Intermenstrual bleeding

Intermenstrual bleeding
Intermenstrual bleeding
Other names	Metrorrhagia, irregular vaginal bleeding
Specialty	Gynecology
Symptoms	Bleeding in between periods
Risk factors	Family history
Diagnostic method	Based on physical examination
Differential diagnosis	Irregular menstruation

Intermenstrual bleeding (IMB) is vaginal bleeding at irregular intervals between expected menstrual periods.^[1] It may be associated with bleeding with sexual intercourse.^[2]

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, in which it refers to bleeding or spotting between any expected withdrawal bleedings, or bleeding or spotting 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 progestin dose.^[3]

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

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

^ Bacon, JL (June 2017). "Abnormal Uterine Bleeding: Current Classification and Clinical Management". Obstetrics and Gynecology Clinics of North America. 44 (2): 179–193. doi:10.1016/j.ogc.2017.02.012. PMID 28499529.
^ Smith, Roger P. (2023). "60. Postcoital bleeding". Netter's Obstetrics and Gynecology: Netter's Obstetrics and Gynecology (4th ed.). Philadelphia: Elsevier. pp. 139–140. ISBN 978-0-443-10739-9.
^ Carlson, Karen J., MD; Eisenstat, Stephanie A., MD; Ziporyn, Terra (2004). The New Harvard Guide to Women's Health. Harvard University Press. p. 385. ISBN 0-674-01343-3.{{cite book}}: CS1 maint: multiple names: authors list (link)

[Bac2017-1] Bacon, JL (June 2017). "Abnormal Uterine Bleeding: Current Classification and Clinical Management". Obstetrics and Gynecology Clinics of North America. 44 (2): 179–193. doi:10.1016/j.ogc.2017.02.012. PMID 28499529.

[Smith2023-2] Smith, Roger P. (2023). "60. Postcoital bleeding". Netter's Obstetrics and Gynecology: Netter's Obstetrics and Gynecology (4th ed.). Philadelphia: Elsevier. pp. 139–140. ISBN 978-0-443-10739-9.

[3] Carlson, Karen J., MD; Eisenstat, Stephanie A., MD; Ziporyn, Terra (2004). The New Harvard Guide to Women's Health. Harvard University Press. p. 385. ISBN 0-674-01343-3.{{cite book}}: CS1 maint: multiple names: authors list (link)

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