Spotting or bleeding between menstrual periods is an event that many women find alarming in terms of their general health. One of the most common questions women have is whether the bleeding that occurs between menstrual periods is an indicator of any serious health problems or a mere transient physiological disturbance.
This event occurs due to the fact that our menstrual period is a communication process between our brain and our ovaries, and when this interaction is somehow disturbed or the physical environment of the uterus is altered, the body reacts by way of intermenstrual bleeding. Dr Madhushree Vijayakumar, Consultant- Obstetrician & Gynecologist, Motherhood Hospitals, Hebbal, Bangalore explains why this happens and how to address it.
A Game of Hormones
The normal menstrual cycle for women will be the function of hormonal fluctuations between progesterone and estrogen. The former helps establish an optimal environment within the uterus in the pre-ovulatory phase, while the latter helps stabilize the environment after ovulation. If the hormonal changes do not occur in time or if there is a significant discrepancy in the hormonal levels in the female body, then it may lead to the instability in the uterine lining causing some minor bleeding before the scheduled period. One of the common occasions where this happens is when you ovulate. As the egg is released from the ovaries, there is often a slight reduction in the levels of estrogen, resulting in some minor bleeding that will last one or two days.
External Factors
Apart from the natural cycle of ovulation, there are many external factors that determine the behaviour of your hormones. Your body reacts very sensitively to stressful situations since the brain system responsible for controlling the reproduction process in your body is also responsible for handling the stress reaction. In situations where your body feels highly stressed physically or emotionally, it may favour survival over reproduction, hence resulting in abnormal hormone production, which causes spotting. This is also the reason why major weight fluctuations, highly vigorous exercises, or even drastic dietary changes may result in intermenstrual bleeding.
Physiological Changes
We should not forget about the physical condition of the organs themselves. There are instances where the cause of the bleeding is not due to hormonal fluctuations, but due to physiological changes in the structure of the reproductive organs themselves. Uterine fibroids and cervical polyps are extremely common benign tumours that can bleed during irritation and growth. Although the term tumour may sound scary, this type of tumour is usually not cancerous and generally harmless. Nonetheless, a proper diagnosis needs to be made by means of a scan or a gynecological examination. On the other hand, there are some infections that lead to inflammation in the cervical area and uterus, causing them to bleed whenever the affected person exercises or has sexual intercourse.
Use of Contraception
Another extremely frequent cause is hormonal contraception use. No matter whether you take the birth control pill, use an IUD, or even have a hormonal implant, there will be a period of hormonal adjustment for your body. While the first several months after introducing a new form of birth control pills, breakthrough bleeding becomes a frequent experience. It is caused by the fact that due to missing a dose or using the medicine irregularly, there is a dramatic drop in hormone levels. The uterine wall, in response, sheds prematurely, as a result of which this process occurs. Knowing that this is merely one of the many side effects of the drugs can help to significantly reduce anxiety.
Perimenopause
With regard to mature women who enter the perimenopausal stage of their lives, it is common to witness in between period cycles. Perimenopausal women have inconsistent menstrual cycles due to irregular ovulation, with their estrogen levels fluctuating drastically. As a consequence of the hormone imbalance, the uterus tends to be thicker than it should be, hence irregular bleeding may be experienced by such women. On the other hand, young girls at the early stages of their menses tend to undergo the same irregularities as they learn how to balance hormones.
Can This Be Fixed? If Yes, How?
The process of fixing this problem requires proper diagnosis, for which reason it is strongly encouraged that one keeps a log book of their symptoms. In advance of seeing a doctor, it is necessary to note down the exact timing of the episodes, their duration, and whether they are associated with pain or any other abnormalities. This information serves as the most potent weapon against the problem. Should hormonal imbalance caused by stress or unhealthy behaviour be discovered to be the root cause, then the solution may simply lie in getting back into a biological balance. This could range from getting enough rest, making sure you are consuming enough calories, or managing ongoing stress effectively.
When the source of the problem is physiological in nature, there are a number of different treatments that can help to alleviate this. Polyps and fibroids, which can lead to light bleeding, can be treated easily through modern medical intervention, with many being able to be surgically removed as an outpatient procedure to cease the bleeding. When the bleeding has been caused by hormonal fluctuations or perimenopause, then the use of a birth control pill or a progesterone supplement can serve as the framework that the lining of the uterus needs before menstruation.
Although many causes for intermenstrual bleeding are not at all serious, it must be remembered that anything new or unusual about your period is worthy of being talked about with an expert. The first thing we need to do is to make sure nothing serious is going on, such as precancerous lesions in the cervix or uterus, because these problems become much easier to deal with if discovered at an early stage. In addition, if your intermenstrual bleeding involves enough volume that you soak through a pad, or is accompanied by pelvic pain so severe that you cannot ignore it, then it needs to be investigated by a physician immediately.
