Vaginal bleeding between periods
Bleeding between periods; Intermenstrual bleeding; Spotting; MetrorrhagiaThis article discusses vaginal bleeding that occurs between a woman's monthly menstrual periods. Such bleeding may be called "intermenstrual bleeding."
Related topics include:
- Dysfunctional uterine bleeding
Dysfunctional uterine bleeding
Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Bleeding may be heavier o...
ImageRead Article Now Book Mark Article - Heavy, prolonged, or irregular menstrual periods
Considerations
Normal menstrual flow lasts about 5 days. It produces a total blood loss of 30 to 80 mL (about 2 to 5 tablespoons), and occurs normally every 21 to 35 days.
Vaginal bleeding that occurs between periods or after menopause can be caused by various problems. Most are benign and can be easily treated. Sometimes, vaginal bleeding may be due to cancer or pre-cancer. Therefore, any unusual bleeding should be evaluated right away. The risk for cancer increases to about 10% in women with postmenopausal bleeding.
Make sure that bleeding is coming from the vagina and is not from the rectum or the urine. Inserting a tampon into the vagina will confirm the vagina, cervix, or uterus as the source of bleeding.
Vagina
The vagina is the female body part that connects the womb (uterus) and cervix to the outside of the body.
Cervix
The cervix is the lower end of the womb (uterus). It is at the top of the vagina. It is about 2. 5 to 3. 5 centimeters (1 to 1. 3 inches) long. Th...
A careful exam by your health care provider is most often the best way to find the source of the bleeding. This exam can be done even while you are bleeding.
Causes
Causes may include:
- Uterine fibroids or cervical or uterine polyps
Uterine fibroids
Uterine fibroids are tumors that grow in a woman's womb (uterus). These growths are typically not cancerous (benign), and do not become cancerous....
ImageRead Article Now Book Mark ArticleUterine polyps
The endometrium is the lining of the inside of the womb (uterus). Overgrowth of this lining can create polyps. Polyps are fingerlike growths that a...
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- Inflammation or infection of the cervix (cervicitis) or uterus (endometritis)
Endometritis
Endometritis is an inflammation or irritation of the lining of the uterus (the endometrium). It is not the same as endometriosis.
ImageRead Article Now Book Mark Article - Injury or disease of the vaginal opening (caused by intercourse, trauma, infection, polyp, genital warts, ulcer, or varicose veins)
Genital warts
Genital warts are soft growths on the skin and mucous membranes of the genitals. They may be found on the penis, vulva, urethra, vagina, cervix, and...
ImageRead Article Now Book Mark ArticleVaricose veins
Varicose veins are swollen, twisted, and enlarged veins that you can see under the skin. They are often red or blue in color. They most often appea...
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Intrauterine device
An intrauterine device (IUD) is a small plastic T-shaped device used for birth control. It is inserted into the uterus (womb) where it stays to prev...
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Ectopic pregnancy
An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus).
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- Other pregnancy complications
- Vaginal dryness due to lack of estrogen after menopause
Menopause
Menopause is the time in a woman's life when her periods (menstruation) stop. Most often, it is a natural, normal body change that occurs between ag...
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- Using hormonal birth control irregularly (such as stopping and starting or skipping birth control pills, patches, or estrogen rings)
- Underactive thyroid (low thyroid function)
- Use of blood thinners (anticoagulants)
- Cancer or pre-cancer of the cervix, uterus, or (very rarely) fallopian tube
- Pelvic exam, cervical biopsy, endometrial biopsy, or other procedures
Cervical biopsy
A colposcopy is a special way of looking at the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. Abno...
ImageRead Article Now Book Mark ArticleEndometrial biopsy
Endometrial biopsy is the removal of a small piece of tissue from the lining of the uterus (endometrium) for examination.
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Home Care
Contact your provider right away 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.
If possible, aspirin should be avoided, as it may prolong bleeding. However, NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen can be used to minimize bleeding and cramping.
When to Contact a Medical Professional
Contact your provider if:
- You are pregnant.
- There is any unexplained bleeding between periods.
- There is any bleeding after menopause.
- There is heavy bleeding with periods.
- Abnormal bleeding is accompanied by other symptoms, such as pelvic pain, fatigue, dizziness.
What to Expect at Your Office Visit
Your provider will perform a physical exam and ask questions about your medical history. The physical exam will include a pelvic exam.
Questions about the bleeding may include:
- When does the bleeding occur and how long does it last?
- How heavy is the bleeding?
- Do you have cramps too?
- Are there things that make the bleeding worse?
- Is there anything that prevents it or relieves it?
- Do you have any other symptoms such as abdominal pain, bruising, pain when urinating, or blood in urine or stools?
Blood in urine
Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the...
ImageRead Article Now Book Mark ArticleStools
Black or tarry stools with a foul smell are a sign of a problem in the upper digestive tract. It most often indicates that there is bleeding in the ...
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Tests that may be done include:
- Blood tests to check thyroid and ovarian function
- Cervical cultures to check for a sexually transmitted infection
- Colposcopy and cervical biopsy
- Endometrial (uterine) biopsy
- Pap smear
Pap smear
The Pap test mainly checks for changes in the cervix that may turn into cervical cancer. Cells scraped from the opening of the cervix are examined u...
ImageRead Article Now Book Mark Article - Pelvic ultrasound
Pelvic ultrasound
A pelvic (transabdominal) ultrasound is an imaging test. It is used to examine organs in the pelvis.
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- Hysterosonogram
- Hysteroscopy
Hysteroscopy
Hysteroscopy is a procedure to look at the inside of the womb (uterus). Your health care provider can look at the:Cervix, the opening to the wombIns...
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Most causes of intermenstrual bleeding are easily treatable. The problem can most often be diagnosed without too much discomfort. Therefore, it is important not to delay in having this problem evaluated by your provider.
References
Bulun SE, Babayev E. Physiology and pathology of the female reproductive axis. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 15.
Ellenson LH, Roberts DJ. The female genital tract. In: Aster JC, Abbas AK, Kumar AK, Debnath J, Das A, eds. Robbins, Cotran & Kumar Pathologic Basis of Disease. 11th ed. Philadelphia, PA: Elsevier; 2026:chap 22.
Ryntz T, Lobo RA. Abnormal uterine bleeding: etiology and management of acute and chronic excessive bleeding. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 26.
Female reproductive anatomy - illustration
Internal structures of the female reproductive anatomy include the uterus, ovaries, and cervix. External structures include the labium minora and majora, the vagina and the clitoris.
Female reproductive anatomy
illustration
Bleeding between periods - illustration
Normal menstrual flow lasts about 5 days and produces a total blood loss of 60 to 250 mL and occurs every 28 days. There are several causes of abnormal vaginal bleeding and a careful exam by a health care provider is frequently the best way to sort out the source of the bleeding.
Bleeding between periods
illustration
Uterus - illustration
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Uterus
illustration
Female reproductive anatomy - illustration
Internal structures of the female reproductive anatomy include the uterus, ovaries, and cervix. External structures include the labium minora and majora, the vagina and the clitoris.
Female reproductive anatomy
illustration
Bleeding between periods - illustration
Normal menstrual flow lasts about 5 days and produces a total blood loss of 60 to 250 mL and occurs every 28 days. There are several causes of abnormal vaginal bleeding and a careful exam by a health care provider is frequently the best way to sort out the source of the bleeding.
Bleeding between periods
illustration
Uterus - illustration
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Uterus
illustration
- Menstrual disorders - InDepth(In-Depth)
Review Date: 5/22/2025
Reviewed By: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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