Intermenstrual bleeding is bleeding at times other than menstrual flow. In a normal ovulatory cycle, one ovum is released from the ovaries; if fertilization does not occur, the ovum and a part of thickened endometrial tissue (endometrium is the inner layer of the uterus) are sloughed off with the beginning of menstruation. Menstrual cycles usually range between 21 and 35 days in length, although most women begin their periods around 10-14 days following ovulation.

If the person is not using hormonal contraception, menstruation a regular intervals indicates that ovulation has occurred, and the person is not pregnant. Usually, the amount of blood discharged is less than 80 ml.

What is Abnormal Uterine Bleeding?

Bleeding outside the normal menstrual cycle in a woman female who is not on hormones, for instance, bleeding before day 20 of the cycle is abnormal uterine bleeding. Bleeding between periods has explicitly been variously described as intermenstrual bleeding. It is estimated that 14-17% of women bleed between periods. If anyone gets vaginal bleeding after stopping hormones or after menopause are also considered as abnormal uterine bleeding.

Causes of Intermenstrual Bleeding

Age and Developmental Stage: On the occasions of younger girls who have just started going through menstruation, it is very typical for them to possess irregular cycles. This may take as much as six years to get the cycle right. Similarly, during perimenopause-a transition stage before menopause-the irregularity of the cycle occurs because of changes in levels of hormones.

Spotting vs. Heavy Bleeding: First and foremost, distinguish between spotting and heavy bleeding. Light bleeding, or spotting, may occur in early pregnancy or as a side effect of hormonal birth control and is generally not a concern. Heavy bleeding can be indicative of structural problems, such as polyps, uterine a or fibroids, or hormonal imbalances contributing to ovulatory dysfunction.

Structural Abnormalities: Heavy bleeding during periods may be caused by living conditions such as polyps and fibroids. Monitoring hormone levels, specifically estrogen and progesterone levels, is recommended in heavy bleeding as it may point to endocrine disorders.

Infection: Infection along the reproductive tract may cause bleeding from the vagina. In most instances, the body clears the infection itself; however, medical consultation may be helpful to avoid future complications, such as scarring of the affected area, which can reduce fertility.

Cancer: This is rarely the cause, but intermenstrual bleeding can be a sign of cancer, such as that of the cervix, endometrium, or vagina. Medical advice must be sought to rule out these severe conditions.

What causes intermenstrual bleeding?

Anemia: Heavy bleeding between periods carries some primary risks, one of which is anemia, an outcome of blood loss that results in a deficiency of hemoglobin in the blood. Anemia-related symptoms include fatigue, dizziness, headaches, and irregular heartbeat. It can be treated with iron supplements. If the anemia is severe, someone might need a blood transfusion.

Impact on Fertility: Whether intermenstrual bleeding results in infertility depends upon the cause. Hormonal imbalances may affect ovulation and, hence, make conception tough. Structural causes make fertilization difficult. Single episodes of intermenstrual bleeding may not result in any difference in fertility, but frequent episodes diminish this opportunity.

Persistent bleeding between periods does not necessarily need to be ignored. Although related to common issues such as hormonal fluctuations or structural problems, the problem can denote other severe conditions in certain instances. It requires timely diagnosis, and only a proper investigation by a healthcare provider will determine the cause and recommended treatment.

The first thing to consider is whether age may be contributing.

Irregular periods are very common in girls who have only just started their periods. In fact, it can take up to six years for the menstrual cycle to become regular. Thus, whilst it is worth monitoring dates and timings, irregularities in menstruation in females of this age are rarely anything to be concerned about.

Abnormal cycles are also frequently seen in women who are approaching the menopause. The years that precede the menopause are known as the perimenopause. It is during these years that ovulation starts to slow down and menstruation becomes irregular, then sporadic, before ceasing altogether.

It is also important to establish the type of bleeding; whether it is heavy and period-like, or spotting. Spotting is light, there will not be enough to fill a tampon or pad, and the blood will usually be dark red or brown.

It can happen during pregnancy (particularly in the early stages when the fertilised egg first implants) and as a side effect to hormonal birth control. Spotting is not usually anything to worry about and can simply be an indication that not all of the endometrial tissue was removed during menstruation. Monitor any spotting and if it is consistent and becoming heavier see your doctor.

Heavy bleeding between periods can be caused by structural abnormalities, such as polyps and fibroids; or hormonal imbalances causing ovulatory dysfunction. If you are experiencing heavy intermenstrual bleeding your doctor may want to check your oestrogen and progesterone levels across your cycle to identify whether you have an endocrine disorder.

Another cause of intermenstrual bleeding is infection. Vaginal bleeding can be a symptom of an infection of the reproductive tract. Often the body is able to clear infections without the need for medical intervention; but you should still consult a doctor for confirmation and to ensure that there will be no lasting negative effects. In severe cases, infection-induced scarring of the reproductive organs can result in difficulties in conceiving.

In rare cases, intermenstrual bleeding can be a sign of cancer. Abnormal bleeding between periods can be a symptom of cervical, endometrial or vaginal cancer. You should consult a doctor, who will be able to perform the necessary tests to rule this out as a possibility.

The health risks of intermenstrual bleeding

One of the main health risks of heavy bleeding between periods is anaemia. The symptoms of anaemia are fatigue, headaches, dizziness and an irregular heartbeat. It can be treated with iron supplements.

You may also wonder whether frequent episodes of intermenstrual bleeding will have an effect on fertility. This will largely depend on the reason for the bleeding. If fluctuating hormone levels are responsible, you may experience difficulty conceiving because your hormones need to be present at exactly the right levels for ovulation to occur. Likewise, structural barriers can impede fertilisation.

If the bleeding occurs as a single episode, you are unlikely to fall pregnant that cycle, but may find that your fertility is actually enhanced during the cycle that follows. Subsequent cycles should not be affected. Repetitive episodes of intermenstrual bleeding probably will lower your overall chances of conceiving.

No woman should have to put up with persistent bleeding. It can be draining from a financial, physical and emotional perspective. Diagnosis may have to be made via a process of elimination, but it is essential that doctors consider all eventualities and perform the necessary tests, so that the right treatment can be instigated.

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 Sources:

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