Vaginal bleeding between periods

• stress
• injury or disease of the vaginal opening (caused by intercourse, infection, polyp, genital warts , ulcer , or varicose veins )
• vaginal injury from insertion of foreign objects, from malignancy , or from infection
• dry vaginal walls resulting from lack of estrogen after menopause
• abortion (spontaneous or induced)
• fluctuation in hormone levels
• stopping and starting birth control pills or estrogens
• low thyroid function
• IUD use can cause occasional spotting (if bleeding is slight, it can be ignored)
• drugs such as anticoagulants
• cervical conization or cauterization procedures

Note: There may be other causes of bleeding between periods. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for bleeding between periods, occurring alone or in combination with other problems.

Home Care:
Bed rest is recommended if bleeding is heavy.

The number of pads or tampons used should be recorded (so that the amount of bleeding can be determined). Change tampons regularly, at least twice a day.

Because aspirin may prolong bleeding, it should be avoided if possible.

Call Your Healthcare Provider If:

• there is any unexplained bleeding between periods.
• there is any bleeding after menopause .
• abnormal bleeding is accompanied by other symptoms.

What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting vaginal bleeding between periods detail may include:

• time pattern
  • When did this bleeding between periods begin?
  • Does it occur consistently, such as every month?
  • When (during the course of a menstrual cycle) does this bleeding begin?
  • How long does the in-between bleeding last?

• quality
  • Is the bleeding heavy?
  • How many tampons or pads are required?
  • Do cramps accompany the bleeding?

• aggravating factors
  • What makes it worse?
  • Does increased physical activity make the bleeding worse?
  • Is increased stress associated with the bleeding?

• relieving factors
  • Does anything relieve or prevent it?

• other symptoms
  • What other symptoms are also present?
  • Do you have abdominal pain or cramps?
  • Increased bruising elsewhere on the body?
  • Do you have any difficulty, pain or burning with urination?
  • Is there bloody urine or blood in the stools ?

• other important information
  • Are you pregnant ?
  • Have you had a miscarriage or abortion ?
  • Have you had a D & C ?
  • What medications are being taken?
  • Are tampons used? What kind? What size?
  • At what age did menstruation start?
  • Have there been normal periods without bleeding between in the past?
  • Is sexual activity occurring?
  • Is birth control being used? What kind?
  • Have there been any injuries?
  • Have there been any medical or surgical treatments?

A thorough menstrual history will be obtained and a physical examination performed with an emphasis on the pelvic area. Uterine blood loss can be estimated if the patient knows how many sanitary napkins or tampons were used during a period.

Diagnostic tests that may be performed include:

• pap smear (if bleeding is inactive)
• endometrial biopsy

After seeing your health care provider:
You may want to add a diagnosis related to bleeding between periods to your personal medical record.


This is an illustration of the female reproductive system. Both internal and external views are shown here.