Abnormal Vaginal Bleeding Between Menstrual Periods: What You Need to Know

Any vaginal bleeding that occurs during a time when you aren’t on your menstrual period is considered abnormal. Fortunately, irregular vaginal bleeding, also known as uterine bleeding, is usually not serious and can often be treated easily. However, this spotting could also be a sign of a more serious condition, like fibroids, an infection, or polyps.

Read on to learn more about the causes and treatment of abnormal vaginal bleeding.

An Overview of Irregular Vaginal Bleeding

Irregular vaginal bleeding is defined as any bleeding that doesn't occur inside the menstrual period. It is a common occurrence. Roughly 30% of people of childbearing age will experience it at some point in their lifetimes.

Typically, the type of irregular bleeding is grouped into one of two categories: anovulatory and ovulatory. This means that the bleeding could be caused by a condition related to a lack of ovulation, which is when an egg is released from the ovaries, or because of ovulation patterns.

Causes of Abnormal Bleeding

There are various things that can cause a person to experience bleeding outside of their menstrual period.

Birth Control

There are several variations of birth control that can lead to irregular vaginal bleeding. They include:

• Combined hormonal contraceptives: Combined hormonal contraceptives contain both estrogen and progesterone, which are female sex hormones. They come in the forms of pills, patches, and vaginal rings. The most common side effect of this type of birth control is irregular vaginal bleeding. As many as 50% of people using this form of birth control will experience it within the first six months of use.
• Hormonal intrauterine devices (IUD): An IUD is a T-shaped device inserted into the uterus as a way to prevent an unwanted pregnancy. The device can stay in the body for up to seven years in some cases. Hormonal IUDs contain a progestin hormone known as levonorgestrel, which acts similarly to progesterone. People who choose this birth control route can expect irregular vaginal bleeding for the first six months. However, the bleeding from IUDs should decrease slowly after that first six-month period.
• Copper IUDs: A copper IUD contains copper as opposed to hormones. It is placed in the uterus in the same way as a hormonal IUD. For people with the copper IUD, irregular vaginal bleeding is incredibly common. Up to 70% of people who use this method will have to deal with the side effect for up to six months after getting it inserted.
• Implants: Placed in the upper arm below the skin, the implant contraceptive works by releasing the hormone progestin at specific times. Once it is in place in the upper arm, it can stay there for up to three years. The most common side effect of a contraceptive implant is irregular bleeding. As many as 78% of people who use the implant will experience it.
• Injectable contraceptives: Injectables, or shots, are administered through a quarterly injection. They contain the hormone progestin. One of the most common side effects of the shot is a complete loss of a menstrual period, or amenorrhea. In the first three months, users often experience irregular vaginal bleeding.

Stress and Lifestyle Changes

Stress and lifestyle changes can cause a host of changes within the body, one of which is irregular vaginal bleeding.

One study investigated how psychological stress affected students and found that 91% of participants experience some issue with their normal menstrual patterns. Out of that 91%, 9.3% experienced irregular vaginal bleeding.

Bodyweight can also be a factor when it comes to abnormal uterine bleeding. One study investigated the connection between obesity and irregular vaginal bleeding and found that when a person had obesity, it also increased their risk of irregular vaginal bleeding.

Dieting or changing your exercise routine can also cause changes in your menstrual cycle, which can lead to bleeding between periods.

Menarche and Menopause

Menarche is the term used to describe the onset of menstruation, whereas menopause is when menstruation stops. During these times, the menstrual cycle's rhythm is off, leading to bleeding irregularities.

On average, the menstrual cycle begins when a person reaches the age of 12 or 13. It can, however, come on earlier or later. The menstrual cycle during menarche isn’t the same as it is in adulthood. The cycle itself lasts between 21 and 45 days, whereas in adulthood, the average length is between 21 and 34 days. During the initial onset of menstruation, bleeding between periods can occur.

Similarly, menopause is predated by perimenopause, during which menstruation becomes irregular and begins to disappear. The spotting or irregular bleeding that occurs during this transitional time is typically caused by changing hormones.

