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Breakthrough Bleeding: Causes And Ways To Deal With It

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Breakthrough Bleeding: Causes And Ways To Deal With It

Unexpected spotting or bleeding between periods can be worrying besides being most annoying. It is important to pin down the problem quickly – especially if you’re pregnant or you’re at risk of problems like sexually transmitted infections, PCOS, or even cancer. You may also just experience spotting due to an intrauterine device, birth control pills, or an implantation of a pregnancy. But it is better to put your mind at rest and get treated if it is something more serious.

Dealing with monthly menstrual bleeding is something you’ve managed to work into your routine. But when you notice spotting or an unexpected bleed between periods, it can throw you off both mentally and physically. Arm yourself with the knowledge of what’s causing the problem so you are better equipped to cope. You might even find a way to prevent future instances. And if the reasons warrant a visit to the doctor, you’ll know better than to put it off for later.

10 Causes Of Breakthrough Bleeding

Here are some of the top reasons for bleeding or spotting between periods. Some of these are more serious than others and will need urgent medical attention. For others, a simple check with your OB/GYN may put your mind at ease. In all cases, while you could exercise certain precautions to prevent things from worsening, the best care you can give yourself is to connect with your doctor and have yourself checked.

1. Polycystic Ovary Syndrome (PCOS)

PCOS can cause reproductive hormones to be out of balance with the male sex hormone testosterone, which tends to be overproduced. The menstrual irregularity that accompanies the condition can cause breakthrough bleeding or spotting.1

Dealing with the problem: While there are no known cures for PCOS, losing as little as 5 percent of excess body weight can help alleviate symptoms. Exercise regularly and eat whole grain foods, lean protein, and fresh produce. The contraceptive pill can help those with irregular periods. Those trying to conceive may need the help of medicines or in vitro fertilization to get pregnant.2

2. Birth Control Pills

Hormonal contraceptives, including the combined oral contraceptive pill (or what you know better as simply “the pill”), progestogen-only contraceptive pill, contraceptive patch, contraceptive implant, and contraceptive injection, can spark breakthrough bleeding. However, this typically happens only in the first three months from when you begin taking the contraceptive.

You may spot beyond the initial months if you miss taking your pill; or if you miss the pill- or patch-free week. Sometimes, having diarrhea or being sick may also cause this problem while you’re on the pill. Any problems with the contraceptive patch may also cause spotting between periods.

Some medication like herbal remedy St John’s Wort or some other prescription medications may interact with your pill and cause bleeding.3

Dealing with the problem: It is important to check with your gynecologist as well as physician to ensure there are no such interactions with medications you’ve been prescribed. If it does, you may need to use alternative medicines or change to a different method of birth control.4

3. Emergency Contraceptive Pill

Taking the emergency contraceptive pill, also known as the morning-after pill, can cause bleeding between your periods. While this is not a common outcome of taking the pill, the combination of hormones, whether it is progestin along with estrogen or just progestin, can cause breakthrough bleeding in some women.5 A note of caution, though: Bleeding may happen for some women on the pill and may not be a cause for concern. But if you also experience abdominal pain, dizziness, or heavier bleeding, or you bleed for more than day or two, you should seek the help of a doctor to rule out any other issues like an adverse reaction to the medication.

Dealing with the problem: While you can’t do much about the spotting once the emergency contraceptive pill has been taken, you can be careful and ensure the problem doesn’t escalate and need medical attention.6

4. Abortion

An abortion may also cause spotting or breakthrough bleeding. According to the American Pregnancy Association, this may happen for as much as 2 to 4 weeks after you have undergone a procedure to terminate the pregnancy.7

Dealing with the problem: For spotting or bleeding that mimics the heaviness of a normal menstrual period, you shouldn’t be worried as these symptoms will pass in a couple of weeks. You should contact your doctor right away if

  • bleeding is very heavy and doesn’t abate;
  • you have a fever over 100.4°F;
  • you have extreme abdominal or back pain that keeps you from even standing up;
  • you notice foul-smelling discharge; or
  • you have symptoms of continued pregnancy.8

5. Vaginal Dryness

Vaginal dryness, a problem that can occur at any stage of your life, may cause spotting. This may be common after intercourse, especially due to a lack of arousal during intercourse. Vaginal dryness may also be a result of menopause. Another reason is the drying out of the region due to the use of harsh soaps or feminine sprays. Also, those with low estrogen levels, women who have had a hysterectomy, as well as those who have undergone chemotherapy may have this problem.9

Dealing with the problem: Just using a good lubricant can make all the difference. Water-soluble ones like KY jelly work well and are similar to the natural lubricant produced by your own body. Apply before intercourse to avoid spotting. Petroleum-based lubricants like vaseline may also work.

