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Alternative Names Return to topBleeding between periods; Intermenstrual bleeding; Spotting; Metrorrhagia
Definition Return to top
Intermenstrual bleeding is bleeding from the uterus that occurs between menstrual periods.
Considerations Return to top
Normal menstrual flow lasts about 4 days, produces a total blood loss of 30 to 80 ml (about 2 to 8 tablespoons), and occurs normally every 28 days (plus or minus 7 days).
Vaginal bleeding that occurs between periods or after menopause sometimes may be due to cancer or precancer, and should be evaluated promptly. The risk of cancer increases with age.
Make sure that bleeding is coming from the vagina and is not from the rectum or in the urine. Inserting a tampon into the vagina will confirm the vagina, cervix, or uterus as the source of bleeding.
A careful exam by your health care provider is frequently the best way to sort out the source of the bleeding. This exam can be accomplished even while you are bleeding. Do not delay getting an exam just because you are currently bleeding.
Causes Return to top
Home Care Return to top
Immediately contact a health care provider if bleeding is very heavy.
Keep track of the number of pads or tampons used over time so that the amount of bleeding can be determined. Uterine blood loss can be estimated by keeping track of how frequently a pad or tampon is soaked and how often one needs to be changed.
Because aspirin may prolong bleeding, it should be avoided, if possible.
When to Contact a Medical Professional Return to top
Call your health care provider if:
What to Expect at Your Office Visit Return to top
The doctor will peform a physical exam and ask questions about your medical history. The physical examination with include an emphasis on the pelvic area.
Questions may include:
Tests that may be done include:
References Return to top
Lobo RA. Abnormal uterine bleeding: ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007:chap. 37.
Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008;35(2):219-234.Update Date: 6/26/2008 Updated by: Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.