Intermenstrual Bleeding

Introduction

• Description: Bleeding between otherwise normal menstrual cycles. Constitutes a special form of dysfunctional (abnormal) uterine bleeding.

• Prevalence: 10%–15% of all gynecologic visits involve menstrual disturbances.

• Predominant Age: Reproductive age; highest in adolescents and patients who are climacteric.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Uterine (pregnancy, endometrial polyps, endometrial hyperplasia, endometrial carcinoma, endometrial hypoplasia [atrophy, hormonal contraception] leiomyomata, intrauterine contraceptive device [IUD]), cervical (polyps, cervicitis, cervical erosion, cervical dysplasia/neoplasia), vaginal (trauma, infection, atrophy), perineal (vulvar lesions, hemorrhoids).

• Risk Factors: None known. The purported relationship to surgical sterilization has been disproved.

Signs and Symptoms

• Intermenstrual bleeding (painless)

• Bleeding after intercourse (common)

Diagnostic Approach