intermenstrual bleeding intermenstrual bleeding intermenstrual bleeding, previously known as metrorrhagia, is uterine bleeding at irregular intervals, particularly between the expected menstrual periods. it is a cause of vaginal bleeding. not to be confused with menorrhagia. intermenstrual bleedingother namesmetrorrhagia, irregular vaginal bleedingspecialtygynecologysymptomsbleeding in between periodsrisk factorsfamily historydiagnostic methodbased on physical examinationdifferential diagnosisirregular menstruation in some women, menstrual spotting between periods occurs as a normal and harmless part of ovulation. some women experience acute mid-cycle abdominal pain around the time of ovulation (sometimes referred to by the german term for this phenomenon, mittelschmerz). this may also occur at the same time as menstrual spotting. the term breakthrough bleeding or breakthrough spotting is usually used for women using hormonal contraceptives, such as iuds or oral contraceptives, in which it refers to bleeding or spotting between any expected withdrawal bleedings, or bleeding or spotting at any time if none is expected. if spotting continues beyond the first 3-4 cycles of oral contraceptive use, a woman should have her prescription adjusted to a pill containing higher estrogen:progesterone ratio by either increasing the estrogen dose or decreasing the relative progestin dose. besides the aforementioned physiologic forms, metrorrhagia may also represent abnormal uterine bleeding and be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids, uterine cancer, or vaginal cancer. if the bleeding is repeated and heavy, it can cause significant iron-deficiency anemia. cause intermittent spotting between periods can result from any of numerous reproductive system disorders: neoplasia: cervical cancer uterine cancer vaginal cancer endometrial cancer primary fallopian tube cancer ovarian cancer inflammation: cervicitis endometritis vaginitis sexually transmitted infections pelvic inflammatory disease endometrial abnormalities: endometriosis adenomyosis uterine leiomyomas endometrial hyperplasia polyps endocrinological causes: hormone imbalance dysfunctional uterine bleeding diets which induce ketosis, such as the atkins diet polycystic ovarian syndrome bleeding disorders: von willebrand disease pancytopenia due to leukemia drug induced: use of progestin-only contraceptives, such as depo provera change in oral contraception overdose of anticoagulant medication or aspirine abuse traumatic causes: automutilation sexual abuse or rape related to pregnancy: implantation bleeding ectopic pregnancy (incomplete) miscarriage other causes: enlarged uterus with menorrhea breakthrough bleeding breakthrough bleeding (btb) is any of various forms of vaginal bleeding, usually referring to mid-cycle bleeding in users of combined oral contraceptives, as attributed to insufficient estrogens. it may also occur with other hormonal contraceptives. sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of metrorrhagia, and sometimes it is classified as not abnormal. in the context of hemophilia, the term describes a bleeding that occurs while a patient is on prophylaxis. presentation the bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding. it is estimated that breakthrough bleeding affects around 25 % of combined oral contraceptive pill (cocp) users during the initial 3 to 4 months of use, it then usually resolves on its own. mechanism breakthrough bleeding is commonly due to 4 factors: physiologic effects of ocs on the endometrium, oc-related parameters, (dose, formulation, and regimen), patient behavior, (compliance, using concomitant medications, and smoking) and benign or malignant pathology. treatment breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth control. terminology metrorrhagia is from metro = measure, -rrhagia = abnormal flow. the term is no longer recommended.