Bleeding Between Periods (Metrorrhagia)
What is metrorrhagia?
Bleeding from the uterus between menstrual periods is called metrorrhagia.
How does it occur?
There are many reasons why women may have metrorrhagia. They are:
- hormone imbalance (the imbalance is sometimes caused by improper use of hormone medicine, such as birth controlpills)
- polyps, which are growths on the cervix (the opening of the uterus) or inside the uterus; polyps are usually noncancerous
- infection or inflammation of the uterus or cervix
- erosion of the cervix (loss of the surface skin of the cervix)
- pregnancy complications, including miscarriage, threat of miscarriage, and ectopic (tubal) pregnancy
- use of an IUD (intrauterine device), depo provera, Implanon or birth control pills
- endometriosis (uterine tissue growing outside the uterus)
- cancer of the cervix or other parts of the uterus
- chronic medical problems (for example, thyroid problems, diabetes, and blood-clotting problems)
- adhesions (scar tissue) inside the uterus.
How is it diagnosed?
Your medical history and menstrual cycle history are important information to obtain. Dr. Hardy or the Nurse Practitioner may ask you to keep a diary of bleeding and nonbleeding days, including notes about how heavy the bleeding was. You will also have a physical exam. There are blood tests and procedures that may be ordered to further evaluated why you are having irregular menstrual cycles. They are:
- CBC (complete blood count), TSH (thyroid stimulating hormone), Prolactin
- Endometrial biopsy: Dr. Hardy or the Nurse Practitioner will take a sample of tissue from the inside of the uterus. The tissue is then sent off to the laboratory for evaluation.
- 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.
- Sonohysterogram: An ultrasound scan is 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. This procedure is performed in the office.
- Hysteroscopy: Dr. Hardy inserts a thin metal tube with a light and tiny camera through the vagina and cervix and into the uterus. This allows him to see the inside of the uterus. This procedure is typically performed as a same-day surgery but may be done in the office as well.
How is it treated?
The treatment depends on the cause of the problem. For example, if you have a hormone imbalance, we may prescribe hormones. If an IUD is causing the problem, it may be removed. Erosion of the cervix may be treated removing or destroying some of the cervical tissue.
Sometimes surgery is needed. Possible surgical treatments include:
- D&C, in which tissue is scraped or suctioned from the uterus
- hysteroscopy (to remove a polyp, for example)
- hysterectomy, which is removal of the uterus.
- Endometrial ablation, which is perfomed in the office.
If cancer is found, it may be treated with surgery, radiation, or chemotherapy (anticancer drugs).
How long will the effects last?
This depends on the cause and treatment.
How can I take care of myself?
If you have bleeding between periods for 2 months in a row, call the office for an appointment. If you have severe bleeding or pain, lightheadedness, or dizziness, you should call the office immediately.