oral contraceptives should take them as prescribed. Aspirin should be avoided, if possible, because it may cause bleeding. Many cases cannot be prevented, but can be treated.

    What are the long-term effects of the condition?

    Too much blood loss can result in anemia, or a low blood count. Other long-term effects are primarily related to the underlying cause. For instance, pelvic inflammatory disease may result in infertility, or the inability to have children. Trauma to the vagina may heal and cause no long-term effects. Cancer may result in death.

    What are the risks to others?

    Bleeding between periods is not contagious and usually poses no risks to others. If the cause of bleeding is an infection, the infection may be contagious and passed on to sexual partners.


    Treatment & Monitoring

    What are the treatments for the condition?

    If bleeding is heavy, medications may be given to help stop the bleeding. Progesterone medicines are often given. Blood transfusions are rarely needed.

    Other treatment is directed at the cause. For instance, an infection may need to be treated with antibiotics. Women with cancer may need surgery, chemotherapy, or radiation therapy. Women with adenomyosis may need a hysterectomy, or surgery to remove the uterus.

    What are the side effects of the treatments?

    Side effects depend on the treatments used. All medications have possible side effects. For instance, progesterone drugs can cause headache and nausea. Antibiotics can cause allergic reactions and stomach upset. Specific side effects depend on the drugs used. All surgery carries a risk of bleeding, infection, and reactions to any pain medications used.

    What happens after treatment for the condition?

    This depends on the cause. If the cause is an infection and the infection is treated with antibiotics, no further treatment or monitoring may be needed. If the cause is cancer, close monitoring and treatment may be needed for life.

    How is the condition monitored?

    For heavy bleeding, a CBC to measure the blood counts are used. Other monitoring depends on the underlying cause. For instance, a woman found to have an early pregnancy might need frequent monitoring to determine whether or not she has lost the fetus.


    Attribution

    Author:Adam Brochert, MD
    Date Written:
    Editor:Smith, Elizabeth, BA
    Edit Date:06/20/00
    Reviewer:Gail Hendrickson, RN, BS
    Date Reviewed:06/01/01

    Sources

    Danforth's Obstetrics and Gynecology, 1999, Scott et al.


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