Occurring in about 13% of people who have or have had periods, metrorrhagia occurs most often in women over 40. But what is metrorrhagia?

Although it can be a mild condition that does not cause problems, in some cases metrorrhagia can be a symptom of a serious condition. Read our article to learn all about the causes, symptoms and treatment!

Metrorrhagia - What is it & How does it manifest itself?

Specialists describe it as abnormal uterine bleeding outside of menstruation. Specifically, it is bleeding similar to menstruation but not part of a menstrual cycle.

If you see blood spots outside of your period for the first time, don't panic! First, make sure you protect yourself from stains with daily absorbent pads made only from 100% organic cotton.

What you need to know is that this bleeding can occur for many reasons and it can be brown or red discharge! To be sure that everything is fine, we recommend that you consult a doctor. But let's see what can be the causes of metrorrhagia.

The difference between bleeding and menstruation

The main difference between metrorrhagia and menstruation is normality. Menstruation is a natural, normal function that occurs regularly with each menstrual cycle, i.e. every 26-30 days. Metrorrhagia is abnormal, irregular bleeding that is not associated with menstrual bleeding.

Basically, during menstrual bleeding (metrorrhagia), blood is removed from the uterus like menstruation - but the difference is that this type of bleeding is not a regular period.

The cause is another difference underlying the two types of bleeding. Menstruation occurs after ovulation, after the ovaries release an egg that causes the lining of the uterus to thicken. If the egg is not fertilized, this lining is shed and causes menstrual bleeding. Metrorrhagia, on the other hand, can be caused by many other causes including spontaneous abortion, genital infections, injuries from sexual contact, certain contraceptive methods, postpartum bleeding (or lochia, which I told all about HERE ) and others.

Other important differences between the two types of bleeding are related to:

• Regularity: menstruation occurs every 26-30 days; the metrorrhagia is not regular and an interval at which it recurs cannot be established.

• Duration: Menstrual bleeding lasts between 2 and 7 days; abnormal bleeding between periods may last less or longer.

• Flow: Menstrual flow is different for every woman, but a loss of about 30-50ml of blood with each period, with or without clots, is considered normal. If you want to read more about what is and isn't normal when you have period clots, see our article . On the other hand, in the case of intermenstrual bleeding, it can be much heavier bleeding, or much weaker bleeding.

Bleeding between brown periods

There are several reasons why you may pass brown blood between periods. The brown color is actually a result of oxidation. Red vaginal bleeding turns brown if it stays in the body for a long time before being eliminated.

When your body produces too little estrogen, the lining of your uterus may be shed even between periods. And if this takes longer, the discharge may turn brown. Such bleeding between brown periods, or spotting, can occur even at ovulation and during pregnancy, without being a cause for concern. They only indicate that the blood was not immediately removed from the body.

This can also happen following an infection or an ectopic pregnancy, so it's important to talk to your doctor if the spotting is heavy or persists for a long time.

Metrorrhagia - Symptoms

Although doctors do not have an exact definition of abnormal vaginal bleeding, metrorrhagia is that severe bleeding that can affect your daily activities and your physical and mental state. How do you recognize the symptoms? The following signs could indicate a metrorrhagia:

• Heavy bleeding and the need to change the pad or pad every hour for several hours

• Bleeding that lasts more than 8 days - it can also be menometrorrhagia

• Any bleeding outside of menstruation

When should you go to the doctor?

Although harmless most of the time, metrorrhagia can be a sign of cancer, as mentioned above. In addition, abnormal uterine bleeding can be signs of conditions that can affect your fertility. Therefore, it is very important to consult a doctor if you suffer from bleeding outside of your period or if you have heavy periods longer than 8 days.

Causes of Metrorrhagia - Why do bleeding occur between periods?

Metrorrhagia is also known as intermittent bleeding or breakthrough bleeding. To know if the spotting you see on the pad is metrorrhagia, you need to know the time frame of your menstrual cycle and when your period occurs – including how long it lasts. Because menstruation is different for every woman.

There are a variety of reasons for bleeding between periods!

