Have you ever had bleeding outside of your menstrual period? Do you know why it happens and when you should see a specialist? In this article, you will learn the reasons why bleeding between periods can occur and when it is necessary to see a specialist.
For this, we have the collaboration of Dr. Ana Fernández Molina, specialist in Gynecology and Obstetrics at the Centro de Asistencia Integral de la Mujer Andalucía.
According to the gynecologist, bleeding between periods, also known as intermenstrual bleeding or spotting, can be normal when it occurs sporadically or coinciding with ovulation. It can also be normal when taking contraceptives, especially in the first 3 months, in which it is common even to spot during the whole cycle.
However, it is important to be alert to bleeding that occurs during menopause or when intermenstrual bleeding is heavier than menstruation or if it coincides with sexual intercourse.
Causes of bleeding between periods
There are multiple causes that can give rise to intermenstrual bleeding. Dr. Fernández Molina explains the most frequent ones:
- It is usually caused by ovulation. In this case, it is a scanty bleeding that lasts 2 or 3 days, coinciding with the middle of the menstrual cycle. Some women experience it in all their cycles; others experience it only sporadically.
- Women taking contraceptives or who have an IUD may also experience bleeding between periods, but it usually subsides within the first 3 months. If the bleeding continues, a change of contraceptives with a higher dose may be considered.
- Another cause of this bleeding is benign uterine pathologies, such as polyps or myomas. In some cases, the bleeding does not come from inside the uterus, but from the cervix due to an injury or the presence of a polyp. When this occurs it is normal for spotting to occur with sexual intercourse, known as cohorting.
- Isthmocele, which is a sac that sometimes forms in the scar from a cesarean section, can also cause this type of bleeding, but it is not very common.
If the bleeding is a one-time occurrence, should we be concerned?
When intermenstrual bleeding occurs only once or sporadically, we should not be concerned, because it can be caused by ovulation itself or by different external factors, which can cause alterations in our menstrual cycle, such as changes in diet, stress, intense exercise, etc.
Tests to determine the origin of intermenstrual bleeding
Dra. Fernández Molina explains that the tests necessary to determine the origin of the bleeding include an adequate clinical history to know the characteristics of the bleeding: when it occurs, the amount, whether it causes pain or not, etc.
On the other hand, a gynecological examination will be performed to determine the origin of the blood: whether it comes from the uterus, cervix or vagina.
A cytology will also be taken to rule out microscopic lesions in the cervix and a transvaginal ultrasound will be performed, which will allow us to visualize the existence of polyps, myomas or a thickening of the endometrium. In some cases, an endometrial biopsy may also be taken.
If no organic alteration is visualized, a hormonal analysis will be requested to rule out endocrine alterations that may alter the bleeding pattern.