Intermenstrual bleeding

{{short description|Vaginal bleeding at irregular intervals between expected menstrual periods}}

{{Infobox medical condition (new)

| name = Intermenstrual bleeding

| synonyms = Metrorrhagia, irregular vaginal bleeding

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| field = Gynecology

| symptoms = Bleeding in between periods

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| risks = Family history

| diagnosis = Based on physical examination

| differential = Irregular menstruation

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Intermenstrual bleeding (IMB), or metrorrhagia, is vaginal bleeding at irregular intervals between expected menstrual periods.{{cite journal |last1=Bacon |first1=JL |title=Abnormal Uterine Bleeding: Current Classification and Clinical Management. |journal=Obstetrics and Gynecology Clinics of North America |date=June 2017 |volume=44 |issue=2 |pages=179–193 |doi=10.1016/j.ogc.2017.02.012 |pmid=28499529}} It may be associated with bleeding with sexual intercourse.{{cite book |last1=Smith |first1=Roger P. |title=Netter's Obstetrics and Gynecology: Netter's Obstetrics and Gynecology |date=2023 |publisher=Elsevier |location=Philadelphia |isbn=978-0-443-10739-9 |pages=139–140 |edition=4th |chapter-url=https://books.google.com/books?id=COK2EAAAQBAJ&pg=PA139 |language=en |chapter=60. Postcoital bleeding }} The term metrorrhagia, in which metro means measure and -rrhagia means abnormal flow,{{cite web|url=http://dictionary.reference.com/browse/rrhagia |title=Rrhagia | Define Rrhagia at Dictionary.com |publisher=Dictionary.reference.com |access-date=2013-06-27}} is no longer recommended.

In some women, menstrual spotting between periods occurs as a normal and harmless part of ovulation. Some women experience acute mid-cycle abdominal pain around the time of ovulation (sometimes referred to by the German term for this phenomenon, mittelschmerz). This may also occur at the same time as menstrual spotting.

The term breakthrough bleeding (or breakthrough spotting) is usually used for women using hormonal contraceptives, such as IUDs or oral contraceptives. It refers to bleeding or spotting between any expected withdrawal bleeding, or at any time if none is expected. If spotting continues beyond the first 3-4 cycles of oral contraceptive use, a woman should have her prescription adjusted to a pill containing higher estrogen:progesterone ratio by either increasing the estrogen dose or decreasing the relative progesterone dose.{{cite book|author1=Carlson, Karen J., MD|author2=Eisenstat, Stephanie A., MD|author3=Ziporyn, Terra|title=The New Harvard Guide to Women's Health|year=2004|publisher=Harvard University Press|isbn=0-674-01343-3|page=[https://archive.org/details/newharvardguidet00carl/page/385 385]|url-access=registration|url=https://archive.org/details/newharvardguidet00carl/page/385}}

Besides the aforementioned physiologic forms, IMB may also represent abnormal uterine bleeding and be a sign of an underlying disorder, such as a hormone imbalance, endometriosis, uterine fibroids, uterine cancer, or vaginal cancer.{{Citation needed|date=December 2024}}

If the bleeding is repeated and heavy, it can cause significant iron-deficiency anemia.{{Citation needed|date=December 2024}}

Causes

Intermittent spotting between periods can result from any of numerous reproductive system disorders:{{citation needed|date=April 2022}}

Neoplasia:

Inflammation:

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Endometrial abnormalities:

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Endocrinological causes:

Hormone imbalance
Dysfunctional uterine bleeding
Diets which induce ketosis, such as the Atkins diet
polycystic ovarian syndrome}}

Bleeding disorders:

Von Willebrand Disease
Pancytopenia due to leukemia

Drug induced:

Use of progestin-only contraceptives, such as Depo Provera
Change in oral contraception
Overdose of anticoagulant medication or Aspirine abuse

Traumatic causes:

Automutilation
Sexual abuse or rape

Related to pregnancy:

Implantation bleeding
Ectopic pregnancy
(Incomplete) miscarriage

Other causes:

Enlarged uterus with menorrhea{{div col end}}

Breakthrough bleeding

Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding, usually referring to mid-cycle bleeding in users of combined oral contraceptives as attributed to insufficient estrogens.[http://medical-dictionary.thefreedictionary.com/Breakthrough+Bleeding Farlex Medical Dictionary > Breakthrough Bleeding], in turn citing:

McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002 It may also occur with other hormonal contraceptives. Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of IMB.[http://www.merriam-webster.com/medical/breakthrough%20bleeding Merriam-Webster's Medical Dictionary > Breakthrough bleeding] Retrieved on Feb 28, 2010

In the context of hemophilia, the term describes a bleeding that occurs while a patient is on prophylaxis.{{Cite web|url=https://elearning.wfh.org/elearning-centres/prophylaxis/#barriers_and_challenges|title=Prophylaxis: Barriers and challenges - World Federation of Hemophilia|website=www.wfh.org|language=en|access-date=2018-07-05}}

=Presentation=

The bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding.{{citation needed|date=April 2022}}

It is estimated that breakthrough bleeding affects around 25% of combined oral contraceptive pill (COCP) users during the initial 3 to 4 months of use, it then usually resolves on its own.{{cite journal |author1=M. Hickey |author2=I. S. Fraser |title=Iatrogenic unscheduled (breakthrough) endometrial bleeding |journal=Rev Endocr Metab Disord |volume=13 |pages=301–308 |date=2012 |issue=4 |doi=10.1007/s11154-012-9227-3|pmid=23224719 |hdl=11343/220598 |s2cid=26184273 |hdl-access=free }}{{cite journal |author1=Patricia A. Lohr |author2=Mitchell D. Creinin |title=Oral contraceptives and breakthrough bleeding: What patients need to know |journal=The Journal of Family Practise |volume=55 |issue=10 |pages=872–80 |date=2006 |pmid=17014753}}

=Mechanism=

Breakthrough bleeding is commonly due to 4 factors: physiologic effects of OCs on the endometrium, OC-related parameters, (dose, formulation, and regimen), patient behavior, (compliance, using concomitant medications, and smoking) and benign or malignant pathology.

=Treatment=

Breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth control.{{citation needed|date=April 2022}}

References

External links

{{Medical resources

| DiseasesDB = 6847

| ICD10 = {{ICD10|N|92|1|n|80}}, {{ICD10|N|92|4|n|80}}

| ICD9 = {{ICD9|626.6}}

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| MeshID = D008796

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Category:Menstrual disorders