Bleeding Outside Of Your Period: Signs You Should Look Out For

When a young girl reaches puberty, her body starts to undergo a series of physiological changes that result in the development of secondary sexual characteristics. Similarly, menstruation starts with the onset of the first period (menarche). In the first year or two, the body is progressively adapting to that change, and as a result periods might be irregular and inconsistent.

However, past that stage, every woman should ideally have a consistent menstrual cycle where menses are expected at a specific interval of time, and once every month. Normal menstrual cycles may range from 21 to 35 days, and some women have less predictable periods. However, vaginal bleeding should be constricted to the time of your period. If you bleed between periods or think that your periods come closer together than once every 21 days, you need to get a doctor involved.

Causes of abnormal uterine bleeding

Several factors can explain abnormal uterine bleeding — bleeding with an unknown cause that occurs when you aren't having your period. Not all of them are dangerous, but all deserve a closer look.

Uterine pathologies

Uterine fibroids are benign tumors that are found in the wall of the uterus. Their growth and development is influenced by estrogen, which is why they are more common in women of reproductive age. They are classified based on the layer of the uterus from which they develop. If they grow within the myometrium, they are called intramural. Uterine fibroids can also be submucosal (develop under the uterine mucosa), subserosal (from the outermost layer of the uterus) or pedunculated (develop at the surface of the uterus). Depending on how big they are, uterine fibroids can sometimes be palpated (felt) from the outside.

The diagnosis of uterine fibroids is confirmed with an abdominal ultrasound, and the treatment options (from medical to surgical) depending on each woman.

Endometriosis is another medical condition that could cause bleeding outside of periods. It is medically defined as the presence of endometrial tissue outside of the uterine cavity. This tissue should normally only be present in the uterus. Some common locations are the ovaries, the rectum, or the pouch of Douglas (space between the large intestine and the uterus). There are several theories that attempted to explain the presence of endometrial tissue in those sites. Just like in the case of uterine fibroids, women suffering from endometriosis present significantly heavier and longer periods, as well as moderate to severe abdominal cramping. Additionally, they might report bleeding and pain with defecation (if the endometrial tissue is present in the rectum). Treatment options include hormonal control, pain medications (as the pain can be excruciating at time) and surgical management.

See Also: Bleeding Between Periods - Causes

Polycystic ovarian syndrome

Also commonly known as PCOS, polycystic ovarian syndrome is an endocrine abnormality in which a woman presents with several mature follicles in the ovaries but yet is unable to ovulate. The pathophysiology of this disease is multifactorial, and only few aspects of this disorder have been understood up to today.  The most common complication of PCOS is infertily, which is why this diagnosis can be life changing in a woman in her reproductive age. Symptoms of this condition vary from moderate to severe, according to the individual. They include lack of ovulation, the absence of periods or irregular periods (lighter bleeding, periods lasting less than 5 days, skipped periods, etc.) acne, involuntary weight gain and even trouble losing weight. Occasionally, women may experience hair thinning on the scalp. The diagnosis of this condition is very complex and requires a series of medical investigations.

Dysfunctional Uterine Bleeding

Dysfunctional uterine bleeding is defined as abnormal uterine bleeding outside of menses that is no attributable to any anatomic, physiologic or organic causes. Henceforth, it is a diagnosis of exclusion, a diagnosis made when no other cause can be found.

Dysfunctional uterine bleeding is thought to be caused by an alteration in the level of hormones during menstrual cycle in many cases. Some texts report that in this condition, the female fails to ovulate, and in that aspect it slightly resembles (but is not the same as) PCOS. This condition presents almost as all other bleeding problems cited in this article: periods lasting longer than normal, heavier bleeding (need to change sanitary pads more often, sometimes 5 to 6 times per day), severe cramps and abdominal bloating during menses, vaginal spotting long after the end of menses, passing clots during and after periods, and irregular period timing. It is good to know that soaking through a maxi pad more than once every hour can pose an immediate danger to your health, and women experiencing severe bleeding should see a doctor as soon as possible.

Other factors

Sometimes, the problem does not stem from the inside, but rather from the outside. Medications such as steroids (oral contraceptives are an example) can have an impact on our hormonal cycle and cause a certain level of imbalance, which in turn can result in abnormal uterine bleeding. Also, miscarriage is a possible cause of bleeding outside one’s period.

If you suspect that you might be pregnant (if you have missed your period for instance) and you are experiencing some uterine bleeding and spotting, consult immediately with your Gynecologist to ensure that what you are experiencing is not a miscarriage.

Symptoms to look out for

There is a myriad of symptoms that you can experience and that are tell-tale signs of abnormal uterine function. These are the primary symptoms that should indicate to you that something is going south, and should prompt you to consult with your physician immediately:

-          Menses that are heavier than normal;

-          Abnormal cramping during menses

-          Vaginal spotting several days after the end of your menses;

-          Bleeding during sexual intercourse.

See Also: Perimenopause Problems: Depression, Bleeding and Weight Control

What should I do if I experience bleeding outside of my period?

If you ever experience bleeding outside of your period, the first step is to consult your Gynecologist (or family physician) as soon as possible. It is very important to take quick and immediate action by doing so, as your Gynecologist is the best professional entity that could help you sort things out. Abnormal bleeding outside of your periods could be a sign of an underlying medical condition that needs to be addressed.

Following investigations (blood tests, ultrasounds, etc.) your doctor will be able to identify the cause of your abnormal uterine bleeding, and depending on the cause (as well as on your personal choice), different treatment options are available. For some females, hormonal therapy and pain medications (if any pain is experienced) are just enough. For others, surgical correction (such as in the case of severe fibroids) are the sole option. Discuss with your Gynecologist and find out what is right for you.