Intermenstrual bleeding

Intermenstrual bleeding, previously known as metrorrhagia, is uterine bleeding at irregular intervals, particularly between the expected menstrual periods. It is a cause of vaginal bleeding. In some women, menstrual spotting between periods occurs as a normal and harmless part of ovulation. Some women experience acute mid-cycle abdominal pain around the time of ovulation (sometimes referred to by the German term for this phenomenon, mittelschmerz). This may also occur at the same time as menstrual spotting. The term breakthrough bleeding or breakthrough spotting is usually used for women using hormonal contraceptives, such as IUDs or oral contraceptives, in which it refers to bleeding or spotting between any expected withdrawal bleedings, or bleeding or spotting at any time if none is expected. If spotting continues beyond the first 3-4 cycles of oral contraceptive use, a woman should have her prescription adjusted to a pill containing higher estrogen:progesterone ratio by either increasing the estrogen dose or decreasing the relative progestin dose. Besides the aforementioned physiologic forms, metrorrhagia may also represent abnormal uterine bleeding and be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids, uterine cancer, or vaginal cancer. If the bleeding is repeated and heavy, it can cause significant iron-deficiency anemia. Intermittent spotting between periods can result from any of numerous reproductive system disorders: Neoplasia: Cervical cancer Uterine cancer Vaginal cancer Endometrial cancer Primary fallopian tube cancer Ovarian cancer Inflammation: Cervicitis Endometritis Vaginitis Sexually Transmitted Infections Pelvic inflammatory disease Endometrial abnormalities: Endometriosis Adenomyosis Uterine leiomyomas Endometrial hyperplasia Polyps Endocrinological causes: Hormone imbalance Dysfunctional uterine bleeding Diets which induce ketosis, such as the Atkins diet polycystic ovarian syndrome Bleeding disorders: Von Willebrand Disease Pancytopenia due to leukemia Drug induced: Use of progestin-only contraceptives, such as Depo Provera Change in oral contraception Overdose of anticoagulant medication or Aspirine abuse Traumatic causes: Automutilation Sexual abuse or rape Related to pregnancy: Implantation bleeding Ectopic pregnancy (Incomplete) miscarriage Other causes: Enlarged uterus with menorrhea Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding, usually referring to mid-cycle bleeding in users of combined oral contraceptives, as attributed to insufficient estrogens.