Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Metrorrhagia, commonly called intermenstrual bleeding, is vaginal bleeding that occurs at irregular intervals not associated with themenstrual cycle. While the blood comes from the uterus as it does during menstruation, the bleeding does not represent a normal period.
There are several causes of metrorrhagia, some of which are harmless. In other cases, metrorrhagia can be a sign of a more serious condition.
This article will explain the symptoms, causes, and treatment options for metrorrhagia.
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Metrorrhagia vs. Menorrhagia
Metrorrhagia is specific to vaginal bleeding that happens during the month other than when someone is having or would expect to have their menstrual period.
What’s Considered Dysfunctional Uterine Bleeding?
Symptoms of Metrorrhagia
Some women who menstruate regularly experience light bleeding orspottingat various times throughout their cycle, especially atovulation. In these cases, symptoms such as mild discomfort and spotting at mid-cycle may not be unusual.
Sometimes the bleeding seems to follow a pattern and it may feel like you’re having “a second period” in between your usual periods. In other cases, the bleeding is entirely random and unpredictable.
It may be painless when the bleeding occurs, or you may experience cramps and other symptoms associated with your period, such asbloating.
Intermenstrual bleeding is often light but can also be quite heavy. In some cases, it may even be heavier than your regular period.The color of the blood can range from dark brown to red to light pink. Some people may see clots or mucus in their underwear or when they wipe.
Tell your healthcare provider about the characteristics of the bleeding as well as its duration. This information can help them pinpoint a cause.
What Is the Cause of Metrorrhagia?
There are many potential causes of metrorrhagia, though hormone levels play a key role in most cases.
During a regular menstrual period,hormonal changesdirect the lining of the uterus to build up in preparation to receive and nourish a fertilized egg. If this does not occur, the lining is shed and passes through the vagina.
With dysfunctional uterine bleeding, the lining is shed at another point in the cycle. Interruptions in the normal functioning of the hormones that direct the process can have various causes. Some, while inconvenient, are harmless, don’t last long, and can be easily treated.
Menarche and Menopause
When a woman first starts having a menstrual cycle (known asmenarche), it is not unusual for cycles to be erratic. This can include spotting that occurs at various times throughout the cycle. Usually, this resolves as adolescence progresses and hormones stabilize.
This type of unpredictable, irregular bleeding may also occur at the other end of a woman’s reproductive life as they begin to transition intomenopause.
Stress
Interruptions to the menstrual cycle can occur during times of emotional and physical stress, such as after starting a new job or while traveling.
Birth Control and Medications
Abnormal or unexpected bleeding may be experienced when starting or stopping a form ofhormonal birth control, such as “the pill.” Irregular use of hormonal contraception can also cause abnormal bleeding patterns, sometimes called “breakthrough bleeding,” which will usually resolve once use becomes consistent or a person changes to another method of birth control that works better for them.
Other medications that can cause dysfunctional uterine bleeding includeDepo-Provera shots, blood thinners like warfarin and aspirin, and supplements such asginseng.
Malnourishment
Abnormal uterine bleeding and even the complete ceasing of the menstrual cycle can occur when a woman is malnourished and/or underweight. This can include restricting certain food groups, such as on the Atkins or Keto diet.
Fertility Treatments
Women who are undergoing fertility treatments often experience symptoms related to menstruation, including bleeding at unexpected times during their cycle, bleeding more or less than usual, or havingpremenstrual symptoms.
Underlying Health Conditions
Metrorrhagia can also be a sign of an underlying health condition. While some of the conditions are considered benign (harmless), others can have serious consequences if left untreated.
Metrorrhagia can occur with:
While many cancers of the reproductive system have few, if any, signs and symptoms in the early stages, abnormal uterine bleeding may be one.It is especially important to take note ofabnormal vaginal bleedingif you are no longer having periods and have entered menopause.
The following cancers may cause metrorrhagia:
Unexpected vaginal bleeding or spotting can also be an early sign of pregnancy. If you experience metrorrhagia and think you could be pregnant, see your healthcare provider. In rare cases, this can signal an ectopic pregnancy.
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Diagnosing Metrorrhagia
Your primary care doctor will most likely refer you to a reproductive healthcare provider, usually anobstetrician/gynecologist(OB/GYN), a doctor who specializes in reproductive health conditions.
An OB/GYN will talk to you in-depth about your symptoms. They will likely ask you questions about the bleeding, such as:
They may review any other medical conditions you have or have had in the past, as well as any medications and supplements you are taking.
