Intermittent or irregular vaginal bleeding

Vaginal bleeding at an unexpected time is often quite frightening. Fortunately, however, there is usually nothing serious to worry about. In the vast majority of cases the cause is hormonal; the female hormones work less regularly or the balance between the hormones is temporarily disturbed. In more than 50% of women who experience intermittent or irregular bleeding, no cause can be found. Occasionally there is more going on.
Interim bleeding is blood loss between two menstrual periods. The normal menstrual pattern then remains (largely) recognizable. Bleeding that occurs only after sexual intercourse or after touching the genitals is called post-coital bleeding and contact bleeding. With irregular or abnormal bleeding, it is no longer clear when your period starts or ends. If you lose more blood than normal during menstruation, this is also called abnormal blood loss.

Innocent cause of unexpected blood loss

Abnormal bleeding is especially common in the first years of menstruation and in the years just before menopause. But abnormal blood loss can also occur in the period in between. It is usually caused by a disturbance in the hormonal balance. The balance between the female hormones estrogen and progestin is then (temporarily) lost. This can happen, for example, if you suddenly exercise a lot, lose weight, gain weight, are overtired or very emotional. In that case, the abnormal blood loss is harmless and usually disappears on its own. Irregular bleeding also usually has a harmless hormonal cause. The amount of estrogen and progestin in the blood sometimes fluctuates and the hormones then work less regularly. In that case, the irregular bleeding almost always occurs on fixed days.

Unexpected blood loss due to abnormalities of the cervix

Irregular bleeding and intermediate bleeding that occurs at varying times and lasts longer than three months is sometimes caused by an inflammation of the cervix or cervix (cervicitis). The cause of a bacterial infection is often a sexually transmitted disease (STD), such as chlamydia or gonorrhea. But other bacteria and fungi can also cause inflammation of the cervix or neck. The infection is accompanied by vaginal discharge and sometimes blood loss and pain during intercourse or urination. An infection of the cervix or neck must be treated with antibiotics.
A polyp in the cervix can also sometimes lead to abnormal or interim bleeding. A polyp is an overgrowth of the mucous membrane on the inside of the cervix. The growth usually has the shape of a grape and grows to about 2 cm in size. A polyp is almost always harmless, but can cause complaints such as watery or bloody vaginal discharge and heavier menstruation. The cervix can be sensitive and bleed easily, especially after sex. Because there is a small risk that the polyp will eventually become malignant, it is usually removed.
The cervix is sometimes turned inside out, causing the fragile and thin inner wall to lie on the outside. This condition is called ectropion or eversion and can occur in children, pregnant women and women who are on the pill. Often there is no clear cause. Occasionally, ectropion occurs as a result of childbirth or inflammation. The condition is often accompanied by excessive, mucous vaginal discharge and sometimes bleeding after sexual intercourse. If there is pus and blood in the discharge, there is usually also an inflammation of the cervix. Occasionally there are also wounds (erosion) in the mucous membrane of the uterus. These may be caused by, among other things, trauma, inflammation of the cervix or chemicals (e.g. spermicides or vaginal douches). The erosive areas can bleed easily, causing frequent bleeding during pregnancy and after intercourse. Ectropion is harmless and does not always need to be treated. The complaints disappear automatically after menopause. Erosion must always be treated because it increases the risk of cervical cancer.
In a very small minority of cases, irregular or intermittent bleeding is caused by a malignant growth in the cervix .

Unexpected blood loss due to abnormalities in the uterus itself

Inflammation of the lining of the uterus can cause irregular or intermittent bleeding. The inflammation usually occurs as a result of an operation (for example a curettage or caesarean section) or by the insertion of an IUD. However, a sexually transmitted infection (STD) or an inflammation that has arisen elsewhere in the body can also lead to an uterine infection. The inflammation is often accompanied by pain in the lower abdomen and lower back, pain during urination and intercourse, abnormal vaginal discharge and irregular periods. A uterine infection is treated with antibiotics and painkillers. Occasionally an operation is necessary.
Sometimes a polyp , a growth in the mucous membrane of the uterine wall, causes unexpected blood loss. A uterine polyp is a spherical growth of 1 to 3 centimeters in size, which is attached to the mucous membrane wall of the uterus by a stalk. A uterine polyp is quite common in women between the ages of 30 and 50. A polyp often occurs when the lining of the uterus is stimulated too much, for example due to inflammation or during pregnancy. However, in most cases the cause of the polyp is unknown. A polyp can cause watery or brown vaginal discharge, interim bleeding, heavy bleeding during menstruation, blood loss after menopause or contact bleeding (blood loss after intercourse). In more than 95% of cases, a polyp in the uterus is and remains benign. However, as a precaution, the polyp is usually removed.
Abnormal blood loss can also be caused by fibroids in the uterus (myomas). These are benign lumps of the muscle tissue of the uterine wall. The lumps vary in size from a pinhead to a large orange or larger. Fibroids almost always develop during a woman’s childbearing years. About half of women develop one or more fibroids. The fibroids prevent the uterus from contracting properly. In addition, they sometimes cause blood flow disorders in the uterine wall and the mucous membrane. This can lead to severe abdominal pain and irregular (sometimes heavy) bleeding. Fibroids are generally only removed if they are very large or if they bother you a lot. In certain cases,
endometriosis can lead to very heavy and prolonged menstruation. In this condition, the lining of the uterus has expanded to places where it should not be (inside or even outside the uterus). The uterine lining is renewed every month during menstruation. The old mucous membrane then disappears from your body. The endometriosis spots respond, just like the normal mucous membrane, to the monthly cycle. If the spots are located in the uterine wall, they can lead to abnormal bleeding. Other complaints include (severe) abdominal pain and painful menstruation.
In a very small minority of cases, irregular or intermittent bleeding is caused by a malignant growth in the uterus.

