An Overview of Metrorrhagia

Getty.
In This Article
Table of Contents

Metrorrhagia, now commonly called intermenstrual bleeding, is vaginal bleeding that occurs at irregular intervals not associated with the menstrual cycle. While the blood comes from the uterus as it does during menstruation, the bleeding does not represent a normal period. There are several causes of metrorrhagia, some of which are harmless. In other cases, metrorrhagia can be a sign of a more serious condition.

Symptoms

When bleeding occurs outside the expected timeframe of the menstrual cycle, it is sometimes referred to as abnormal or dysfunctional uterine bleeding.

Some people who menstruate regularly experience light bleeding or spotting at various times throughout their cycle, especially at ovulation. In these cases, symptoms such as mild discomfort and spotting at mid-cycle, may not be unusual for a person.

However, if you have not experienced these symptoms in the past but suddenly begin having them, your doctor can help you figure out the cause.

Metrorrhagia is specific to vaginal bleeding that happens at another time during the month other than when someone is having or would expect to have their menstrual period.

Sometimes the bleeding seems to follow a pattern and may feel like you're having “a second period” at another time during the month. In other cases, the bleeding is completely random and unpredictable.

When the bleeding occurs it may painless or you may experience cramps and other symptoms associated with your period, such as bloating.

Intermenstrual bleeding is often light, but can also be quite heavy. In some cases, it may even be heavier than your regular period.

The color of the blood can range from dark brown to red to light pink. Some people may see clots or mucus in their underwear or when they wipe.

Tell your doctor about the characteristics of the bleeding, as well as its duration. This information can help them pinpoint a cause.

Causes

There are many potential causes of metrorrhagia, though in most cases hormone levels play a key role.

During a regular menstrual period, hormonal changes direct the lining of the uterus to build up in preparation to receive and nourish a fertilized egg. If this does not occur, the lining is shed and passes through the vagina.

When a person experiences dysfunctional uterine bleeding, the lining is shed at another point in the cycle. Interruptions in the normal functioning of the hormones that direct the process can be caused by a variety of sources. Some, while inconvenient, are harmless, don’t last long, and can be easily treated.

Menarche and Menopause

When a young person first starts having their menstrual cycle, it is not unusual for cycles to be erratic. This can include spotting that occurs at various times throughout the cycle. Usually, this resolves as adolescence progresses and hormones stabilize.

This type of unpredictable, irregular, bleeding may also occur at the other end of a person’s reproductive life when they begin to transition into menopause.

Stress

Throughout a person’s life, interruptions to the menstrual cycle can occur during times of emotional and physical stress, such as after starting a new job or while traveling.

Birth Control and Medications

A person may also experience abnormal or unexpected bleeding if they start or stop using a form of hormonal birth control, such as the Pill. Irregular use of hormonal contraception can also cause abnormal patterns of bleeding which will usually resolve once use becomes consistent or a person changes to another method of birth control that works better for them.

Other medications that can cause dysfunctional uterine bleeding include Depo-Provera shots, blood thinners like Warfarin and aspirin, and supplements such as ginseng.

Malnourishment

Abnormal uterine bleeding and even the complete ceasing of the menstrual cycle can occur when someone is malnourished and/or underweight. This can include people restricting certain food groups, such as on the Atkins or Keto diet.

A person who is underweight may not be ovulating at midcycle. Anovulatory cycles are a common cause of irregular menstrual bleeding. These interruptions to normal ovulation can occur whenever the hormone balance in the body is interrupted, which can be caused by reasons other than a person's weight or body fat percentage.

Fertility Treatments

People who are undergoing fertility treatments often experience symptoms related to menstruation, including bleeding at unexpected times during their cycle, bleeding more or less than usual, or having premenstrual symptoms.

Underlying Health Conditions

Metrorrhagia can also be a sign of an underlying health condition. While some of the conditions are considered benign, others can have serious consequences if left untreated.

Metrorrhagia can occur in people with:

  • Uterine inflammation (endometritis)
  • Cervical inflammation (cervicitis)
  • Vaginal inflammation (vaginitis)
  • Pelvic inflammatory disease
  • Sexually-transmitted infections
  • Endometriosis
  • Polycystic ovarian syndrome (PCOS)
  • Adenomyosis
  • Ovarian cysts
  • Fallopian tube torsion
  • Uterine fibroids or polyps
  • Thyroid disease
  • Conditions affecting the pituitary gland and/or adrenal glands
  • Coagulation disorders such as Von Willebrand Disease
  • Bleeding disorders associated with leukemia
  • Disorders of the structure, size, or position of the uterus (such as an enlarged or retroverted uterus)

While many cancers of the reproductive system have few, if any, signs and symptoms in the early stages, abnormal uterine bleeding may be one. It is especially important to take note of abnormal vaginal bleeding if you are no longer having periods and have entered menopause.

The following cancers may cause metrorrhagia:

Unexpected vaginal bleeding or spotting can also be an early sign of pregnancy. If you experience metrorrhagia and think you could be pregnant, see your doctor. In rare cases, an ectopic pregnancy may occur.

Diagnosis

If you are experiencing abnormal vaginal bleeding, your doctor will start by asking you questions about your general health, particularly your menstrual cycle and sexual activity. They may also ask about the health of your family members; for example, if your mother or sister has ever been diagnosed with endometriosis, uterine fibroids, or reproductive cancer.

