| Intermenstrual bleeding | |
|---|---|
| Other names | Metrorrhagia, irregular vaginal bleeding |
| Specialty | Gynecology |
| Symptoms | Bleeding in between periods |
| Risk factors | Family history |
| Diagnostic method | Based on physical examination |
| Differential diagnosis | Irregular menstruation |
Intermenstrual bleeding (IMB), ormetrorrhagia, isabnormal vaginal bleeding at irregular intervals between expectedmenstrual periods.[1] It may be associated withbleeding with sexual intercourse.[2] The term metrorrhagia, in which metro means measure and -rrhagia means abnormal flow,[3] is no longer recommended.[1]
In some women, menstrual spotting between periods occurs as a normal and harmless part ofovulation. 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 termbreakthrough bleeding (or breakthrough spotting) is usually used for women usinghormonal contraceptives, such asIUDs ororal 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 higherestrogen:progesterone ratio by either increasing the estrogen dose or decreasing the relative progesterone dose.[4]
Besides the aforementioned physiologic forms, IMB may also representabnormal uterine bleeding and be a sign of an underlying disorder, such as a hormone imbalance,endometriosis,uterine fibroids,uterine cancer, orvaginal cancer.[citation needed]
If the bleeding is repeated andheavy, it can cause significantiron-deficiency anemia.[citation needed]
Intermittent spotting between periods can result from any of numerous reproductive system disorders:[citation needed]
Neoplasia:
Inflammation:
Endometrial abnormalities:
Endocrinological causes:
Bleeding disorders:
Drug induced:
Traumatic causes:
Related topregnancy:
Other causes:
Breakthrough bleeding (BTB) is any of various forms ofvaginal bleeding, usually referring to mid-cycle bleeding in users ofcombined oral contraceptives as attributed to insufficient estrogens.[5] It may also occur with other hormonal contraceptives. Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of IMB.[6]
In the context ofhemophilia, the term describes a bleeding that occurs while a patient is onprophylaxis.[7]
The bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding.[citation needed]
It is estimated that breakthrough bleeding affects around 25% ofcombined oral contraceptive pill (COCP) users during the initial 3 to 4 months of use, it then usually resolves on its own.[8][9]
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.[9]
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 ofbirth control.[citation needed]
{{cite book}}: CS1 maint: multiple names: authors list (link)| International | |
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