What is meant by intermenstrual bleeding?

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 (Q 24.6). 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.

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