This is vaginal bleeding that occurs in-between menstrual periods. If bleeding occurs after the normal menstrual flow has stopped and before the next menstrual period is expected to commence, it is referred to as intermenstrual bleeding. It is a form of abnormal vaginal bleeding. It may be minimal or heavy bleeding. 

What are the causes of intermenstrual bleeding?

1. Uterine fibroid
2. Uterine / cervical polyp
3. Hormonal contraception (e.g. contraceptive implant, progesterone contraceptive injection)
4. Use of intrauterine contraceptive device (IUCD) 
5. Hormonal imbalance
6. Vaginal dryness
7. Vaginal injury during sexual intercourse (especially with vaginal dryness)
8. Infection of the uterine lining (endometritis) through sexually transmitted infection
9. Cancer of the uterine lining (endometrial cancer)
10. Cervical cancer

Evaluation of intermenstrual bleeding

The information required by a doctor to properly evaluate a woman with intermenstrual bleeding includes history of the onset and progression of the bleeding as obtained from the affected individual, examination (including vaginal examination) and specific investigations targeted at the presumed cause(s) as obtained from the initial interactions. Specific investigations that may be necessary include:

1. Ultrasound – May be necessary to check the thickness of the uterine lining (endometrium), the size of the uterus, presence of fibroid / polyp as well as other structures such as the ovaries.
2. Screening for infection – This is done by taking swab from the uterus and / or cervix and sending such to the laboratory to identify the specific organisms involved and the antibiotic sensitivity.
3. Endometrial biopsy – This involves taking a sample of the uterine lining (biopsy) and sending such to the laboratory to check the cells for possible development of cancer.

Treatment of Intermenstrual Bleeding 

The treatment of intermenstrual bleeding is directed at the cause. This necessitates the affected person to present to a doctor for evaluation as soon as possible. This will help the doctor to determine the cause and institute the right management at the right time.

1. For those related to hormonal contraception, discontinuation of the method is all that is needed.
2. If infection is determined to be the cause, antibiotic treatment of the infectious agent is what is required to achieve a cure.
3. Uterine fibroid may need drug treatment to shrink the fibroid / control the bleeding, surgical removal of the fibroid or removal of the entire uterus.
4. Hormonal imbalance can be corrected by supplementation of the inadequate hormone(s).
5. Cancer may need surgical removal of the uterus in the early stage or other modalities of treatment in the late stage.

Prevention of intermentrual bleeding

The following steps may help in preventing some of the causes of intermenstrual bleeding. These include:

1. Proper assessment before taking on contraception: Women who are prone to abnormal bleeding should avoid hormonal contraception.
2. Regular use of condom by women who engage in sex with multiple sexual partners in order to avoid endometritis.
3. Prompt treatment of uterine fibroid when diagnosed.