Many women are familiar with intermenstrual bleeding, which occurs independently of menstruation during the female cycle. Zwischenblutungen can be both harmless, as well as an expression of worse diseases. Intermediate bleeding should therefore always be clarified by a doctor.
What is intermenstrual bleeding?
Intermittent bleeding is additional bleeding that occurs independently of female menstruation during the cycle. It is a bleeding disorder that may manifest as light spotting with light or brownish blood. However, intermenstrual bleeding can also last for several days and be very heavy. Intermittent bleeding should definitely be taken seriously, as it can have very different – sometimes not harmless – causes. For this reason, intermittent bleeding should always be clarified by the attending physician, ideally a gynecologist. In the case of sudden, very heavy bleeding, which may also be accompanied by pain, the patient should immediately see a doctor or go to the nearest hospital, as such intercostal bleeding can be an acute emergency.
Causes
There are many causes of intermenstrual bleeding. They can be harmless, for example, if it is ovulation bleeding or contact bleeding after sexual intercourse. Frequently, intermenstrual bleeding is hormonal, such as when there is a deficiency of corpus luteum hormones, menstrual disorders, or when taking hormonal contraceptives. Hormonal disturbances of the female cycle occur particularly frequently at the beginning of sexual maturity (puberty) or before menopause. Intermediate bleeding can also occur in connection with (early) pregnancy, when the fertilized egg implants in the uterine mucosa or when there is an ectopic pregnancy. Mental or psychological problems can also cause intermenstrual bleeding. However, diseases of the reproductive organs such as inflammation of the uterus or fallopian tubes, benign fibroids or polyps, endometriosis or benign and malignant tumors are also possible triggers. Metabolic diseases such as thyroid dysfunction or diabetes and organ diseases such as liver and kidney disorders must also be clarified by the doctor as a cause of intermenstrual bleeding.
Symptoms, complaints and signs
Bleeding between periods may be accompanied by the classic symptoms of menstruation, such as lower abdominal pain or breast tenderness. Characteristically, it occurs outside the normal menstrual cycle. Often there is spotting shortly before the period, which can be recognized by a brownish coloration and is hormonally caused. Intermediate bleeding is also possible in the middle of the cycle. This is often lighter in color and can indicate ovulation. Implantation bleeding of a fertilized egg also belongs to the category of intermenstrual bleeding. Inconsistent use of hormonal contraceptives can also trigger intermenstrual bleeding in a woman. The same applies to a too weakly dosed contraceptive. Intermittent bleeding can be a one-time event, but it can also occur regularly in the cycle. However, not all bleeding is caused by hormones. Intermittent bleeding outside the menstrual cycle can also occur as a result of sexual intercourse. This is also called contact bleeding, which can also occur after a gynecological examination. It is often a symptom of intermenstrual bleeding that it is much weaker than the normal period. It also often does not last that long and can be over after only two days. Often, physical exertion or heavy pressing when going to the toilet also triggers the intermenstrual bleeding, which then often disappears quickly.
Diagnosis and course
In the event of intercostal bleeding, the patient should always ask her gynecologist for advice. He or she will first find out the accompanying circumstances, such as pain, fever, duration and strength of the bleeding, by questioning the woman and then choose the examination method based on his or her tentative diagnosis. A palpation examination and microscopic examination of the vaginal secretion smear provide him with initial indications of any pelvic inflammation. A blood test gives the doctor indications of inflammation, hormonal problems or metabolic disorders. With the help of an ultrasound examination, the gynecologist can determine whether changes such as tumors, fibroids or polyps are visible in the abdomen.If necessary, further diagnostics are required for clarification: Various surgical procedures, such as uteroscopy or laparoscopy, are available to diagnose interstitial bleeding. The course of intercostal bleeding depends on the cause and can be harmless or severe, depending on the cause.
Complications
In most cases, intermenstrual bleeding is not problematic. Complications can occur if bleeding is particularly heavy or lasts excessively long. Then anemia and deficiency symptoms may occur, and the risk of a serious underlying disease also increases. Even light bleeding can indicate a serious condition of the reproductive female organs, such as cervical cancer or inflammation of the fallopian tubes, which can lead to serious complications if left untreated. If fibroids in the uterus underlie an intercostal bleeding, swollen legs, low back pain, constipation and other sequelae may occur in the further course, which require independent treatment. Sometimes bleeding outside the period also indicates a hormonal imbalance – psychological complaints and physical changes can be associated with it. Infections are also occasionally manifested by intermenstrual bleeding and can develop into serious inflammations in the uterus and cervix if not treated. In pregnant women, intermittent bleeding can indicate a condition called placental abruption. In this case, the placenta detaches from the uterine wall and causes life-threatening complications for both woman and child. To rule out this and other complications, intercurrent bleeding should definitely be clarified by a gynecologist.
