Bloody discharge in the middle of the cycle

Bloody discharge in the middle of the cycle differs from menstruation, firstly, untimeliness, secondly, the degree of intensity, thirdly, duration. As a rule, they are scanty pinkish or brownish smears on the underwear, appearing between menstruation, sometimes - more intense, but still not reaching the level of menstrual bleeding.

The appearance of intermenstrual bloody discharge is often associated with the period of ovulation, taking hormonal drugs, and is not always a signal of serious disorders. Nevertheless, the appearance of traces of blood, blood or bleeding in the middle of the cycle refers to potential gynecological pathologies (metroragia). Therefore, it is worth analyzing this event, try to link it with innovations in the usual routine, for example, the use of a new contraceptive or the cancellation of the old, it is desirable to consult a doctor, so as not to miss the development of the disease.

Causes of the bleeding mid-cycle

Consider the causes of traces of blood on underwear between menstrual periods.

1. Transition to taking oral contraceptives - the first months of taking the so-called breakthrough bleeding is observed, mostly it is a smeary bloody discharge, caused by the fact that the body is readjusting to the reception of exogenous hormones. The action of this series of drugs is based on the inhibition of the ovulatory cycle. Then, if you clearly follow the scheme of reception, the symptoms disappear, menstrual cycle stabilizes, periods are not so abundant and are not accompanied by painful syndromes. Such side effects are expected and are described in the instructions for popular oral contraceptives: Regulon, Jes, Klyra.
2. Use of other forms of hormonal contraception - patches, implants, injections.
3. Violation of the scheme of use of hormonal contraceptives, their withdrawal.
4. Use of intrauterine contraceptive devices, the most well-known and used of which is the IUD.
5. Taking medications - hormonal, thrombolytics, neuroleptics, tranquilizers, antidepressants and some others.
6. Consequences of gynecological manipulations, e.g. laser cauterization of cervical erosion, endometrial cryodestruction, biopsy of the cervix, polyp removal, ovarian resection, abortion, etc. The patient is usually warned about possible intermenstrual discharge by her doctor.
7. Hormone replacement therapy.
8. Of undetermined etiology.

Bloody discharge in the middle of the cycle may be due to causes that require examination and treatment. These include:

1. Ovarian dysfunction. Such a symptom indicates insufficient levels of estrogen, produced by the ovaries, which should normally be high in the middle of the cycle. Hypoproduction of sex hormones can be caused both by chronic stress, poor eating behavior, and ovarian tumors, polycystic, endocrine pathologies.
2. Pathologies of the body and cervix (polyps, myoma, endometrial hyperplasia, malignant neoplasms), its appendages.
3. Inflammatory processes in the pelvic organs, including those caused by STIs.
4. Vaginal Injuries.
5. Abnormal bloody discharge in the expectant mother may be a precursor to miscarriage, a disrupted ectopic pregnancy, indicate the presence of a placental polyp, malposition or placental abruption, fetal demise, or the presence of the above conditions.

Risk factors

Bloody discharge in the intermenstrual period can be provoked not only by gynecological pathologies, which are the main factors that provoke their appearance. Some systemic diseases can also be accompanied by this symptom. These include:

• blood diseases and hematopoietic organs leading to poor coagulation;
• Endocrine pathologies - hyper- and hypothyroidism, pituitary disorders including Icenko-Cushing syndrome, adrenal cortex hyperplasia, diabetes;
• hepatic and renal failure;
• neuroses, acute and chronic stress disorders.

The risk of intermenstrual discharge increases during periods of hormonal instability: puberty, when the menstrual cycle is not yet established, and premenopause and its beginning, when fertility fades, during the period of carrying a baby. Even poor nutritional behavior, long-term unbalanced dietary intake can cause the appearance of bloody discharge in the middle of the cycle. Non-pathologic causes also include rupture of the follicular sheath during ovulation, implantation of the embryo in the myometrial layer.

Pathogenesis

The mechanism of the appearance of metroragia is diverse and is considered depending on the cause that led to the onset of the pathological symptom. However, if we do not delve into the pathogenesis of the original diseases, then a direct relation to the appearance of untimely bloody discharge has a natural disruption of ovarian function associated with the production of female sex hormones, or its artificial suppression. Such organic pathologies as myoma, polyps, endometriosis, malignant tumors of the female genital organs, leading to the appearance of metroragia, are hormone-dependent neoplasms. Ovarian pathologies - direct (inflammation, neoplasms), caused by endocrinologic diseases, naturally low hormonal background during the restructuring of the body (menarche, menopause), lead to insufficient production of the hormones estrogen and progesterone.

Normally, estrogen levels should be at their highest before ovulation, which helps fertilize the egg. After ovulation, the level of progesterone, which ensures the pregnancy will proceed smoothly, also increases. By the end of the cycle, if fertilization has not occurred, the concentration of hormones decreases, the endometrial layer atrophies and is rejected with a certain amount of blood (menses). In the case of hormonal insufficiency, a similar process occurs in the middle of the cycle, the lack of hormones leads to endometrial depletion, atrophy and rejection, which is accompanied by bloody discharge in the middle of the cycle.

