From the Guidelines
Spotting before and after your menstrual cycle can be caused by several factors, including hormonal fluctuations, birth control methods, structural issues, infections, and medical conditions. The most common cause of intermenstrual bleeding is hormonal fluctuations, particularly changes in estrogen and progesterone levels that can lead to breakthrough bleeding when the uterine lining sheds irregularly 1. Some key factors that can contribute to intermenstrual bleeding include:
- Hormonal fluctuations
- Birth control methods, such as pills, patches, IUDs, and implants, which can cause spotting, especially during the first few months of use 1
- Structural issues, such as uterine fibroids, polyps, or endometriosis, which can lead to irregular bleeding patterns
- Infections, such as sexually transmitted infections or pelvic inflammatory disease, which can cause spotting
- Medical conditions, including polycystic ovary syndrome (PCOS), thyroid disorders, or certain cancers, which might manifest as spotting If you experience persistent spotting, spotting with severe pain, very heavy bleeding, or spotting after menopause, you should consult a healthcare provider for proper evaluation, as these could indicate more serious underlying conditions requiring treatment 1. It is essential to note that unscheduled spotting or bleeding is common during the first 3–6 months of extended or continuous combined hormonal contraceptive use and is generally not harmful, decreasing with continued combined hormonal contraceptive use 1. However, if an underlying gynecological problem is found, treat the condition or refer for care 1. Additionally, if an underlying gynecological problem is not found and the woman wants treatment, consider advising the woman to discontinue combined hormonal contraceptive use for 3–4 consecutive days or offering alternative contraceptive methods 1.
From the Research
Causes of Intermenstrual Bleeding
The causes of intermenstrual bleeding before and after the menstrual cycle can be attributed to various factors, including:
- Hormonal imbalances, particularly in women with polycystic ovary syndrome (PCOS) 2, 3, 4, 5, 6
- Use of certain medications, such as spironolactone, which can affect estrogen and progesterone levels 5
- Insulin resistance and hyperandrogenism, common in PCOS patients 2, 3, 4, 6
- Endometrial thickness and serum sex steroid levels, which can be affected by PCOS and its treatment 5
Polycystic Ovary Syndrome (PCOS) and Intermenstrual Bleeding
PCOS is a common endocrine disorder that can cause irregular menstrual cycles, hyperandrogenism, and infertility 2, 3, 4, 6. Women with PCOS are at a higher risk of developing insulin resistance, type 2 diabetes, and cardiovascular disease 2, 3, 6. The use of hormonal contraceptives and other medications can help manage PCOS symptoms, including intermenstrual bleeding 4, 5.
Treatment and Management of Intermenstrual Bleeding
Treatment for intermenstrual bleeding in women with PCOS often involves lifestyle changes, such as weight loss and exercise, as well as medication to regulate hormonal imbalances 2, 3, 4, 6. Herbal remedies and alternative therapies may also be effective in managing PCOS symptoms, including intermenstrual bleeding 3. A comprehensive and systematic approach to treatment is crucial for managing PCOS and its associated symptoms 6.