Bleeding from contraceptive methods

Bleeding between periods is common in the first few months after starting hormonal contraception, such as:

• the combined oral contraceptive pill

• the progesterone-only birth control pill

• contraceptive patch

• contraceptive implant or injection

• intrauterine device (IUD)

You may also bleed between periods if:

• You forget to take a pill from the contraceptive kit

• You have a problem with the patch or intrauterine device

• You take the morning-after pill (you can read more about emergency contraception here )

Implantation bleeding

Metrorrhagia can also occur in the form of implantation bleeding. This is a bleeding in reduced amount, there are a few drops of blood between periods that can appear 10-14 days after conception. Why does it appear?

It's not a rule for everyone (only a third of women have this bleeding), but it happens when the fertilized egg attaches to the lining of the uterus - which causes some blood vessels to break. This is normal and does not require treatment. If you have more questions about this type of bleeding, we have told you everything in our article HERE .

Miscarriage or termination of pregnancy

Complications during pregnancy can cause bleeding: so metrorrhagia can also be an effect of miscarriage, but an ectopic pregnancy can also cause you to bleed. An ectopic pregnancy occurs when a fertilized egg implants in the fallopian tubes instead of the uterus.

But as I mentioned earlier, spotting may not mean you have a miscarriage, it could be implantation. However, if you are pregnant and have vaginal bleeding, we recommend that you contact your doctor immediately.

Bleeding as a symptom of a sexually transmitted disease

Another reason you should see a doctor is vaginal bleeding between periods which may indicate an infection or sexually transmitted disease. An infection can cause both bleeding and inflammation, and in addition to sexually transmitted diseases, it can also have causes:

• vaginal washes

• the sexual act

• pelvic inflammatory disease

Wounds / Vaginal Injuries

Vaginal dryness or injury to the vagina - for example, due to penetrative sex can also be causes for metrorrhagia. Read more about vaginal dryness and how it can be treated here: see article.

Hormonal causes of metrorrhagia

Estrogen and progesterone are the two hormones that regulate your cycle. Spotting occurs when the level of these hormones is no longer balanced, for various reasons:

• dysfunctional ovaries

• thyroid gland problems

• starting or stopping treatment with birth control pills

Also, some women have metrorrhagia during ovulation as a result of hormonal changes. Sometimes very high levels of estrogen can cause the lining of the uterus to thicken, which can lead to increased blood loss and clots.

Furthermore, hormone levels are often unstable during perimenopause, which can cause irregular periods, spotting, and heavy bleeding. Perimenopause is the period that precedes menopause. This can last up to 10 years as hormone levels in the body change.

Diseases that can cause metrorrhagia

Several conditions of the female genital organs can cause metrorrhagia. Among them are

• Endometriosis - which I told you all about HERE

• Adenomyosis

• Polycystic ovary syndrome

• Cervical polyps

• Cervical cancer

If you are between the ages of 25 and 64, it is recommended that you have a regular cervical screening test to detect any changes in your cervix. Consult your doctor in case of irregular bleeding, especially after intercourse, to rule out the possibility of a condition such as cancer:

• of the cervix

• vaginally

• of the fallopian tubes

• ovarian

• vulvar

• endometrial

Risk factors for abnormal bleeding

There are several risk factors for the occurrence of metrorrhagia, among which the most common are:

• Hormonal imbalances

• Certain medications

• Metabolic disorders

• Stress

• Starting menstruation later (adolescence)

• Pre-menopausal

• The onset of menopause

What else you need to know is that abnormal vaginal bleeding can be of several types:

• Menorrhagia or hypermenorrhoea – when you have very heavy periods

• Metrorrhagia – when the bleeding is outside of menstruation

• Menometrorrhagia – when you have very heavy cycles but also bleeding outside of your period

Diagnosis of metrorrhagia

When you have abnormal bleeding, we recommend you go to the gynecologist. The doctor will do all the necessary tests and together you will discover what are the causes of metrorrhagia in your case, and depending on the result, the gynecologist will prescribe a treatment to avoid any complications.

