Vaginal bleeding between periods
This article discusses vaginal bleeding that occurs between a woman's monthly menstrual periods. Such bleeding may be called "intermenstrual bleeding."
Related topics include:
Bleeding between periods; Intermenstrual bleeding; Spotting; Metrorrhagia
Normal menstrual flow lasts about 5 days. It produces a total blood loss of 30 to 80 ml (about 2 to 8 tablespoons), and occurs normally every 21 to 35 days.
Vaginal bleeding that occurs between periods or after menopause can be caused by various problems. Most are benign and treatable. Sometimes vaginal bleeding may be due to cancer or pre-cancer. So any unusual bleeding should be evaluated promptly. The risk of cancer increases to about 10% in women with postmenopausal bleeding.
Make sure that bleeding is coming from the vagina and is not from the rectum or the urine. Inserting a tampon into the vagina will confirm the vagina, cervix, or uterus as the source of bleeding.
A careful exam by your health care provider is most often the best way to find the source of the bleeding. This exam can be done even while you are bleeding.
Causes may include:
Contact a provider right away if bleeding is very heavy.
Keep track of the number of pads or tampons used over time so that the amount of bleeding can be determined. Uterine blood loss can be estimated by keeping track of how frequently a pad or tampon is soaked and how often one needs to be changed.
Because aspirin may prolong bleeding, it should be avoided, if possible. However, NSAIDS such as ibuprofen can be used to minimize bleeding and cramping.
When to Contact a Medical Professional
Call your health care provider if:
What to Expect at Your Office Visit
The provider will perform a physical exam and ask questions about your medical history. The physical exam with include an emphasis on the pelvic area.
Questions about the bleeding may include:
Tests that may be done include:
Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 17.
Lobo RA. Abnormal uterine bleeding: ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 37.
Review Date: 5/9/2015
Reviewed By: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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