Other causes of intermittent or irregular bleeding

Certain medications that contain hormones (for example the pill or corticosteroid injections or tablets) can cause a disruption in the hormonal balance. As a result, intermittent or irregular bleeding may occur. A copper-containing IUD or an IUD that releases hormones can also lead to this. Especially in the first months after it has been inserted. If you have been using the IUD for a while without any problems, it is unlikely that this is causing the unexpected blood loss.
Vaginitis , an inflammation of the inner walls of the vagina, the labia and the tissue around the vagina, can sometimes lead to some interim bleeding. The infection is usually caused by a bacterium or a fungus (for example candida). The symptoms are abnormal vaginal discharge (sometimes with a little blood), itching, a burning sensation and pain during intercourse. Depending on the cause, vaginitis can be treated with antibiotics or antifungals.
Irregular bleeding can also be a sign of impending miscarriage or ectopic pregnancy . In the latter case, the fertilized egg has not implanted in the uterus but outside, for example in the fallopian tube. When the egg starts to grow, severe abdominal pain occurs. You will experience abdominal cramps and possible vaginal bleeding. You may also feel dizzy, faint, feel nauseous and have a constant urge to urinate or defecate. In most cases, an ectopic pregnancy is caused by damage to one or both fallopian tubes, for example due to inflammation. Other causes may be previous surgery on the fallopian tube, a previous ectopic pregnancy, adhesions in the abdominal cavity or endometriosis. An ectopic pregnancy is a potentially life-threatening condition and should always be treated.
Very occasionally, very heavy menstruation is the result of a blood clotting disorder . The blood then does not clot properly, causing you to bleed faster and continue to bleed for longer. An example of this is Von Willebrand’s disease. This is a hereditary disease in which clotting problems arise due to the lack of sufficient specific proteins. In addition to heavy bleeding during menstruation, this disease also causes mucous membrane bleeding (nose and gums) and bruising. However, a clotting disorder is only rarely the cause of heavy bleeding during menstruation.

Examination by the GP or gynaecologist

It is always important to go to the doctor if you experience intermittent or irregular bleeding. This can rule out any serious causes. Before you go to the doctor, it is wise to keep a menstrual calendar for some time. Here you keep track of whether and how much blood you lose per day, whether you have used the pill or other medicines and whether you have had sexual intercourse. This makes it easier for the GP to recognize a certain pattern and determine a possible cause.
The GP will usually perform an internal examination and take a smear to demonstrate or rule out an inflammation or other abnormality in the uterus (neck), such as a fibroid. If in doubt, you will be referred to the gynecologist, who will perform an ultrasound scan or hysteroscopy (internal examination with a viewing tube). Depending on the cause, appropriate treatment can be instituted.

Contraceptive pill as a possible treatment

However, in most cases no clear cause is found. The intermittent or irregular bleeding is almost certainly caused by a hormonal imbalance (which cannot always be determined). This is harmless and usually disappears on its own. In that case, you may want to use the contraceptive pill. This often makes blood loss less and more regular. After a few months (three to six) you can usually stop taking the pill again to see how things go. Sometimes, however, the blood loss is caused by the contraceptive pill. Then consider switching to another pill. This may cause blood loss to become less and more regular.
Intermittent and irregular bleeding that has a hormonal cause generally disappears on its own. However, if the symptoms persist for a long time after your doctor’s visit (more than 3 months), if the symptoms get worse or if you develop pain or fever, go to the doctor again. There may still be an inflammation, for example. In addition, heavy blood loss (due to heavy menstruation) that lasts for months can lead to anemia. Your doctor can check this with a blood test and prescribe medication if necessary.

read more

  • Abnormal bleeding due to a polyp in the uterus
  • Fallopian tube inflammation: severe abdominal pain, fever and blood loss
  • Pain in the lower abdomen: uterus, fallopian tubes and ovaries
  • Vaginal infections: usually harmless, but annoying
  • Vaginal bleeding after menopause
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