What is Vaginal Bleeding Between Periods?

An unusual vaginal bleeding in the vagina that is different from your menstrual cycle. It also includes light spotting between the periods, you may notice this when you wipe it with tissue paper.

The bleeding that occurs between periods can range from extremely mild bleeding (sometimes called "spotting") to heavy bleeding with significant amounts of blood loss.

Unusual vaginal bleeding can be a one-time occurrence or persist for several days.​

Causes: Vaginal Bleeding between Periods

Vaginal bleeding can cause by a wide array of factors, some of which include:

Pregnancy-related Causes:

• Implantation bleeding: The occurrence of light bleeding that takes place when the fertilized egg attaches itself to the lining of the uterus.
• Miscarriage: The presence of bleeding and cramping during pregnancy is an indication of a miscarriage.
• Ectopic pregnancy: The implantation of the embryo outside the uterus, this condition also leads to vaginal bleeding and is considered a medical emergency.
• Placenta previa and placental abruption: The conditions where the placenta covers the cervix or separates from the uterine wall prematurely, causing bleeding.
  

Hormonal Causes:

• Use of birth control: Any alteration in contraceptive methods or starting/stopping the usage of birth control pills may result in irregular bleeding.
• Hormone imbalance: Conditions such as polycystic ovarian syndrome (PCOS) can lead to irregular bleeding as a result of disruptions in hormone levels.

Infections or Inflammation:

• Sexually transmitted infections (STIs): Some STIs such as gonorrhea and chlamydia cause unusual vaginal bleeding.
• Pelvic inflammatory disease (PID): An infectious condition that specifically targets the reproductive organs also causes vaginal bleeding.
• Vaginal infections: Yeast infections or bacterial vaginosis can cause bleeding.

Other Medical Conditions:

• Fibroids or polyps: The non-cancerous growth in the uterus or cervix may cause vaginal bleeding.
• Endometriosis: The condition in which tissue resembling the uterine lining grows outside the uterus resulting in vaginal bleeding.
• Cervical or uterine cancer: Abnormal vaginal bleeding may indicate the presence of this cancerous growth.
• Thyroid disorders: An imbalance of thyroid hormones might impact the regularity of menstrual cycles.

Trauma or Other Causes:

• Vaginal trauma: Any injury that might occur during sexual intercourse, vaginal examinations, or the insertion of objects.
• Certain medications: Blood thinners or hormonal medications might cause bleeding.
• Stress: Emotional or physical stress can sometimes cause vaginal bleeding.

Symptoms

Vaginal bleeding can occur due to various reasons. Some common symptoms associated with vaginal bleeding include:

Abnormal bleeding: When you bleed outside of your normal monthly cycle or unexpected bleeding.

Heavy bleeding: A heavy blood flow for a prolonged period during your menstrual cycle.

Pain or inflammation: Some people may feel pain, cramping, or soreness along with vaginal bleeding.

Irregular periods: Periods that do not follow a regular pattern.

Bleeding after intercourse: Bleeding that happens after sexual activity can indicate several problems.

Bleeding after menopause: Vaginal bleeding that occurs after menopause should be checked, as it's not considered normal.

Additional symptoms: Depending on the cause, vaginal bleeding may come with additional symptoms like fever, vertigo, nausea, or abdominal pain.

Diagnosis

Your doctor may perform several tests or procedures when diagnosing abnormal vaginal bleeding. These tests may include:

A Pregnancy Test: When you have a miscarriage, you bleed a lot. A pregnancy test can show positive up to 35 days after the loss of the pregnancy. In the early stages of pregnancy, women also often have light bleeding.

Blood Tests: Your doctor can check your blood clots and do a complete blood count.

A Thyroid Test: Problems with your thyroid function may indicate that there is also a problem with your ovary function that could be a contributing factor to your unusual vaginal bleeding.

Hormone Levels Test: Hormone imbalances may be causing your abnormal bleeding.

A Hysteroscopic Exam of your uterus lining (endometrium). This test checks for fibroids, polyps, or signs of cancer.

A Pelvic Sonography: Sonohysterogram, also called saline-infusion sonography, is a highly sensitive imaging procedure performed by your doctor that can help him to identify abnormal growth in your uterus like polyps or fibroids.

A Biopsy of your Endometrium: Your provider can collect tissue samples from your uterus lining and check any signs of cancer or pre-cancer cells.

Treatments for Vaginal Bleeding Between Periods

There are several treatment options for abnormal vaginal bleeding between periods. The treatment will depend on the cause of your bleeding and your age.

