What is bleeding between periods?

Menstruation is part of the process your body goes through to get ready for the possibility of pregnancy each month. Changes in body chemicals called hormones make the menstrual cycle happen. In the first half of the menstrual cycle, levels of the hormone estrogen rise and make the lining of the uterus grow and thicken. The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus. If a man’s sperm does not fertilize the egg, hormone levels drop and your uterus sheds the lining it prepared for a baby. When the uterus sheds its lining, blood flows out of your vagina. This is called your period. Your period may last from 2 to 7 days.

Bleeding from the uterus between menstrual periods is a common problem. The bleeding may be light spotting, or may be like a regular period. It’s especially common if you are a teenager or if you are getting close to menopause.

What is the cause?

Bleeding between periods may be caused by:

• Hormone imbalance
• Early pregnancy
• Some medicines, such as blood thinners
• Stress
• Use of an IUD or birth control pills
• Polyps, which are growths in the uterus
• Fibroids, which are noncancerous growths in the uterus
• Infection of the uterus, cervix, or vagina
• Endometriosis (tissue the same as the lining of the uterus that is growing outside the uterus)
• Scar tissue in the uterus
• Long-term medical problems, such as thyroid problems or diabetes
• Cancer of the uterus or ovary and sometimes cancer of the vagina or cervix (the opening of the uterus into the vagina)

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you, including a pelvic exam. Tests may be done to find the cause of your bleeding. They may include:

• Blood tests
• Ultrasound, which uses sound waves to show pictures of the pelvic organs
• Sonohysterogram, which is an ultrasound scan done after fluid is put into the uterus through a tube
• Endometrial biopsy, which uses a tiny tube put through your vagina and into the uterus to take a small sample of tissue of the lining of the uterus
• Hysteroscopy, which uses a small lighted tube put into your vagina, through the cervix, and into the uterus to examine the inside of the uterus. A biopsy may be taken to help make a diagnosis. A biopsy is the removal of a small sample of tissue for testing.
• Laparoscopy, which uses a small, lighted tube put into the belly through a small cut to look at the organs and tissues inside the belly. A biopsy may be taken to help make a diagnosis.
• Hysterosalpingogram, which uses X-rays and a dye put into your vagina to show the uterus and fallopian tubes

Many of these procedures may be done in your healthcare provider’s office. Others may be done in an outpatient clinic.

How is it treated?

The treatment depends on the cause of the problem. For example, if you have a hormone imbalance, your healthcare provider may prescribe hormones. If an IUD is causing the problem, your provider may remove the IUD.

Sometimes surgery is needed. Possible surgical treatments include:

• Dilation and curettage (D&C), which is a procedure for opening the cervix and then scraping or suctioning tissue from inside the uterus
• Hysteroscopy, which may be done to remove tissue, such as a polyp
• Hysterectomy, which is surgery to remove the uterus. If your uterus is removed, you will no longer be able to get pregnant.

If cancer is found, it may be treated with surgery, radiation, or chemotherapy (anticancer drugs).

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Keep track of your symptoms in a diary or on the calendar. Let your provider know what seems to help.

Ask your provider:

• How and when you will hear your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.