The defining characteristics of a normal menstrual period can vary widely: Some women have light periods that last three or four days, while others experience a heavier flow for two or three days, followed by another two or three days of light or “spotty” bleeding.
What’s not normal, however, is uterine bleeding between periods.
At New Beginnings OB/GYN in Shenandoah, Texas, our women’s wellness team specializes in diagnosing common gynecological concerns, including abnormal uterine bleeding. As Dr. Christina Parmar and Dr. Rania Ibrahim explain why bleeding between periods should always prompt you to visit our office.
The average woman starts her menstrual cycle in early adolescence and continues having regular periods until she reaches menopause in middle age. Outside of any pregnancies, most women have a monthly period for about four decades — or half their typical lifespan.
A typical menstrual cycle lasts 28 days (four weeks), but a normal cycle can last anywhere between 21 days (three weeks) and 35 days (five weeks). Controlled by the rise and fall of the female sex hormones estrogen, progesterone, and follicle-stimulating hormone (FSH), this reproductive cycle has four phases:
During the follicular phase, your ovaries prepare to release a mature egg as your uterus thickens with blood to prepare for the possibility of pregnancy. Ovulation, or the release of a mature egg into the uterus, occurs about halfway through the menstrual cycle.
If pregnancy doesn’t occur during the post-ovulation luteal phase, your hormone levels drop, prompting your uterus to shed its blood-thickened lining. This marks the start of the menses phase, otherwise known as your monthly period. A normal period lasts three to seven days.
Bleeding between periods — also known as intermenstrual bleeding, metrorrhagia, or spotting — isn’t just an unexpected inconvenience; it can also be cause for concern. Spotting between periods may appear as:
Breakthrough bleeding during the middle of a menstrual cycle isn’t uncommon and can happen for many reasons. While spotting isn’t usually a sign of a serious underlying health problem, it can be — and for this reason, it always warrants an evaluation with our team.
Before you come to our office for an evaluation, it’s helpful to track when your spotting is happening (i.e., randomly, usually after intercourse), whether it seems to be associated with other symptoms, and if the bleeding patterns of your period have also changed.
We typically begin by considering your age and reproductive stage of life. We may also:
Some of the most common causes of intermenstrual bleeding include:
Hormonal changes are a frequent cause of spotting. It can occur as a routine side effect of perimenopause, as a side effect of hormone replacement therapy (HRT) during menopause called withdrawal bleeding, and as a side effect of inconsistent or changing (i.e., starting or stopping) hormonal contraceptive use.
Polycystic ovary syndrome (PCOS) and thyroid disorders are other hormonal-driven causes of bleeding between menstrual periods.
Cervical, endometrial, and uterine polyps can cause spotting, as can uterine fibroids.
Bleeding between periods can be a sign of a sexually transmitted infection (STI) like gonorrhea, chlamydia, or herpes. Pelvic inflammatory disease (PID) is also associated with spotting.
Intermenstrual bleeding may also be a sign of a pregnancy complication. If you experience spotting after a recent regular period and could be pregnant, it’s important to rule out an ectopic pregnancy or miscarriage.
Less commonly, bleeding between periods may be caused by:
Obesity, diabetes, severe kidney or liver disease, and celiac disease can all cause bleeding between periods, but spotting from systemic illness is relatively rare.
Gynecological cancers — including ovarian, cervical, uterine, vaginal, and vulvar cancers — are possible, albeit less common, causes of spotting.
Come see us if you’ve been bleeding between periods — especially if it recurs, persists, or worsens. The bottom line? Spotting that’s caused by perimenopause or cancer looks the same, and the only way to know the difference is to have it evaluated.
Are you worried about abnormal uterine bleeding? We can get to the bottom of the problem and find a treatment solution to help. Call or click online to schedule an appointment today at New Beginnings OB/GYN in Shenandoah, Texas.