Your regular doctor will most likely refer you to a reproductive health practitioner, usually a gynecologist. This type of doctor is specially educated and trained in reproductive health conditions. If you are pregnant, you will also need to see an obstetrician or midwife.

An OBGYN will talk to you more in depth about your symptoms. They will likely ask you questions about the bleeding, such as:

  • When the bleeding started
  • How long it lasts
  • Your sexual history
  • If you have ever been pregnant and given birth

They may review any other medical conditions you have or have had in the past, as well as any medications and supplements you are taking.

Physical Exam

When you are in the office, they may do a physical exam. During the physical exam, you will be asked to change into a gown, position yourself on the exam table, and place your feet in stirrups. The doctor may listen to your heart with a stethoscope, as well as your belly. They may use their hands to feel your abdomen and pelvis. If you experience any pain during this exam, let them know.

Your doctor may also do a rectovaginal exam. Using a lubricated glove, they will place a finger inside your rectum and vagina. This helps them feel for any abnormalities.

A vaginal exam, where they use a speculum to help them see inside the vaginal canal up to your cervix, may also be done. Often your doctor will use a long Q-tip to take a sample for testing.

While these exams can cause slight discomfort, they usually do not take long.

If you feel uncomfortable physically or emotionally during the exam, you can tell your doctor or the nurse assisting them that you need to pause or stop.

Labs and Tests

The doctor may want to do some other types of tests to help determine the cause of metrorrhagia. They will usually start with less invasive tests and only move on to interventions like surgery if they think it will be necessary to correctly diagnose and treat the cause of the bleeding.

Tests your doctor may order if you are experiencing metrorrhagia include:

  • Blood tests to check for disorders that cause bleeding, nutritional deficiencies, infections, m[arkers of inflammation, and other findings
  • Tests to check your hormone levels and thyroid function
  • Urine samples to check for pregnancy, infection, or STDs
  • Ultrasounds of your abdomen and pelvis, including transvaginal ultrasounds
  • CT scans or MRIs
  • Pap smear to test for cervical cancer
  • Other tissue biopsies to look for other types of cancer
  • Surgery (laparoscopy or laparotomy)

Treatment

The treatment for menorrhagia will be specific to its cause, as well as the individual needs of the patient. Some treatments will be safer and more effective than others. For example, while hormonal contraception can be used to treat abnormal uterine bleeding, birth control pills may not be appropriate for a person with a history of blood clots.

Once your doctor has figured out why you are experiencing menorrhagia, they can help you decide on the best way to treat it.

Lifestyle Changes

In some cases, the condition may be temporary and responsive to changes in your lifestyle. You may be able to treat discomfort with over-the-counter pain relievers (such as NSAIDs) while you work on reducing stress or getting yourself back on a routine after a vacation, for example. If you are underweight, you may notice your symptoms improve when you begin to regain the weight.

Hormonal Therapy

Some people decide to use different types of hormonal therapy, especially progestin, to treat abnormal bleeding. These can include birth control pills, IUDs, estrogen patches, and other options. Another form of therapy called Gonadotropin-releasing hormone (GnRH) agonists may also be prescribed. However, these medications can only be used short-term and can have many side effects.

If you are not sexually active or have never had sex, you can still use hormonal methods to treat problems with your menstrual cycle. Your doctor will help you decide which one is best for you.

Dilation and Curettage

Procedures like dilation and curettage (D & C) may be recommended if you have heavy bleeding that is causing other problems, like anemia. You don't necessarily need to go to the hospital for a D&C—the procedure can often be done in a doctor's office or at a reproductive health clinic.

Although D&C is not surgery per se, it is typically performed while you are under anesthesia. While it can be useful for figuring out why you are bleeding abnormally, D&C procedures don't solve the problem indefinitely. They are also more invasive than other options and come with their own risks. Your doctor will help you decide if it's the appropriate option for you.

Treating Underlying Health Conditions

If menorrhagia is being caused by another health condition, it’s important that it is properly diagnosed and treated. You may need to see another type of doctor or with several doctors who will work together to come up with a care plan.

Sexually-transmitted infections can often be treated with medication, such as antibiotics. If you are diagnosed with an STD, it is important that you notify any sexual partners you’ve had and practice safe sex.

For conditions that affect another part of your body, such as your thyroid or blood disorders, you will likely need to work with a specialist for treatment. Once you address the underlying disease that is causing your symptoms, menorrhagia will usually resolve.

If you are diagnosed with a more serious condition, you will need to work with a team of doctors who will help you decide on treatment. Surgery may be required, especially for conditions such as endometriosis, fibroid tumors, and reproductive cancers which usually need specialized surgery.

If you get a cancer diagnosis, you will work with a team of doctors and surgeons to come up with a treatment. This may include chemotherapy and radiation, medications, and surgeries. In some cases, your doctor may recommend you have a partial or complete hysterectomy.

A Word From Verywell

Metrorrhagia, also called intermenstrual bleeding, abnormal vaginal bleeding, or dysfunctional uterine bleeding is vaginal bleeding that happens when a person is not having their period. Sometimes the bleeding occurs due to lifestyle factors like stress, weight loss, or travel, but it can also be due to hormonal changes, medications, and certain health conditions. This type of bleeding can have many causes, some of which are more serious than others. The type of treatment will depend on the cause and the specific needs of the person experiencing metrorrhagia.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.