Dr. Guy Gutman, M.D. Senior Specialist in Gynecology and Obstetrics and a Leading Surgeon in the Field

Intermenstrual bleeding – causes and treatments

Intermenstrual bleeding

Metrorrhagia is mild vaginal bleeding, which usually appears as a reddish-brown stain that can last for several days and occurs between regular menstrual periods. Bleeding is a symptom of several things, such as pregnancy, hormonal changes, and in extreme cases, also cervical cancer. 

This article will provide a broader picture of the possible causes of intermenstrual bleeding and will provide you with guidance on identifying and treating the issue.

What might intermenstrual bleeding indicate?

Abnormal bleeding between your periods does not just appear; it indicates an internal mechanism in the female system that requires medical attention. This phenomenon occurs in 10% -15% of women, and although it should not be a source of concern in most cases, a gynecologist should still be seen to examine the symptom and its cause.

Here are 10 possible reasons for the onset of metrorrhagia:

  • Using hormonal contraceptives
    1. Birth control pills are hormonal contraceptives. Their function is to prevent the release of the egg from the ovary and thereby prevent ovulation. One of the side effects that can occur due to birth control pills is intermenstrual bleeding. This bleeding may last until the body gets used to the hormonal change – about three months of taking pills regularly and correctly. The appearance of this bleeding does not indicate a mismatch of the pills to the body, nor does it indicate their effectiveness.
    2. The bleeding may last beyond three months due to the following reasons:
      • Irregularities in taking the pill
      • Change of contraception
      • The IUD moved or needs to be replaced after several years (depends on the brand).
      • You took the birth control pill late.

If the bleeding continues after these three months, go to your gynecologist and consult him/her about the contraception you are using and check if it’s still a suitable choice.


  • Endometriosis

Endometriosis is an inflammatory disease in which cells resembling endometrial cells grow outside the uterus. This medical condition can cause severe pelvic and lower abdominal pain in women who suffer from it, and one of its symptoms is abnormal menstrual bleeding.

 To learn more about endometriosis, click this link.

  • Perimenopause

Menopause is when a woman undergoes a significant hormonal change due to the end of her fertile period. The period before menopause is the period of perimenopause. This time is characterized by irregularity of the menstrual cycle due to hormonal changes (decrease in the level of progesterone and estrogen), so the appearance of intermenstrual bleeding becomes more common.

Even if the intermittent bleeding occurs during the perimenopausal period, the gynecologist should be consulted to verify that this is indeed the cause of the bleeding.

  • Ovulation

Ovulation is the process of ovulation where the eggs are released into the fallopian tube for fertilization, which occurs about fourteen days after the end of menstruation. This process is accompanied by hormonal changes, one of which is intermenstrual bleeding. However, this phenomenon is not so common – less than 5% of women will experience short intermenstrual bleeding during or near ovulation.

  • Pregnancy

Between 15% -and 25% of women can bleed during the first trimester of pregnancy. This may be due to the rooting of the pregnancy in the uterus – the fertilized egg migrates into the uterine cavity and takes root in it. In cases where such a stain appears in early pregnancy, the gynecologist should be examined to make sure that it is not a miscarriage.

  • Trauma to the vaginal area

 Intermenstrual bleeding can be caused due to damage to the vaginal area, such as having sex, a gynecological examination (vaginal ultrasound or colposcopy), or taking a biopsy. The bleeding should be light and last only a few days.

  • Polyp and fibroids

Polyps and fibroids are types of benign tumors that are of various sizes. Polyps may grow in the cervix or uterus. Fibroids grow out of the muscle tissue of the uterine wall, especially during the fertile period, due to high hormone levels. These benign tumors are often discovered during an examination by the gynecologist and are not noticeable, but quite often, women experience pain or bleeding because of them. In such cases, they can be removed.

  •  Cervical cancer 

Cervical cancer is one of the most common cancers among women globally. Although this type of cancer develops slowly, if you do not perform routine Pap tests, you may not discover it until a late and irreversible stage. One of the symptoms of cervical cancer is the appearance of abnormal menstrual bleeding, so one should immediately go to the gynecologist to see if there are any cancerous changes in the cervix that need treatment.


  • Stress

Stress can cause significant hormonal changes in a woman’s body and cause menstrual irregularities or bleeding throughout the month.


  • Sexually transmitted diseases and inflammatory bowel disease (PID)

There are sexually transmitted diseases (STDs) that can cause intermenstrual bleeding, such as chlamydia. The bleeding often comes with other side effects like pelvic pain, abnormal discharge, and pain during intercourse or while urinating. If a sexually transmitted disease is suspected, the gynecologist should be consulted, and a STD test should be taken

Another condition that can cause intermenstrual bleeding is pelvic inflammatory disease (PID). It is a disease caused by infections based on inflammation in the reproductive organs – fallopian tubes, ovaries, cervix, and uterus.

How do you differentiate between menstruation and intermenstrual bleeding?

Intermenstrual bleeding is supposed to be weak in intensity and lasts less time than regular menstrual bleeding.

A medical examination should be approached when bleeding is accompanied by an abnormal odor, vaginal irritation, fatigue, high fever, and different vaginal discharge.

Wishing us all good health ♥

About the Author
Dr. Guy Gutman

Dr. Guy Gutman

A senior physician at the Clalit Health Fund's Women's Health Center, a specialist in gynecology and cervical medicine, with 20 years of successful experience in fertility, obstetrics and gynecology.

Dr. Guy Gutman

Dr. Guy Gutman

A senior physician at the Clalit Health Fund's Women's Health Center, a specialist in gynecology and cervical medicine, with 20 years of successful experience in fertility, obstetrics and gynecology.