Physical Exam
During a physical exam, you will be asked to change into a gown, position yourself on the exam table, and place your feet in stirrups. Your healthcare provider may listen to your heart as well as your abdomen with a stethoscope. They may use their hands to palpate (push on lightly) your abdomen and pelvic region. If you experience any pain during this exam, let them know.
Your healthcare provider may also do arectovaginalexam. Using a lubricated glove, they will place a finger inside your rectum and vagina. This helps them feel for any abnormalities.
Apelvic exam(during which a speculum is inserted into your vagina and the vaginal walls are spread) may also be done. This exam helps your healthcare provider see inside the vaginal canal up to your cervix.
While these exams can cause slight discomfort, they usually do not take long.
If you feel uncomfortable physically or emotionally during the exam, don’t hesitate to tell your healthcare provider or the assisting nurse that you need to pause or stop.
Labs and Tests
Your healthcare provider may want to do some other types of tests to help determine the cause of metrorrhagia.
Tests your healthcare provider may order if you are experiencing metrorrhagia include:
How Do You Treat Metrorrhagia?
The treatment for metrorrhagia will be specific to its cause, as well as the individual needs of the person. Some treatments will be safer and more effective than others. For example, while hormonal contraception can be used to treat abnormal uterine bleeding, birth control pills may not be appropriate for a person with a history ofblood clots.
Once your healthcare provider has figured out why you are experiencing metrorrhagia, they can help you decide the best way to treat it.
Treatment options may include:
Lifestyle Changes
In some cases, the condition may be temporary and responsive to changes in your lifestyle. You may be able to treat discomfort with over-the-counter pain relievers (such as NSAIDs) while you work on reducing stress or getting yourself back on a routine after a vacation.
For example, if being underweight seems to be the cause of metrorrhagia, you may notice your symptoms improve if you gain weight.
Hormonal Therapy
Certain types of hormonal therapy, especially those that include progestin, may be used to treat abnormal bleeding. These can include birth control pills,IUDs, estrogen patches, and other options.
Another form of therapy calledGonadotropin-releasing hormone(GnRH) agonists may also be prescribed.However, these medications can only be used short-term and can have many side effects.
If you are not sexually active or have never had sex, you can still use hormonal methods to treat problems with your menstrual cycle. Your healthcare provider will help you decide which one is best for you.
Dilation and Curettage
Procedures likedilation andcurettage(D&C)may be recommended if you have heavy bleeding that is causing other problems, like anemia.A D&C involves removing some endometrial tissue with a special tool, a curette, inserted into the uterus through the vagina.
You don’t necessarily need to go to the hospital for a D&C, the procedure can often be done in a healthcare provider’s office or at a reproductive health clinic.
Although D&C is not surgery per se, it is typically performed while you are under anesthesia. While it can be useful for figuring out why you are bleeding abnormally, D&C procedures don’t solve the problem indefinitely. They are also more invasive than other options and come with risks. Your healthcare provider will help you decide if it’s the appropriate option for you.
Treating Underlying Health Conditions
Sexually transmitted infectionscan often be treated with medication, such as antibiotics. If you are diagnosed with an STI, it is important to notify any sexual partners you’ve had about your condition and to practicesafer sex.
For conditions that affect another part of your body, such as your thyroid or blood disorders, you will likely need to work with a specialist for treatment. Once you address the underlying disease that is causing your symptoms, metrorrhagia will usually resolve.
If you are diagnosed with a more serious condition, you will need to work with a team of healthcare providers who will help you decide on treatment. Surgery may be required, especially for conditions such as endometriosis, fibroid tumors, and reproductive cancers which usually need specialized surgery.In some cases, your healthcare provider may recommend you have a partial or completehysterectomy.
Summary
Metrorrhagia, also called intermenstrual bleeding, abnormal vaginal bleeding, or dysfunctional uterine bleeding is vaginal bleeding that happens outside of the normal menstrual cycle.
Sometimes the bleeding occurs due to lifestyle factors like stress, weight loss, or travel, but it can also be due to hormonal changes, medications, and certain health conditions.
This type of bleeding can have many causes, some of which are more serious than others. The type of treatment will depend on the cause and the specific needs of the person experiencing metrorrhagia.
