In childbearing age, non-pregnant women have their menstrual period approximately every three to five weeks. Occasionally, however, additional intermenstrual bleeding occurs outside the cycle, which can have a variety of harmless but also dangerous causes. Therefore, interim bleeding should be taken seriously and clarified by a gynecologist.
Bleeding between periods and spotting
The blood discharges can be light spotting or longer-lasting additional bleeding. Spotting is when there is bleeding with little brown blood that occurs just before menstruation, in the middle of the cycle, or even at the time of ovulation.
If intermittent bleeding occurs for a short time, the doctor will – depending on the age – first clarify a possible pregnancy before looking for organic causes in the area of the vagina, uterus and ovaries as well as hormonal disorders, metabolic disorders or psychosomatic factors.
In the case of light red bleeding after sexual intercourse, an injured vessel, e.g. in the vagina, is often the cause of this intermittent bleeding. Taking estrogens can then bring about an improvement.
Bleeding between periods: a sign of cancer?
But cancer of the cervix may also be behind such bleeding. In the early stages of this cancer, the affected tissue is excised in a cone shape; in the advanced stages, the uterus is removed completely and radiation therapy and/or chemotherapy are administered.
Also, if cells of the uterine lining (uterine cancer) have malignantly changed, interstitial bleeding may occur. Therapy consists of either scraping the uterus, hormone treatment, and radiation therapy, or the uterus (including lymph nodes if necessary) is removed and radiation therapy is given.
Inflammatory bleeding and bulging follicles
There are a number of other intermenstrual hemorrhages that are due to serious organic causes. For example, inflammatory bleeding can occur when the lining of the uterus is chronically inflamed (endometritis). Acute inflammation of the fallopian tubes and ovaries can even become life-threatening. For this reason, patients should see a doctor immediately if they experience severe pain in the abdomen, fever and a general feeling of illness in addition to intermittent bleeding.
If the cause is a bacterial infection, treatment with antibiotics is probably necessary. Prolonged bleeding is usually the result of benign muscular growths (fibroids) in the uterine wall or on its outer surface. Ovarian cysts make continuous bleeding. They develop due to a hormonal disorder. The matured follicle does not burst for one or more cycles and forms a cyst. Treatment can be done using hormonal contraceptive and progestogens.
Hormonal imbalances often the cause of spotting
Mostly more harmless causes, on the other hand, are the following types of spotting or bleeding between periods:
- Ovulation bleeding: this light and short bleeding of one to three days duration takes place at the time of ovulation. The cause is the drop in the hormone estrogen shortly after ovulation. To stabilize the hormonal situation in an ovulation bleeding, taking the pill or treatment with estrogen or progestogen estrogen preparations in the middle of the cycle may be advised.
- Spotting before or after the period as a result of luteal weakness (premenstrual bleeding) or delayed luteal regression (postmenstrual bleeding): the corpus luteum develops after ovulation and produces small amounts of estrogen and especially progesterone (the luteal hormone). Hormone imbalance can be compensated for, if necessary, by hormone replacement therapy with progestogen preparations. However, growths or tumors in the uterus or inflammation in the pelvic area can also be the cause.
- Bleeding when starting to take a pill with low estrogen content: taking the mini-pill (low-dose progestogen preparation), the three-month injection, as well as the insertion of an IUD can lead to interstitial bleeding.
- Implantation bleeding (nidation bleeding): it occurs when an embryo implants in the lining of the uterus, which is about 7 to 10 days after ovulation. Often, nidation bleeding is not visible to the outside at all.