How to prepare for this gynecologist consultation? You should know that the tests can be blood - for pregnancy (as a few drops of blood between periods can be among the first signs of pregnancy ), a Pap test (to rule out cancer), or other tests such as colposcopy or biopsy.

Metrorrhagia treatment

Each patient will receive a personalized treatment, because there are several types of treatment, but not all of them work for everyone. For example, hormonal treatment can be effective.

Possible recommended treatments are:

Hormonal therapy

When bleeding between periods is caused by certain hormonal imbalances, the doctor may recommend hormonal treatments.

These include birth control pills, non-steroidal anti-inflammatory drugs, progestin (administered by injection or by fitting an intrauterine device) or other drugs that affect hormone levels.

Hormonal treatment can also be recommended for postmenopausal metrorrhagia.

Curettage

If metrorrhagia begins after a miscarriage, or if hormonal treatment does not work, the doctor may recommend a dilation and curettage procedure. The same treatment can also be offered to postmenopausal women experiencing metrorrhagia.

The procedure is performed under anesthesia and aims to remove the uterine lining to allow the body to replace it with a new layer.

Treatment of other conditions

Often, vaginal bleeding between periods is actually caused by other health problems. In these cases, they will stop on their own after treating the actual causes.

For example, patients who are bleeding from a sexually transmitted disease will receive treatment for that infection. Patients who have bleeding due to conditions that stop blood clotting or due to thyroid problems will visit the specialist and receive appropriate treatment.

Lifestyle change

Chronic stress, excessive training, weight problems, or a chaotic, nutrient-poor diet can also be causes of temporary breakthrough bleeding.

Changing the lifestyle will be the first measure recommended by the doctor in such situations. If not caused by other conditions, the bleeding will stop on its own with the start of stress management techniques, adequate rest, or working with a nutritionist to improve diet and body mass.

Complications that can occur in the case of untreated metrorrhagia

Unfortunately, metrorrhagia does not come without complications in some cases. This abnormal bleeding can have an impact on your health, especially if it is excessive – when it can cause anemia (lack of red blood cells). Anemia, in turn, is characterized by weakness and chronic fatigue. An alarm signal is when metrorrhagia indicates a type of cancer or a serious condition. To avoid possible health problems, always consult a doctor when you have heavy periods or abnormal bleeding!
And for spotting, always use 100% organic cotton absorbent pads daily , to protect the skin and maintain the pH of the vulva through natural ingredients, without chemicals or plastic!

Prevention of vaginal bleeding between periods

Intermenstrual vaginal bleeding cannot be prevented. What you can do instead is to prevent certain conditions or health problems that can cause bleeding between periods. For example:

• take care of your diet and body weight to prevent menstrual bleeding caused by hormonal imbalances.

• to see a doctor to treat and control conditions such as cysts or endometriosis, which can cause both metrorrhagia and ovarian pain and severe menstrual pain.

• avoid risk factors such as smoking and other harmful habits that can increase the chances of cancer.

• to protect yourself during sexual intercourse to reduce the risk of contacting sexually transmitted diseases .

Bibliography

1. Cleveland Clinic, “Abnormal uterine bleeding”: https://my.clevelandclinic.org/health/diseases/15428-uterine-bleeding-abnormal-uterine-bleeding

2. VeryWell Health, “An Overview of Metrorrhagia”: https://www.verywellhealth.com/an-overview-of-metrorrhagia-4584380

3. NIH, “Abnormal Vaginal Bleeding,” Chapter 173: https://www.ncbi.nlm.nih.gov/books/NBK282/

4. NHS, “Vaginal bleeding between periods or after sex”: https://www.nhs.uk/conditions/vaginal-bleeding-between-periods-or-after-sex/

5. Mayo Clinic Health System, “Heavy, Intermenstrual or Irregular Bleeding”: https://www.mayoclinichealthsystem.org/locations/menomonie/services-and-treatments/obstetrics-and-gynecology/heavy-or-irregular-bleeding

6. Healthline, “Vaginal Bleeding Between Periods”: https://www.healthline.com/health/vaginal-bleeding-between-periods