What is intermenstrual bleeding (IMB)?
This is bleeding or spotting that occurs in between your periods. Most women may experience this at some point.
Why am I experiencing bleeding in between my periods?
- Pregnancy
Miscarriage, ectopic pregnancy and implantation bleeding can be some of the pregnancy-related causes.
- Ovulation
This happens mid-cycle around ovulation, where women may have spotting for a few days. This is usually harmless, but if it persists, do see your gynaecologist.
- Hormonal
Pubertal or perimenopausal women may experience IMB due to hormonal changes.
- Infections
Sexually transmitted infections (STIs) like chlamydia and gonorrhea can cause IMB. Associated symptoms may include bleeding after sex, painful sex, abnormal vaginal discharge and fever.
- Medications
Hormone medications or implants may cause IMB especially in the starting phase. This includes birth control pills (especially if you miss pills), implants (IUD, implanon), hormone replacement therapy (HRT) or injections.
- Uterine (endometrial) polyps
These are growths are attached to the lining of the uterus (endometrial lining).
- Uterine fibroids
These are non-cancerous growths that come from the muscle layer of the uterus (womb). Fibroids that cause IMB are located near or at the lining of the uterus.
- Abnormal uterine lining
These include pre-cancer (endometrial hyperplasia) and endometrial cancer.
- Endometriosis
This is a condition where tissue from the womb lining is found outside the womb, most commonly in the pelvis, where it can affect the ovaries, fallopian tubes and intestines.
- Cervical cancer
This is usually associated with a lack of cervical screening and bleeding after sex.
When should I see my gynaecologist?
- If the IMB occurs more than a few times within a month, or happens for a few months
- If the bleeding is heavy
- If you have other symptoms e.g. painful or prolonged periods, fever, abnormal vaginal discharge, bleeding after sex
What tests do I need?
Your gynaecologist will take a detailed medical history and perform a pelvic examination to check your cervix and uterus. Depending on your symptoms, you may require an ultrasound scan, vaginal swabs, Pap smear/ HPV test, biopsy of the womb lining or blood tests.
How to treat IMB?
This depends on what the cause of your IMB is. You should speak to your gynaecologist about the treatment options suitable for your condition. These may include:
- Birth control pills: these eliminate ovulation and helps rule out mid-cycle ovulatory bleeding as a cause
- Changing hormonal medications (if you are already on)
- Antibiotics: for infection
- Surgery: for structural causes like fibroids or uterine polyps