In pregnant women, this symptom may indicate a threat of miscarriage. In addition to genital infections, uterine abnormalities and genetic predisposition, ovarianhypofunction, causing luteal insufficiency, plays a major role in the pathogenesis of miscarriage.

When taking drugs that affect the production of female sex hormones, (replacement therapy, contraception) artificially changes the hormonal status of a woman - suppresses the production of endogenous estrogen and progesterone. The same processes occur as in natural hormone deficiency, resolved by partial rejection of the endometrium, especially at the beginning of intake, when the body is reorganizing under new conditions (breakthrough bleeding), and after discontinuation of the drug (withdrawal bleeding).

Taking drugs that are not directly related to gynecological problems, such as blood thinners, can cause bleeding in the middle of the cycle. Antipsychotics, antidepressants and other psychotropic drugs have such a side effect as hyperprolactinemia, and as a consequence, the risk of metroragia increases.

Not always the mechanisms of untimely bloody vaginal discharge are pathologic. They may be due to rupture of the follicular sheath during ovulation. In some women, implantation of the embryo in the myometrial layer may be accompanied by scanty spurting discharge. In addition, the already mentioned age-related fluctuations of hormonal background become the cause of minor bleeding outside of menstruation.

Bloody vaginal discharge between menstrual periods, without pain, for the first few weeks after IUD insertion is considered normal. This side effect is expected, the pathogenesis is due to the reaction of the endometrium to the introduction of a foreign object - there may be microdamage during manipulation and / or reaction to gestagen, if it is in the composition of the spiral, as well as the presence of latent inflammatory diseases of the genital sphere in the patient (with obvious symptoms of disease IUD will not be installed). After removal of the intrauterine device, there may also be a small amount of bleeding.

Epidemiology

Bloody discharge outside the menstrual phase of the cycle, regardless of its intensity, is considered to be metrorrhagia and is considered a potentially pathologic symptom. According to world statistics, every tenth consultation with a gynecologist is associated with abnormal uterine bleeding (this includes hemorrhages of different intensity that do not correspond to the norm).

In the overall structure of gynecologic pathologies, metroragia among patients of active fertile age ranges from 3% to 30%, with a higher incidence during menarche and perimenopause. [1]

Symptoms

Bloody discharge in the middle of the cycle without pain, observed for a couple of days, is probably not a reason to worry. Especially if such an event occurred for the first time and your periods have been regular so far. It is just worth observing your condition, analyze the previous events, perhaps the cause will surface by itself. Small smeary bloody discharge in the middle of the cycle, as a rule, coincide with ovulation and do not carry a significant threat to health.

However, if a small bleeding even without other alarming symptoms occurred in a woman with an established menopause, it is already a sign of trouble, and it makes sense to visit the gynecological office. Bloody discharge in the postmenopause should not be a priori. This is considered a pathological symptom and may indicate the presence of inflammatory processes, uterine myoma, endometrial polyps, endometriosis, malignant neoplasms of the genital organs. Women in the postmenopausal period often have a bouquet of chronic diseases and undergo therapy. They may have bloody discharge of a medically induced genesis.

If lower back pain or lower abdomen accompanied by bloody discharge in the middle of the cycle, it is better to see a doctor with these symptoms. Also cause concern should be the presence of fever. Such signs indicate possible inflammation of the genitals.

Mucous bloody discharge in the middle of the cycle with pulling pains in the lower abdomen is normal for women who are using an IUD for the first time after insertion. If the symptoms do not go away and become more pronounced, it is worth paying attention to the doctor. The woman could have a latent form of chronic inflammatory process, which has worsened under the influence of the inserted foreign body. Also, the spiral itself is a risk factor for the development of inflammation.

Intermenstrual bloody discharge in the middle of the cycle can be a symptom of neoplasms. In such cases, they are usually not accompanied by pain, sometimes oily traces on the underwear remain after sex, for example, with cervical polyps. The presence of myomatous nodes, endometritis, endometriosis, endometriosis manifest themselves with brown or bloody traces that remain on the underwear from time to time during the absence of periods.

Bloody discharge with mucus in the middle of the cycle can be a symptom of infection with sexually transmitted pathogens. Mucus in this case is not transparent and has an unpleasant odor. In trichomoniasis - frothy, grayish-yellow with impurities of blood, causing severe itching in the area of the external genitalia. However, there are also sterile forms that do not cause much discomfort. With chlamydia bloody discharge mixed with mucous-purulent, there is pain in the lower abdomen, acute itching. In gonorrhea intermenstrual bloody discharge is adjacent to whitish-yellow or greenish mucus, redness and burning sensations in the area of the small and large labia, burning when urinating. There may be an increase in body temperature. STIs in pure form are almost never encountered, almost always the infection is mixed.