Causes of Heavy Bleeding During Your Period
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American College of Obstetricians and Gynecologists.Abnormal uterine bleeding.MedlinePlus.Vaginal bleeding between periods.Johns Hopkins Medicine.Menorrhagia.American College of Obstetricians and Gynecologists.What you should know about breakthrough bleeding with birth control.National Capital Poison Center. Poison Control.Side effects of ginseng supplements.McGrice M, Porter J.The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: A systematic review.Nutrients. 2017 Feb 27;9(3):204. doi:10.3390/nu9030204Eaton JL, Zhang X, Kazer RR.First-trimester bleeding and twin pregnancy outcomes after in vitro fertilization.Fertil Steril. 2016 Jul;106(1):140-143. doi: 10.1016/j.fertnstert.2016.03.027.Centers for Disease Control and Prevention.About von Willebrand Disease.Centers for Disease Control and Prevention.Symptoms of Gynecologic Cancers.American College of Obstetricians and Gynecologists.Dilation and Curettage (D&C).Additional ReadingHoxhaj O, Gjoni M.Management of acute abnormal uterine bleeding in nonpregnant women.International Journal of Science and Research (IJSR). 2016;5(3):273-275. doi:10.21275/v5i3.nov161858
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American College of Obstetricians and Gynecologists.Abnormal uterine bleeding.MedlinePlus.Vaginal bleeding between periods.Johns Hopkins Medicine.Menorrhagia.American College of Obstetricians and Gynecologists.What you should know about breakthrough bleeding with birth control.National Capital Poison Center. Poison Control.Side effects of ginseng supplements.McGrice M, Porter J.The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: A systematic review.Nutrients. 2017 Feb 27;9(3):204. doi:10.3390/nu9030204Eaton JL, Zhang X, Kazer RR.First-trimester bleeding and twin pregnancy outcomes after in vitro fertilization.Fertil Steril. 2016 Jul;106(1):140-143. doi: 10.1016/j.fertnstert.2016.03.027.Centers for Disease Control and Prevention.About von Willebrand Disease.Centers for Disease Control and Prevention.Symptoms of Gynecologic Cancers.American College of Obstetricians and Gynecologists.Dilation and Curettage (D&C).Additional ReadingHoxhaj O, Gjoni M.Management of acute abnormal uterine bleeding in nonpregnant women.International Journal of Science and Research (IJSR). 2016;5(3):273-275. doi:10.21275/v5i3.nov161858
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American College of Obstetricians and Gynecologists.Abnormal uterine bleeding.MedlinePlus.Vaginal bleeding between periods.Johns Hopkins Medicine.Menorrhagia.American College of Obstetricians and Gynecologists.What you should know about breakthrough bleeding with birth control.National Capital Poison Center. Poison Control.Side effects of ginseng supplements.McGrice M, Porter J.The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: A systematic review.Nutrients. 2017 Feb 27;9(3):204. doi:10.3390/nu9030204Eaton JL, Zhang X, Kazer RR.First-trimester bleeding and twin pregnancy outcomes after in vitro fertilization.Fertil Steril. 2016 Jul;106(1):140-143. doi: 10.1016/j.fertnstert.2016.03.027.Centers for Disease Control and Prevention.About von Willebrand Disease.Centers for Disease Control and Prevention.Symptoms of Gynecologic Cancers.American College of Obstetricians and Gynecologists.Dilation and Curettage (D&C).
American College of Obstetricians and Gynecologists.Abnormal uterine bleeding.
MedlinePlus.Vaginal bleeding between periods.
Johns Hopkins Medicine.Menorrhagia.
American College of Obstetricians and Gynecologists.What you should know about breakthrough bleeding with birth control.
National Capital Poison Center. Poison Control.Side effects of ginseng supplements.
McGrice M, Porter J.The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: A systematic review.Nutrients. 2017 Feb 27;9(3):204. doi:10.3390/nu9030204
Eaton JL, Zhang X, Kazer RR.First-trimester bleeding and twin pregnancy outcomes after in vitro fertilization.Fertil Steril. 2016 Jul;106(1):140-143. doi: 10.1016/j.fertnstert.2016.03.027.
Centers for Disease Control and Prevention.About von Willebrand Disease.
Centers for Disease Control and Prevention.Symptoms of Gynecologic Cancers.
American College of Obstetricians and Gynecologists.Dilation and Curettage (D&C).
Hoxhaj O, Gjoni M.Management of acute abnormal uterine bleeding in nonpregnant women.International Journal of Science and Research (IJSR). 2016;5(3):273-275. doi:10.21275/v5i3.nov161858
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