Metrorrhagia (Bleeding Between Menstrual Periods)

Bleeding from the uterus between menstrual periods is called metrorrhagia. This is common, especially for teenagers and women nearing menopause.

There are many reasons why women may have metrorrhagia, including:

• Hormone imbalance (the imbalance is sometimes caused by improper use of hormone medicine, such as birth control pills)
• Polyps, which are growths on the cervix (the opening of the uterus) or inside the uterus; polyps are usually noncancerous.
• Fibroids, which are noncancerous growths in the uterus
• Infection or inflammation of the uterus, cervix, or vagina
• Erosion of the cervix (loss of the surface skin of the cervix)
• Use of an IUD (intrauterine device) or birth control pills
• Endometriosis (uterine tissue growing outside the uterus)
• Adhesions (scar tissue) inside the uterus
• Dry vaginal walls from decreased estrogen after menopause
• Chronic medical problems (for example, thyroid problems, diabetes, and blood-clotting problems)
• Some medications, such as blood thinners
• Stress
• Cancer of the cervix or other parts of the uterus and vagina

Diagnosing Metrorrhagia

Your healthcare provider will ask about your medical history and menstrual cycles. Your provider may ask you to keep a log of bleeding and non-bleeding days, including notes about how heavy the bleeding was.  You may also have a physical exam.

Sometimes, a blood test or procedure are necessary, these include:

• Endometrial biopsy: Your physician takes a sample of tissue from the inside of the uterus. The tissue is then examined under a microscope.
• Ultrasound scan: Sound waves are used to get pictures of the uterus, ovaries, and pelvis. The ultrasound probe may be placed on your lower abdomen or into your vagina.
• Hysteroscopy: Your physician inserts a thin metal tube with a tiny camera through the vagina and cervix and into the uterus. This allows your provider to see the inside of the uterus. 
• Sonohysterogram: An ultrasound scan done after fluid is injected through a tube into your uterus. This test allows your provider to look for problems with the lining of the uterus, such as fibroids.

Some of these procedures may be done in your healthcare provider's office. Others may be done in an outpatient clinic.

The treatment depends on the cause of the problem. For example, if you have a hormone imbalance, your healthcare provider may prescribe hormones. If an IUD is causing the problem, it may be removed. 

Sometimes surgery is needed. Possible surgical treatments include:

• Dilation & curettage, in which tissue is scraped or suctioned from the uterus
• Hysteroscopy, to remove things like tissue or a polyp
• Hysterectomy, which is removal of the uterus
• Cancer removal, which can also be treated with radiation, chemotherapy (anti-cancer drugs) or any combination of these treatments.

Make an appointment with your provider if you are experiencing irregular bleeding between periods for multiple cycles.