Bleeding from the uterus between menstrual periods is called metrorrhagia. This is a common problem, especially for teenagers and women nearing menopause.
How does it occur?
There are many reasons why women may have metrorrhagia. They are:
hormone imbalance (the imbalance is sometimes caused by improper use of hormone medicine, such as birth control pills)
polyps, which are growths on the cervix (the opening of the uterus) or inside the uterus; polyps are usually
- fibroids, which are noncancerous growths in the uterus
- infection or inflammation of the uterus, cervix, or vagina
- erosion of the cervix (loss of the surface skin of the cervix)
- use of an IUD (intrauterine device) or birth control pills
- endometriosis (uterine tissue growing outside the uterus)
- adhesions (scar tissue) inside the uterus
- dry vaginal walls from decreased estrogen after menopause
- chronic medical problems (for example, thyroid problems, diabetes, and blood-clotting problems)
- some medicines, such as blood thinners
- cancer of the cervix or other parts of the uterus and vagina
Causes and Development
It can be caused by a hormonal imbalance (hyperthyroidism or hypothyroidism); pregnancy disorder; cervical lesions; medications (birth control pills, corticosteroids, hypothalamic depressants, anticholinergics, anticoagulants); uterine fibroids; functional ovarian cysts; polyps; carcinoma of the vagina, cervix, endometium or ovary; renal or liver disease; coagulation disorders; anabolic steroid use; IUDs or other trauma.
How is it diagnosed?
Your healthcare provider will ask about your medical history and menstrual cycles. Your provider may ask you to keep a diary of bleeding and nonbleeding days, including notes about how heavy the bleeding was.
You will also have a physical exam.
You may need a blood test or procedure, such as:
- Endometrial biopsy: Your healthcare provider takes a sample of tissue from the inside of the uterus. The tissue is then examined under a microscope in the lab.
- Ultrasound scan: Sound waves are used to get pictures of the uterus, ovaries, and pelvis. The ultrasound probe may be placed on your lower abdomen or into your vagina.
- Sonohysterogram: An ultrasound scan is done after fluid is injected through a tube into your uterus. This test allows your provider to look for problems with the lining of the uterus.
- Hysteroscopy: Your healthcare provider inserts a thin metal tube with a light and tiny camera through the vagina and cervix and into the uterus. This allows your provider to see the inside of the uterus.
- Hysterosalpingography: Dye is injected into the uterus and fallopian tubes through the cervix. X-rays are then taken. The dye outlines the shape and size of the uterus and tubes.
Many of these procedures may be done in your healthcare provider’s office. Others may be done in an outpatient clinic.
How is it treated?
The treatment depends on the cause of the problem. For example, if you have a hormone imbalance, your healthcare provider may prescribe hormones.
If an IUD is causing the problem, it will be removed. Erosion of the cervix may be treated by removing or destroying some of the cervical tissue.
Sometimes surgery is needed. Possible surgical treatments include:
- D&C: in which tissue is scraped or suctioned from the uterus
- Hysteroscopy: to remove a polyp, for example
- Hysterectomy: which is removal of the uterus
If cancer is found, it may be treated with surgery, radiation, or chemotherapy (anticancer drugs), or any combination of these treatments.
How long will the effects last?
How long you have bleeding between periods depends on the cause and treatment.
How can I take care of myself?
If you have bleeding between periods for 2 months in a row, call your healthcare provider. Call right away if you have severe bleeding or pain.
Follow the treatment recommended by your provider.