Intermenstrual Bleeding or Spotting - Is it Normal or Should I be Worried?

Causes of Intermenstrual bleeding:

Intermenstrual bleeding or bleeding between periods can be caused by a vast number of factors which may be physical or organic and psychosocial. If you are experiencing intermenstrual bleeding, then your doctor maybe a able to rule out one of the below most probable types of causes (from most likely to least likely):

• Complicated Pregnancy: Several early pregnancy complications exist such as ectopic pregnancies, miscarriage, implantation bleeding (not actually a complication but rather a natural physiologic process that leads to spotting) etc. These complications can lead to intermenstrual bleeding or spotting. Your doctor will need to rule that out first.
• Infection: This is one of the most common causes of bleeding between period. Pelvic infections or inflammations such as PID, cervicitis, vaginitis, endometritis, septic abortions, STDs etc can lead to vaginal bleedings between periods.
• Uterine Fibroids or Polyps: These are uterine growths or masses, that are benign or non-cancerous and even though the majority are not symptomatic, but usually can present with instermenstrual bleeding.
• Ovarian Cysts: PCOS/PCOD can lead to intermenstrual bleeding and it is one of the leading causes of bleeding in young women.
• Hormonal Imbalance: Gonadotrophic hormones such as estrogen and progesterone (natural hormones secreted by the female gonads) could become abnormally secreted in the blood stream and hence lead to abnormal vaginal bleeding. Other hormonal systems that influence secretion of these hormones could also be affected, hence contribute to this disorder. Other underlying diseases conditions are usually associated to this.
• Intrauterine Device: Women that happen to use IUD or intrauterine devices as primary birth control method, can experience intermenstrual bleeding.
• Cancer: Rare and usually occurs in older women. Uterine, ovarian, cervical cancers etc
• Rare Causes: Other rarer causes of intermenstrual bleeding exist such as menopause, endometriosis, stress, change in diet plan, trauma, post-coital bleeding, obesity, birth control pills/injections etc

When to See a Doctor:

Even though it is always wise to seek your doctor's opinion when ever you experience an abnormal vaginal bleeding, but it is not always necessary. It is best you observe for persistence (when bleeding is severe) or reoccurence, then you can then seek doctor's opinion. Other symptoms might also guide you in making the decision (quick enough) to see your doctor or health care provider, such as lower abdominal pain, heavy bleeding, dizziness, fatigue, fever.

At Doctor's Consultation:

• You might be required to answer a wide range of questions surrounding especially the bleeding i.e from time of onset, duration, if other previous episodes, associated symptoms with doctor including as much of your gyneco-obstetric history as possible.
• After which, your doctor will then conduct a full physical exams with especially a pelvic exams.
• Specific diagnostic (laboratory and imagery) tests can then be conducted based on the data your doctor has collected. You should expect tests such as complete blood count, STD screening (TPHA/VDRL/ chlamydia IgG, vaginal spear, paps smear), urinalysis, pregnancy tests and pelvic ultrasound or scan. All these aimed at determining the cause of your bleeding. In some cases, analysis of serum levels of estrogen and progesterone might be necessary.
• Once the cause is established, your doctor (most likely a gynecologist) will provide you with an appropriate treatment. In some cases, you might be expected to undergo a surgical procedure.

Complications of Persistent Intermenstrual Bleeding:

Several complications can arise from a neglected persistent or recurrent intermenstrual bleeding such as:

• Anemia
• Hemorrhagic shock
• Infection
• Metastastic cancers
• Miscarriage

In most cases, spotting or intermenstrual bleeding resolves on its own without medical intervention.

How to Prevent Intermenstrual Bleeding:

• It will be hard to tell which exact method is good to prevent intermentstrual bleeding given that they are various possible causes. So, the method will depend on the cause, therefore;
• If you suspect that your pregnant, it is best to start your ANC as soon as possible so a complete evaluation of your pregnancy can be done and prophylactic treatments initiated soon enough.
• From time to time (especially if you practice unprotected sex with multiple partners), it is best you do repeat screen of STDs so they can be detected earlier and treated.
• Do screen for pelvic cancers such as uterine, ovarian, cervical cancers, say ones every year or 2-3 years interval.
• Generally maintain healthy lifestyle, seek doctor's opinion if you suspect medication or IUD responsible for the bleeding.

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