What is meant by intermenstrual bleeding?
Intermenstrual bleeding (IMB) is bleeding between periods that is not associated with intercourse (post-coital bleeding – PCB). Bleeding about fourteen days before periods may be related to ovulation or a little bleeding for a day or two before the period begins properly (premenstrual spotting) may be more of a nuisance than a medical anxiety.
There are a variety of causes for IMB. The bleeding may be coming from the cavity of the womb with causes including those for heavy periods (6). The bleeding could be arising from the cervix or vagina. Whereas heavy regular periods are almost invariably due to benign conditions, intermenstrual bleeding can occasionally be the first indication of more worrying disease.
Physical examination by your doctor should detect problems around the cervix or the vagina. Serious disease within the uterus is unusual before the age of forty. If you are less than forty years old, hormone treatment may resolve the problem. If the IMB persists despite medication or if you have reached forty, further investigation including hysteroscopy and endometrial curettage are usually recommended.
A forty-five year old lady had been happy with a LNG- intrauterine system (Mirena) for three years. She then developed a little irregular bleeding. On examination her uterus was a little bulky but there were no other problems. Ultrasound demonstrated a few small fibroids. Endometrial biopsy showed inflammation and progestogen effects. The bleeding settled completely with a course of antibiotics.
A thirty-eight year old lady presented with intermenstrual bleeding. She had one child but then had difficulty conceiving. She was overweight and there had been evidence of PCO (Q7.1). Hysteroscopy and D and C (hysteroscopy D and C Q 24.12) were performed. The histology of the endometrium (lining of the uterus) demonstrated severe atypia (abnormal cells) and after full discussion hysterectomy (hysterectomy) with bilateral salpingo-oophorectomy (removal of both ovaries and Fallopian tubes -23) was performed. The histology of the uterus showed foci of malignancy. As the malignancy was detected early, radiotherapy was not required and the prognosis is excellent.
Please click on the required question.
- 1 Are heavy periods a common problem?
- 2 What is in my menstrual flow?
- 3 What range of menstrual cycle length is considered to be normal?
- 4 How can menstrual blood loss be measured?
- 5 How can I tell if my periods are abnormally heavy?
- 6 What could be the cause of my very heavy menstrual periods?
- 7 I have been sterilised. Could this be the cause of my heavy periods?
- 8 Should I have tests to find the reason for my heavy periods?
- 9 How will my heavy period problems be investigated?
- 10 What is meant by anaemia due to heavy periods?
- 11 What is intermenstrual bleeding?
- 12 What is a hysteroscopy and D and C?
- 13 What is cervical cautery?
- 14 What happens after the D and C?
- 15 What treatments are available for my heavy periods?
- 16 What are the medical treatments available for heavy periods?
- 17 How do the various medical treatments for heavy periods work?
- 18 What would be reasonable initial treatment for a teenager or young woman with heavy periods?
- 19 What is a hysterectomy?
- 20 What are the indications for hysterectomy?
- 21 What are the risks (complications) of hysterectomy?
- 22 What is vault granulation?
- 23 What are the different types of hysterectomy?
- 24 Is it essential to remove the neck of the womb at hysterectomy?
- 25 Should my ovaries be removed or conserved during hysterectomy?
- 26 How long will I be in hospital when I have my hysterectomy?
- 27 I have had a hysterectomy. Do I still need to have smear tests?
- 28 What are the other surgical alternatives to hysterectomy?
- 29 How do endometrial ablation and hysterectomy compare?
- 30 Are there any psychological effects following hysterectomy?
- 31 How do we decide the best treatment for my period problems?
- 32 Could I have some recommended hysterectomy support groups?
- 33 Are there any support groups?
- Intermenstrual Bleeding - Bleeding between periods.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
