Bleeding or spotting between periods can be a
frightening experience. You never know when bleeding between periods may
occur. Maybe your period was over last week and then you notice that
you're bleeding again. Maybe this isn't the first month you've
experienced bleeding or spotting between periods. Or it could be the
first time you've had bleeding between periods. Whether it's the first
time you've experienced bleeding between periods, or just another month
of spotting, bleeding between periods is a frustrating and stressful
experience.
What Is Normal Menstruation?
Normal menstrual bleeding lasts about four to
five days, and although it may seem like you are losing a lot more
blood, the amount of blood lost during your period is only about two to
eight tablespoons. While normal menstruation occurs on average every 28
days, anywhere from 21 to 35 days between periods is considered normal.
Vaginal bleeding that occurs between periods or
after menopause sometimes may be due to cancer or pre-cancer, and should
be evaluated promptly. The risk of cancer increases with age. Make sure
that bleeding is coming from the vagina and is not from the rectum or in
the urine. Inserting a tampon into the vagina will confirm the vagina,
cervix, or uterus as the source of bleeding.
A careful exam by your health care provider is
frequently the best way to sort out the source of the bleeding. This
exam can be accomplished even while you are bleeding. Do not delay
getting an exam just because you are currently bleeding.
When Should You Worry About Menstrual Bleeding?
If you are post-menopausal, or younger than 11
and vaginal bleeding occurs, consult your physician immediately. You
should try to determine where the bleeding is coming from: Are you
bleeding from your vagina? Your rectum? Or is blood in your urine?
What Causes Bleeding Between Periods?
Although the cause of irregular bleeding can
vary according to individual health situations, some of the more common
causes include:
Miscarriage
Hormonal fluctuations
Starting, stopping, or missing oral
contraceptives or estrogens
Low thyroid levels
Stress
IUDs occasionally cause slight spotting
Injury to the vagina from insertion of objects
Malignant cancers
Undiagnosed vaginal infections
Certain drugs, particularly anticoagulants
Vaginal dryness
GYN procedures
some women have spotting during ovulation,
which is normal
Bed rest may be recommended if between period
bleeding is heavy. Use your menstrual cycle calendar to record the
number of tampons or pads you use. This information can help your doctor
determine whether you are bleeding excessively.
Unless your doctor specifically advises
otherwise, never take aspirin while you are menstruating. Aspirin can
cause bleeding to occur longer and heavier. Of course, you should inform
your doctor about any bleeding or spotting between periods that you
experience.
Home Care
Immediately contact a health care provider if bleeding
is very heavy. Keep track of the number of pads or tampons used over time so
that the amount of bleeding can be determined. Uterine blood loss can be
estimated by keeping track of how frequently a pad or tampon is soaked and how
often one needs to be changed. Because aspirin may prolong bleeding, it should
be avoided, if possible.
When to
Contact a Medical Professional
Call your health care provider if:
You are pregnant
There is any unexplained bleeding between periods
There is any bleeding after menopause
Abnormal bleeding is accompanied by other symptoms
What to Expect
at Your Office Visit
The doctor will perform a physical exam and ask questions
about your medical history. The physical examination with include an emphasis on
the pelvic area.
Questions may include:
Time pattern
When did this bleeding between periods begin?
Does it occur consistently, such as every month?
When (during the course of a menstrual cycle) does
this bleeding begin?
How long does the in-between bleeding last?
Quality
Is the bleeding heavy?
How many tampons or pads are required?
Do cramps accompany the bleeding?
Aggravating factors
What makes it worse?
Does increased physical activity make the bleeding
worse?
Does intercourse bring on the bleeding?
Is increased stress associated with the bleeding?
Relieving factors
Does anything relieve or prevent it?
Other symptoms
What other symptoms do you have?
Do you have abdominal pain or cramps?
Is there increased bruising elsewhere on the body?
Do you have any difficulty, pain or burning with
urination?
Is there bloody urine or blood in the stools?
Other important information
Are you pregnant?
Have you had a miscarriage or abortion?
Have you had a D and C?
Have you ever had an abnormal Pap smear?
What medications are you taking? Do you take
hormones or supplements?
Are you using tampons? What kind? What size?
At what age did your periods start?
Have you had normal periods without bleeding between
in the past?
Are you sexually active?
Do you have a history of sexually transmitted
disease?
Are you using birth control? What kind?
Have you been injured?
Have you received any medical or surgical
treatments?
Tests that may be done include:
Blood tests for thyroid and ovarian functions
Cervical cultures for sexually transmitted diseases
Bleeding or spotting between periods can be a
frightening experience. You never know when bleeding between periods may
occur. Maybe your period was over last week and then you notice that
you're bleeding again. Maybe this isn't the first month you've
experienced bleeding or spotting between periods. Or it could be the
first time you've had bleeding between periods. Whether it's the first
time you've experienced bleeding between periods, or just another month
of spotting, bleeding between periods is a frustrating and stressful
experience. 
20 Resources
on Menstruation
