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Intermenstrual bleeding

Vaginal bleeding at irregular intervals between expected menstrual periods

Field	Value
name	Intermenstrual bleeding
synonyms	Metrorrhagia, irregular vaginal bleeding
field	Gynecology
symptoms	Bleeding in between periods
risks	Family history
diagnosis	Based on physical examination
differential	Irregular menstruation

Intermenstrual bleeding (IMB), or metrorrhagia, is abnormal vaginal bleeding at irregular intervals between expected menstrual periods. It may be associated with bleeding with sexual intercourse. The term metrorrhagia, in which metro means measure and -rrhagia means abnormal flow, is no longer recommended.

In some women, menstrual spotting between periods occurs as a normal and harmless part of ovulation. Some women experience acute mid-cycle abdominal pain around the time of ovulation (sometimes referred to by the German term for this phenomenon, mittelschmerz). This may also occur at the same time as menstrual spotting.

The term breakthrough bleeding (or breakthrough spotting) is usually used for women using hormonal contraceptives, such as IUDs or oral contraceptives. It refers to bleeding or spotting between any expected withdrawal bleeding, or at any time if none is expected. If spotting continues beyond the first 3–4 cycles of oral contraceptive use, a woman should have her prescription adjusted to a pill containing higher estrogen:progesterone ratio by either increasing the estrogen dose or decreasing the relative progesterone dose.

Besides the aforementioned physiologic forms, IMB may also represent abnormal uterine bleeding and be a sign of an underlying disorder, such as a hormone imbalance, endometriosis, uterine fibroids, uterine cancer, or vaginal cancer.

If the bleeding is repeated and heavy, it can cause significant iron-deficiency anemia.

Causes

Intermittent spotting between periods can result from any of numerous reproductive system disorders: Neoplasia:

Cervical cancer
Uterine cancer
Vaginal cancer
Endometrial cancer
Primary fallopian tube cancer
Ovarian cancer

Inflammation:

Cervicitis
Endometritis
Vaginitis
Sexually Transmitted Infections
Pelvic inflammatory disease

Endometrial abnormalities:

Endometriosis
Adenomyosis
Uterine leiomyomas
Endometrial hyperplasia
Polyps}}

Endocrinological causes:

Hormone imbalance
Dysfunctional uterine bleeding
Diets which induce ketosis, such as the Atkins diet
polycystic ovarian syndrome}}

Bleeding disorders:

Von Willebrand Disease
Pancytopenia due to leukemia

Drug induced:

Use of progestin-only contraceptives, such as Depo Provera
Change in oral contraception
Overdose of anticoagulant medication or Aspirine abuse

Traumatic causes:

Automutilation
Sexual abuse or rape

Related to pregnancy:

Implantation bleeding
Ectopic pregnancy
(Incomplete) miscarriage

Other causes:

Enlarged uterus with menorrhea

Breakthrough bleeding

Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding, usually referring to mid-cycle bleeding in users of combined oral contraceptives as attributed to insufficient estrogens.Farlex Medical Dictionary Breakthrough Bleeding, in turn citing:

Segen's Medical Dictionary. Copyright 2012
McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002 It may also occur with other hormonal contraceptives. Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of IMB.

In the context of hemophilia, the term describes a bleeding that occurs while a patient is on prophylaxis.

Presentation

The bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding.

It is estimated that breakthrough bleeding affects around 25% of combined oral contraceptive pill (COCP) users during the initial 3 to 4 months of use, it then usually resolves on its own.

Mechanism

Breakthrough bleeding is commonly due to 4 factors: physiologic effects of OCs on the endometrium, OC-related parameters, (dose, formulation, and regimen), patient behavior, (compliance, using concomitant medications, and smoking) and benign or malignant pathology.

Treatment

Breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth control.

References

(June 2017). "Abnormal Uterine Bleeding: Current Classification and Clinical Management.". Obstetrics and Gynecology Clinics of North America.
(2023). "Netter's Obstetrics and Gynecology: Netter's Obstetrics and Gynecology". Elsevier.
"Rrhagia | Define Rrhagia at Dictionary.com". Dictionary.reference.com.
(2004). "The New Harvard Guide to Women's Health". Harvard University Press.
[http://www.merriam-webster.com/medical/breakthrough%20bleeding Merriam-Webster's Medical Dictionary > Breakthrough bleeding] Retrieved on Feb 28, 2010
"Prophylaxis: Barriers and challenges – World Federation of Hemophilia".
(2012). "Iatrogenic unscheduled (breakthrough) endometrial bleeding". Rev Endocr Metab Disord.
(2006). "Oral contraceptives and breakthrough bleeding: What patients need to know". The Journal of Family Practice.

Info: Wikipedia Source

This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

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