Metrorrhagia or spotting is abnormal bleeding that usually occurs between periods.

There are many possible causes of metrorrhagia, including:

• Hormone imbalance like anovulation
• Abnormal uterine growths like polyps or fibroids
• Sexual intercourse with an injury to the cervix or vagina
• Pregnancy complications
• Infection
• Uterine or vaginal cancer
• Endometriosis
• Ectopic pregnancy
• Miscarriage
• Implantation bleeding

What is a menstrual period?

The menstrual cycle is the time between the first day of the menstrual period or bleeding until the first day of the next bleeding. A menstrual cycle is a regular process that is regulated by hormones and ovulation. The average menstrual cycle lasts around 28 days, but it varies among individuals and may be either longer or shorter, between 21 and 35 days. Each month the uterine lining thickens as it builds up extra blood and tissue in preparation for a potential fertilized egg. An egg that is fertilized by a sperm cell may implant itself in the uterine lining and develop into an embryo, a fetus, and then into a baby. An unfertilized egg or a fertilized egg that does not implant in the uterus is usually absorbed or ejected with the menstrual bleeding. During menstruation, prostaglandins, a hormone-like substance, cause the uterus to contract. The uterine lining sheds and the blood leaves the body through the vagina. 

What are the symptoms of menorrhagia?

The main symptom of metrorrhagia is light to heavy bleeding or spotting between regular menstrual periods. You may or may not experience cramps or abdominal pain with bleeding. A miscarriage or ectopic pregnancy may cause severe cramps with bleeding.

If you have irregular bleeding, your doctor can examine you while you are bleeding. Do not delay an appointment because you are bleeding. It is helpful to keep a record of your periods and irregular bleeding to bring to your appointment.

Your doctor will review your medical history and symptoms. Your doctor will perform a physical examination. During your pelvic examination, cultures may be taken to test for infection or sexually transmitted disease. Blood tests may be used to test your thyroid and hormone levels. You may be tested for pregnancy. A Pap smear may be taken to check for cervical cancer. 

An ultrasound may be used to take pictures of your reproductive organs to check for abnormal growths. For an ultrasound, your doctor will place a conduction device on your lower abdomen or gently place a conduction wand in your vagina. The conduction device transmits sound waves to a computer that creates images on a video monitor.

An endometrial biopsy can be used to obtain cells from your uterus to check for hormone imbalances or abnormalities. There are a few types of biopsy methods, which may be performed in your doctor’s office or as an outpatient with general anesthesia.

What causes metrorrhagia?

1. Spotting or bleeding may be caused by hormone imbalances related to birth control pills, or problems with the hormone-producing glands or areas in the brain.
2. Anovulation, or not ovulating can cause spotting
3. Certain conditions in the uterus or cervix can cause abnormal bleeding, including fibroids or polyps, scar tissue, inflammation, or cancer.
4. Endometriosis, a condition in which the uterine lining tissue grows outside of the uterus, can cause metrorrhagia.
5. Infections, such as genital warts or yeast infections may cause bleeding.
6. Injury to the cervix and/or vagina usually during sexual intercourse can also lead to spotting or bleeding between periods.
7. A miscarriage or an ectopic pregnancy that is growing abnormally in the fallopian tubes can cause bleeding.
8. An intrauterine device (IUD) used for birth control can cause metrorrhagia.
9. Certain chronic conditions such as diabetes, blood clotting disorders, and thyroid disorders can contribute to metrorrhagia.
10. Blood-thinning medications may cause bleeding.

How can you treat menorrhagia?

The treatment for irregular bleeding or menorrhagia depends on the cause of your metrorrhagia:

1. Medications may be used to treat hormone imbalances, infections, and chronic medical conditions. 
2. Surgery may be used to treat polyps, endometriosis, or fibroids. 
3. Cancer may be treated with surgery, chemotherapy, radiation, or a combination of treatments. 
4. An IUD may need to be removed. 
5. Women that experience a miscarriage or ectopic pregnancy need immediate medical treatment. 
6. A dilation and curettage (D&C) may be used to remove the remaining tissue after a miscarriage.

It is important to contact your doctor if you experience metrorrhagia. There are a variety of diagnostic approaches and treatments for metrorrhagia, depending on the cause of the condition.