If the bleeding is caused by a hormonal imbalance then your doctor will wait and see if the bleeding improves on its own.

Some other treatments may include:

Birth Control Pills: Birth control pills contain hormones that can stop the lining of your uterus from getting too thick. They also can help keep your menstrual cycle regular and reduce cramping.

Intrauterine Device (IUD): Certain types of IUDs can be used for both birth control and to minimize or stop vaginal bleeding.

Dilation and Curettage (D&C): A D&C is a procedure in which the opening of your cervix is stretched so that a surgical tool can be put into your uterus. Your doctor uses this tool to remove the lining of your uterus. The removed lining is then checked in a lab for abnormal tissue.

Hysterectomy: This type of surgery removes the uterus. If you have a hysterectomy, you won’t have any more periods and you won’t be able to get pregnant anymore.

Endometrial Ablation: The surgical procedure that destroys the lining of the uterus. Unlike a hysterectomy, it does not remove the uterus. Endometrial ablation may stop all menstrual bleeding. However, some people will have light menstrual bleeding or spotting after endometrial ablation.

Consequences of Ignoring Vaginal Bleeding & Blood Spotting Between Periods

Untreated abnormal vaginal bleeding can have various consequences:

Anemia: Heavy or prolonged bleeding can lead to iron deficiency anemia due to blood loss, causing fatigue, weakness, and other symptoms.

Underlying Health Conditions: Ignoring abnormal bleeding might mean missing underlying health issues like polyps, fibroids, or hormonal imbalances.

Complications in Pregnancy: For women of reproductive age, untreated abnormal bleeding could affect fertility or cause complications during pregnancy.

Emotional Impact: Continual abnormal bleeding can lead to stress, anxiety, or emotional distress, affecting overall well-being.

Risk of Cancer: In some cases, abnormal bleeding might indicate or lead to uterine, cervical, or ovarian cancers if not diagnosed and treated promptly

FAQs

Can stress cause spotting between periods?

Yes, stress can potentially cause spotting between periods. Stress may disrupt the normal hormonal balance in the body, affecting the menstrual cycle. The release of stress hormones like cortisol 

Is vaginal bleeding spotting?

A doctor will only consider vaginal bleeding "spotting" if it occurs before or after your period and does not require a pad or tampon. Heavy bleeding for several days or as long as your menstruation is more concerning

What is ovulation bleeding?

This bleeding occurs before or after your period when estrogen drops. Ovulation bleeding may occur at this phase because estrogen and progesterone levels fluctuate as the ovary releases an egg.

When is bleeding between periods an emergency?

If you are bleeding between periods and also experience fever, dizziness, bruises, or pain, you should seek immediate medical attention.

Conclusion

Vaginal bleeding is a concerning symptom, but understanding its potential causes and knowing when to seek medical attention is crucial.

In most cases, it’s not life-threatening and not a cause for concern. Most vaginal bleeding can be attributed to medical conditions, pregnancy, or hormonal changes.

Talk to your doctor if you’re bleeding from your vagina and not on your menstrual period. They can evaluate your symptoms, perform an exam, and order additional tests to determine a cause for your bleeding.

References

• Health Direct, Bleeding Between Periods. Available at https://www.healthdirect.gov.au/bleeding-between-periods. (Accessed on 30 November 2023)
  
• Health Line, Vaginal Bleeding Between Periods: Causes, Prevention & Diagnosis. Available at https://www.healthline.com/health/vaginal-bleeding-between-periods (Accessed on 30 November 2023)
• WebMD, Vaginal Bleeding and Blood Spotting Between Periods. Available at https://www.webmd.com/women/spotting-between-periods (Accessed on 30 November 2023)
• Medline Plus, Vaginal or uterine bleeding: MedlinePlus Medical Encyclopedia. Available at https://medlineplus.gov/ency/article/007496.htm (Accessed on 30 November 2023)
• Mayoclinic, Vaginal BleedingCauses. Available at https://www.mayoclinic.org/symptoms/vaginal-bleeding/basics/causes/sym-20050756 (Accessed on 30 November 2023)
• verywellhealth, Causes of Spotting and Bleeding After Periods - Verywell Health. Available at https://www.verywellhealth.com/bleeding-between-periods-3520522 (Accessed on 30 November 2023)
• Abnormal Uterine Bleeding: Causes, Diagnosis, and Treatment. Available at https://familydoctor.org/condition/abnormal-uterine-bleeding/ (Accessed on 30 November 2023)