Avoid using harsh-scented soaps or other products in your vaginal region. Local estrogen can also be prescribed to help ease the dryness.10

6. Menopause

Women going through perimenopause also complain of spotting or irregular bleeding. Unlike a normal menstrual cycle where progesterone and estrogen levels rise and fall in a specific pattern, with those in perimenopause the pattern is disrupted, causing this breakthrough bleeding.11 Thinning of the lining of the uterus and vagina after menopause may also cause such bleeding.12

Dealing with the problem: Very heavy bleeding, bleeding that occurs more than once in three weeks, that happens after sex, or that lasts longer than normal all need to be checked by your doctor. If you have continuous spotting during perimenopause, it could also be due to very high estrogen levels and very low progesterone levels that can potentially be corrected. In some cases, progesterone may be prescribed to help control and stop the flow.13

7. Cancer Or Polyps

Endometrial cancer or benign precancerous lesions called cervical or endometrial polyps in the lining of the uterus or cervix could also cause spotting.14 According to the American Cancer Society, cervical cancer can cause bleeding after intercourse and spotting between periods.15

Dealing with the problem: Get yourself checked by a doctor at the earliest if you

  • notice unusual bleeding or pain during sex;
  • experience pain in the pelvis, back or legs;
  • feel tired or nauseous; or
  • lose your appetite. These are some possible signs of gynecological cancers that need urgent treatment.

8. Intrauterine Device (IUD)

For the initial six months or so after it is inserted, an IUD can cause spotting. After that, the spotting should eventually reduce and completely go away.16

Dealing with the problem: If you have spotting after the initial period, or also have smelly discharge, fever, or lower abdomen pain, you could have an infection that needs treating. If you’re uncomfortable or uneasy and feel the need to have the IUD checked, consult your doctor right away.

9. Pelvic Infections

Infection in the pelvic region – in the vagina, uterus, ovaries, fallopian tubes, or cervix, as well as pelvic inflammatory disease can cause bleeding or spotting between periods. This tends to also happen especially after douching or intercourse. Other symptoms to watch for are pain in the pelvic region, fever, unusual vaginal discharge, pain while urinating, tiredness, chills, cramps, and missing a period.17

Dealing with the problem: With a pelvic infection, you will usually need to take a course of antibiotics. For severe cases, hospitalization and intravenous administration of the antibiotics may be suggested.18

10. Sexually Transmitted Infections

If you have contracted a sexually transmitted infection, it could cause you to experience breakthrough bleeding.19

  • Chlamydia, besides spotting, can cause a burning sensation when you pee, pain in the lower abdominal region after sex/during sex, and discharge from the vagina.
  • Gonorrhea has similar symptoms to chlamydia, along with a watery green or yellow discharge from the vagina.
  • Genital warts can sometimes cause bleeding between periods. These are small growths or bumps on the skin in the anal and genital region. There may be accompanying redness and itching but typically no pain.

Dealing with the problem: Chlamydia and gonorrhea are treated with antibiotics. They can be risky and even cause infertility if left untreated. Genital warts are typically treated using creams or with cryotherapy to freeze them off. In case of all three infections, be sure to abstain from sexual intercourse until you are treated. Else, you run the risk of passing the infection on to your partner. Let your partner know so they can also be treated.20

Spotting or bleeding during pregnancy may happen for numerous reasons. Implantation bleeding in the first week to 12 days post conception is normal and no cause for concern. If you bleed after intercourse, it may just be due to sensitive tissue, but do confirm with your doctor. Sometimes an infection could cause the problem so have yourself tested.21

Other causes in the first half of pregnancy could be an ectopic pregnancy (pregnancy implants outside the uterus), molar pregnancy (abnormal tissue develops instead of a fetus), or miscarriage. If you’re into the second half of your pregnancy, you may be going into preterm labor. Watch for signs like cramps, lower abdominal pain or pressure, and unusual vaginal discharge with mucus or blood.

A rare cause for this bleeding is placental abruption where the placenta separates from the uterus in the last 12 weeks of pregnancy. Placenta previa, where the placenta covers the mouth of the cervix, may also cause bleeding. This is also accompanied by pain.22

Dealing with the problem: Bleeding during pregnancy warrants medical attention and you should consult your doctor at the earliest. While it may be nothing serious, you’re better off having it checked. In case of an infection, a course of medication should help you tide over the problem. For bleeding linked to intercourse, abstain from sex until you check with your doctor.23

References   [ + ]

1, 3, 4. What causes bleeding between periods? National Health Service.
2. Treating polycystic ovary syndrome. National Health Service.
5, 6. What if I bleed after taking emergency contraceptive pills? Office of Population Research at Princeton University and by the Association of Reproductive Health Professionals.
7, 8. Abortion Side Effects. American Pregnancy Association.
9, 10. Vaginal dryness. Women’s Health Concern.
11. Perimenopausal Bleeding and Bleeding After Menopause. The American Congress of Obstetricians and Gynecologists.
12, 14. Abnormal Uterine Bleeding FAQ Sheet. Florida Hospital Medical Group.
13. Perimenopause: The Ovary’s Frustrating Grand Finale. Centre for Menstrual Cycle and Ovulation Research.
15. Signs and Symptoms of Cervical Cancer. American Cancer Society.
16. IUS intrauterine system. National Health Service.
17, 18. Pelvic inflammatory disease. U.S. National Library of Medicine.
19, 20. Sexually Transmitted Infections. National Health Service.
21, 22, 23. Bleeding During Pregnancy. American Pregnancy Association.