Intermenstrual bleeding

Intermenstrual bleeding (IMB), or metrorrhagia, is abnormal vaginal bleeding at irregular intervals between expected menstrual periods. It may be associated with bleeding with sexual intercourse. The term metrorrhagia, in which metro- means uterus and -rrhagia means abnormal flow, is no longer recommended. In some women, menstrual spotting between periods occurs as a normal and harmless part of ovulation. Some women experience acute mid-cycle abdominal pain around the time of ovulation (sometimes referred to by the German term for this phenomenon, mittelschmerz). This may also occur at the same time as menstrual spotting. The term breakthrough bleeding (or breakthrough spotting) is usually used for women using hormonal contraceptives, such as IUDs or oral contraceptives. It refers to bleeding or spotting between any expected withdrawal bleeding, or at any time if none is expected. If spotting continues beyond the first 3–4 cycles of oral contraceptive use, a woman should have her prescription adjusted to a pill containing higher estrogen:progesterone ratio by either increasing the estrogen dose or decreasing the relative progesterone dose. Besides the aforementioned physiologic forms, IMB may also represent abnormal uterine bleeding and be a sign of an underlying disorder, such as a hormone imbalance, endometriosis, uterine fibroids, uterine cancer, or vaginal cancer. If the bleeding is repeated and heavy, it can cause significant iron-deficiency anemia.