When should you see a doctor?
A single episode of light intermittent bleeding may indicate the presence of an emotional state of stress. If the challenges are managed in everyday life and no other abnormalities occur, there is no need to consult a doctor. If menstruation starts in young girls, there is often no cause for concern either. The harmonization of the menstrual cycle at the beginning as well as at the end of the sexually mature period often takes a few months until everything runs smoothly. During this time, irregularities occur naturally, which do not have any further medical significance. If the symptoms persist for several months or if the bleeding increases in intensity, a doctor is needed. Regular intermittent bleeding should be discussed with a doctor, as it may indicate a disease. If further complaints occur, such as abdominal pain, abnormal odor or a general feeling of malaise, a visit to the doctor is also necessary. If the intermittent bleeding occurs after an intense sexual experience, this is also rarely a cause for concern. Techniques should be reviewed and optimized to avoid further disturbances. If help is needed for this, consultation with a doctor can be sought. Pregnant women should always consult a physician immediately if they experience intermittent bleeding. In them, bleeding may indicate possible complications during pregnancy and should therefore be clarified as soon as possible.
Treatment and therapy
The treatment of intercostal bleeding is always adapted to the cause. The gynecologist advises his patient about the possible options. If the cause is ovulation or contact bleeding, no further treatment is usually required. If the cause is a hormonal or thyroid problem, the gynecologist will seek drug therapy (hormone replacement therapy or thyroid hormone therapy) to alleviate the symptoms. In the case of hormonal problems, therapy with the contraceptive pill may also be considered if there is currently no desire to have a child. In the case of bleeding during pregnancy, hormonal therapy is also used, as well as physical rest and high doses of magnesium. If fibroids, endometriosis, polyps or tumors are the cause of the bleeding, surgery may be considered in addition to hormonal therapy. The primary goal of surgical removal of the growths is always to preserve the reproductive organs, especially if the woman still wishes to have children. If the patient has cancer, the usual cancer therapy such as surgical removal of the tumor, chemotherapy and radiation are available.If it is a metabolic disease such as diabetes or organic problems such as liver or kidney problems, the gynecologist may refer his patient to a specialist for further treatment of the conditions underlying the intermittent bleeding.
Prevention
To prevent intermenstrual bleeding, a healthy lifestyle is recommended. Women should therefore avoid being overweight, not smoke, eat a healthy diet and exercise a lot. Regular examinations by a gynecologist help to detect changes in the abdomen at an early stage and to initiate appropriate therapy. Pregnant women who are prone to intermenstrual bleeding should take it easy on themselves physically and avoid stress.
Follow-up care
Intermittent bleeding is a normal side effect that affects many females. In most cases, these are completely harmless. A medical clarification is not necessary in normal cases. However, if the bleeding occurs repeatedly or is very heavy, a visit to a gynecologist is recommended. The physician can clarify the causes of the intermittent bleeding and initiate suitable countermeasures. Often hormonal changes are the cause, which can be treated with medication. Follow-up care focuses on treating the symptoms and providing the patient with further support. Depending on the cause of the intermittent bleeding, further specialists can be contacted after the initial treatment. Possible contacts include internists, gastroenterologists or sex therapists. Follow-up care for intermittent bleeding is usually provided by the gynecologist. A final physical examination usually takes place as part of the aftercare. There is also a patient interview so that the doctor can clarify any open questions. Depending on the cause of the complaints, the medical history may also be taken during a consultation. Following the follow-up, normal gynecologist appointments should be resumed. If the complaints recur, the gynecologist must be informed.
What you can do yourself
In the event of recurrent intermittent bleeding, the gynecologist should be consulted. If the medical professional rules out an organic cause, various home remedies can be used to regulate the cycle. Various medicinal plants and remedies with hemostatic effects have proven effective. Shepherd’s purse, for example, has a hemostatic effect and is suitable for heavy or prolonged bleeding. The plant is best taken in the form of a tea until the symptoms have subsided. Monk’s pepper is rich in phytohormones, which support progesterone production in the body. It helps especially with spotting and intermittent bleeding that occurs repeatedly. The medicinal plant can be taken in the form of capsules from the pharmacy or as a tea. General measures such as rest and relaxation are also helpful. Affected women are best to take time off and cure themselves completely when the intermittent bleeding occurs. Plenty of water should be drunk and attention should be paid to a suitable diet. Warm compresses help to relieve pain and feelings of pressure, which can occur especially with repeated bleeding. In addition, moderate exercise can be done. Light stretching or gymnastic exercises regulate the metabolism and release happy hormones. If the discomfort does not subside with these measures, a visit to the gynecologist is recommended.