Structural Abnormalities

Certain structural abnormalities can cause irregular bleeding to occur, such as:

• Uterine fibroids: Uterine fibroids are noncancerous tumors that grow within the uterus.
• Uterine polyps: Uterine polyps are small masses that form within the uterus. The masses are made up of endometrial tissue, which is the tissue that lines the inside of the uterus. They can also be referred to as endometrial polyps.
• Cervical polyps: Cervical polyps grow within the cervix, which is the canal that connects the vagina and the uterus. These types of polyps can be red or purple in color and are typically cylindrical in shape.
• Adenomyosis: When endometrial tissue grows where it’s not supposed to, specifically into the uterus wall, it is referred to as adenomyosis.
• Endometrial hyperplasia: This condition develops when the tissue that lines the uterus grows too thick.

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a condition that causes issues with ovulation and the function of the ovaries.

When ovulation is hindered by the condition, it disrupts the regular menstrual cycle. As a result, a person can experience irregular periods and vaginal bleeding. As many as 85% of people with PCOS will experience abnormal vaginal bleeding.

People with PCOS often experience other issues, such as:

• Insulin resistance
• Infertility
• Excessive hair growth

Pregnancy

Pregnancy can cause irregular vaginal bleeding in a variety of ways, including:

• Implantation bleeding: Some light bleeding occurs when the fertilized egg attaches itself to the womb.
• Changes in the cervix: As the cervix prepares itself for pregnancy, bleeding can occur.
• Miscarriage: The loss of pregnancy, known as miscarriage, can cause bleeding. Typically, bleeding in the first 12 weeks of pregnancy can be a sign that you have miscarried.
• Ectopic pregnancy: An ectopic pregnancy is when a fertilized egg attaches itself to the wall of a fallopian tube or elsewhere outside of the uterus. Bleeding can be a sign that this has occurred.

Cancers of the Reproductive System

In some cases, vaginal bleeding between periods can be a sign of cancer.

Types of cancers that can cause irregular vaginal bleeding include:

• Cervical cancer
• Uterine cancer
• Vaginal cancer
• Ovarian cancer

When to Seek Medical Attention

Any unusual vaginal bleeding warrants a trip to your healthcare provider. Since there are so many possible causes, some of which can be serious, it's better to get it checked out. A diagnosis makes way for treatment, which should remedy the vaginal bleeding.

If you know that you have a disorder that comes with irregular bleeding or you are on birth control, you may be able to wait out the bleeding. You should, however, seek medical care if the bleeding:

• Comes with pain
• Is so heavy that you go through many sanitary products in a short period of time
• Is accompanied by a fever
  

Treatment for Vaginal Bleeding

Treatment for vaginal bleeding depends entirely on what is causing it, but may include medication or surgery.

Medication

Birth control is often used to help address irregular vaginal bleeding. However, it can also cause bleeding to occur, so it's important to take that into consideration when evaluating birth control as a possible treatment method.

Birth control works best to regulate periods. After the first six months, irregular bleeding typically disappears.

Other options that may be used to help treat irregular bleeding include:

• Nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen
• Tranexamic acid, which can be used to help reduce the flow of heavy menstrual bleeding
• Medications that treat underlying health disorders, such as PCOS
  

Surgery

Surgery options are reserved for specific types of irregular bleeding caused by removable growths. These are designed to remove cancer or other growths, polyps, and fibroids.

In rare cases, a hysterectomy may be performed, which removes the entire uterus.

Summary

Irregular vaginal bleeding is a common occurrence that affects many people of childbearing age. It can be caused by something as harmless as switching to a new birth control to something as serious as cancer. Since there are various causes of irregular bleeding, there are also a variety of different treatment options.

If you experience any new irregular bleeding and are unsure of what could be causing it, it's important to discuss it with your healthcare provider to have it checked out. This can rule out any dangerous or serious health issues and begin treatment as necessary.

A Word From Verywell

Irregular bleeding can be bothersome, especially when you already have to cope with monthly menstrual periods. Fortunately, in many cases, irregular bleeding isn't serious and can be treated effectively. Contact your healthcare provider to get checked out and receive treatment to help provide symptom relief.