Intermenstrual bleeding and spotting

Non-pregnant women of childbearing age have their menstrual period about every three to five weeks. Occasionally, however, additional intermenstrual bleeding occurs outside of the menstrual cycle, which can have a variety of harmless but also dangerous causes. Intermenstrual bleeding should, therefore, be taken seriously and clarified by a gynaecologist.

Intermenstrual bleeding and spotting

The bleeding can be light spotting or longer-lasting additional bleeding. One speaks of spotting when it is bleeding with little brown blood that occurs shortly before menstruation, in the middle of the cycle or at the time of ovulation.

If brief periods of bleeding occur, the doctor – depending on the age – will first clarify a possible pregnancy before looking for organic causes in the area of ​​the vagina, uterus and ovaries, as well as for hormonal disorders, metabolic disorders or psychosomatic factors.

If there is light, bright red bleeding after intercourse, a damaged vessel, for example, in the vagina, is often the cause of this intermenstrual bleeding. Taking estrogens can then bring about an improvement.

 

Intermenstrual bleeding: signs of cancer?

But cervical cancer can also be behind such bleeding. In the early stages of this cancer, the affected tissue is cut out in a cone shape; in the advanced stages, the uterus is completely removed, and radiotherapy and chemotherapy are carried out.

Intermenstrual bleeding can also occur if cells in the lining of the uterus (uterine cancer) have changed malignantly. The therapy consists either of a scraping of the uterus, hormone treatment and radiation therapy, or the uterus (including lymph nodes if necessary ) is removed and radiation therapy is carried out.

Inflammatory bleeding and bulging follicles

Several other intermenstrual bleedings can be traced back to severe organic causes. Inflammatory bleeding can occur if the lining of the uterus is chronically inflamed (endometritis). Acute inflammation of the fallopian tubes and ovaries can even become life-threatening. Those affected should, therefore, see a doctor immediately if, in addition to bleeding between periods, there is also severe pain in the abdomen, fever and a general feeling of illness.

If the cause is a bacterial infection, it will likely need to be treated with antibiotics. Long-lasting intermenstrual bleeding is primarily the result of benign muscle growths (fibroids) in the uterine wall or on its outside. Ovarian cysts cause constant spotting. They arise due to a hormonal imbalance. The matured follicle does not rupture for one or more cycles and forms a cyst. Treatment can be with hormonal contraceptives and progestins.

 

Hormonal imbalances are often the cause of spotting.

On the other hand, the following types of spotting or bleeding between periods have mostly harmless causes:

• Ovulation bleeding: This light and brief bleeding lasting one to three days occurs at the time of ovulation. The cause is the drop in the hormone estrogen shortly after ovulation. To stabilize the hormone situation in the event of ovulation bleeding, it may be advisable to take the pill or to be treated with estrogen or progestin-estrogen preparations in the middle of the cycle.
• Spotting before or after your period due to yellow body weakness (premenstrual bleeding) or delayed corpus luteum regression (postmenstrual bleeding): The corpus luteum develops after ovulation and produces small amounts of estrogen and especially progesterone (the corpus luteum hormone). A hormone imbalance can be compensated for by hormone replacement therapy with progestin preparations. However, growths or tumours in the uterus or inflammation in the pelvic area can also be the cause.
• Bleeding when you start taking a pill with a low estrogen content: Taking the minipill (low-dose progestin preparation), the three-month injection and the insertion of an IUD can lead to bleeding between periods.
• An implantation bleed  (implantation bleed) occurs when an embryo implants itself in the lining of the uterus around 7 to 10 days after ovulation. Implantation bleeding is often not visible from the outside.