What is considered intermenstrual bleeding?
Intermenstrual bleeding includes any bleeding between two normal periods. They can be scanty, in the form of a brown or pinkish daub, and abundant, with clots. It is important to note the connection with the time of the cycle and with events: the middle of the cycle, days before menstruation, sexual intercourse, taking a missed contraceptive pill. It is useful to keep a calendar and write down the days, the number of pads and the nature of the discharge - this significantly speeds up the diagnosis. Brown color only means that the blood has oxidized and came out slowly, and in itself does not mean anything bad.
- Spotting in the middle of the cycle
- Spotting a few days before your period
- Blood immediately after intercourse - contact bleeding
- Breakthrough bleeding due to contraception
- Any discharge after menopause
Possible reasons
In the middle of the cycle, short-term spotting is explained by the physiological decrease in estrogen during ovulation. Hormonal contraception, emergency contraception, and intrauterine devices cause breakthrough bleeding, especially in the first 3 months. Structural causes - polyp of the endometrium or cervical canal, fibroids with submucosal growth, adenomyosis, endometrial hyperplasia. Inflammation of the cervix and endometrium, sexually transmitted infections, ectopia and cervical trauma produce contact discharge. In women over 45 years of age and in postmenopause, precancerous changes and endometrial and cervical cancer are first excluded.
- Ovulatory spotting mid-cycle
- Hormonal contraceptives and intrauterine device
- Endometrial or cervical polyp
- Myoma, adenomyosis, endometrial hyperplasia
- Cervicitis, endometritis, genital tract infections
- Complications of pregnancy, including ectopic
- Precancerous changes and malignant tumors
Associated signs that the doctor looks for
The diagnosis is rarely made solely by the nature of the discharge. The doctor takes into account accompanying complaints: pain in the lower abdomen, pain during sexual intercourse, heavy and prolonged menstruation, discharge with an odor. Age, presence of children, plans for pregnancy, and taking medications that affect blood clotting matter. Prolonged, repeated bleeding leads to iron deficiency anemia, so weakness, shortness of breath on exertion, and brittle hair and nails are additionally assessed.
- Pain or heaviness in the lower abdomen
- Pain and blood during intercourse
- Heavy and prolonged menstruation
- Discharge with an unpleasant odor
- Signs of anemia: weakness, shortness of breath, pallor
What examinations are needed
The examination begins with a speculum examination, which allows you to see the cervix and understand where the blood is coming from. Smears for flora and oncocytology are required; if indicated, high-risk HPV testing and colposcopy are required. Pelvic ultrasound, preferably in the second phase of the cycle, evaluates the thickness and structure of the endometrium, shows polyps and fibroids. If the endometrium is thickened or heterogeneous, a pipel biopsy or hysteroscopy with targeted biopsy is performed. During reproductive age, pregnancy is always ruled out.
- Speculum examination and bimanual examination
- Flora smear, PAP test, HPV test
- Ultrasound of the uterus and ovaries
- Pipelle endometrial biopsy
- Hysteroscopy with targeted biopsy
- Blood hCG if pregnancy is suspected
What to do and how to treat it
Before visiting a doctor, you should write down the days and volume of discharge, and if there is heavy bleeding with weakness and dizziness, seek emergency help by calling 103. Treatment depends entirely on the cause: polyps are removed during hysteroscopy, inflammation is treated with antibacterial drugs based on the results of smears, and for endometrial hyperplasia, hormonal therapy or an intrauterine system with gestagen is prescribed. Breakthrough bleeding in the first months of contraception usually goes away on its own, but the regimen is still discussed with your doctor. For anemia, iron supplements are additionally prescribed.
- Keep a diary of your discharge and take it to your appointment.
- Do not select hormonal medications on your own
- Hysteroscopic polyp removal
- Treatment of inflammation based on smear results
- Hormonal therapy for endometrial hyperplasia
- Iron supplements for confirmed anemia