Sucrose discharge with clear or whitish mucus between menstrual periods with sensations of slight discomfort in the lower abdomen, usually quite harmless symptom that accompanies ovulation.

Bloody discharge with clots in the middle of the cycle can also be quite harmless and appear against the background of ovulation or hormonal imbalance, in the presence of an intrauterine device, hormonal contraception. But if they last for a long time, intensify or are accompanied by itching and pain it is necessary to urgently consult a doctor - such symptoms indicate the possibility of inflammation. Discharge with clots may be associated with poor blood clotting, heavy bloody discharge is sometimes manifested by uterine myoma, adenomyosis, polyposis, endometriosis, malignant neoplasms.

After sex, some women also notice immediately or in the morning bloody intermenstrual discharge. The cause of such an event may be trauma to the mucous membrane of the vagina or cervix, caused by strong friction due to lack of vaginal lubrication. Other causes may be the presence of an IUD, cervical polyp, infectious-inflammatory processes and other conditions described above.

Bloody discharge in early pregnancy is not uncommon. They occur during the implantation of the fertilized egg in the myometrial layer of the uterine wall. Usually it is a scanty bloody discharge, they can be noticed for two to three days.

Bloody discharge in early pregnancy can also be a sign of ectopic or frozen pregnancy, symptoms of possible miscarriage, vaginal varices, isthmic-cervical insufficiency. If a woman has had a cesarean section in a previous delivery, bloody discharge during the next pregnancy may be a sign of a uterine suture scar dissection. In addition, the expectant mother may have ectopia, erosion, myomatous node, polyp, infections, inflammation and other causes of this symptom.

In late pregnancy, bloody discharge is a bad sign. They occur in case of abnormal placenta previa or premature detachment of the placenta. In the latter case, the accompanying symptoms will be uterine hypertonicity and quite strong pain sensations. Bloody discharge in the second half of pregnancy can signal the possibility of late miscarriage, about intrauterine fetal death, but sometimes their appearance is simply caused by rough sex the day before.

Diagnostics of the bleeding mid-cycle

In women, bloody discharge in the middle of the cycle is not uncommon, their causes are also, for the most part, quite harmless. However, such a symptom can also indicate the presence of a serious pathology. And by any external signs - the degree of intensity, color, absence or presence of pain independently distinguish a dangerous symptom from harmless will not work. Cancer of the uterus can initially manifest itself with scanty bloody painless discharge, and ovulatory blood - be dark red, even with clots. Therefore, if the event is repeated, it is necessary to consult a doctor and undergo a number of diagnostic measures.

Since the causes of intermenstrual discharge are very diverse, it usually takes time to make a diagnosis. The doctor collects an anamnesis, taking into account the age of the patient. Conducts a gynecological examination. In parallel, she takes tests:

• clinical-- blood and urine;
• blood chemistry;
• vaginal swab for bacteriostasis;
• Papanicolaou smear;
• coagulogram;
• thyroid hormones.

If necessary, the doctor may prescribe other laboratory tests, as well as - consultations with an endocrinologist, nephrologist, neurologist.

First of all, the patient undergoes pelvic ultrasound. If this is not enough, other instrumental diagnostics, such as magnetic resonance imaging of the genital organs, is prescribed. A hysteroscopy of the uterine cavity with material for histologic examination may be prescribed.

Differential diagnosis is carried out on the basis of examination data of the patient and the study of her anamnesis by excluding the most dangerous pathologies.

Treatment of the bleeding mid-cycle

Bloody discharge in the middle of the cycle can be provoked by a variety of factors, so the treatment in each case is individual. It is prescribed according to the results of examination of the patient.

In addition, if a woman with profuse discharge has lost a significant volume of blood, the first priority of the doctors is to compensate for these losses. Compensatory therapy is carried out simultaneously with the examination and diagnosis. The above-mentioned patients are prescribed hemostatic agents, drugs that strengthen the walls of blood vessels, promote the contraction of the uterine musculature. To restore losses, vitamins of the B group, iron-containing preparations, multivitamin complexes are prescribed. If bleeding is caused by hormonal imbalance, then it is restored by taking complex hormonal contraceptive pills. They are taken three to six months course, the hormonal status of the patient is regularly monitored. When detecting neoplasms (polyp of the cervix or uterine cavity, enodometriosis), first of all, the tumor is removed with the performance of diagnostic scraping of the contents of the uterine cavity. Then, after its histological examination, an individual conservative treatment is prescribed to prevent the re-growth of the neoplasm.

Hysteroscopy - is simultaneously used for diagnosis and minimally invasive therapeutic intervention. An endoscopic instrument with an optical nozzle, a hysteroscope connected to a computer, is inserted through the vagina into the uterus. The monitor with a tenfold magnification displays the inner surface of the uterine mucosa. The doctor examines it and removes only parts of the mucosa with signs of benign pathology. The inner surface of the uterus is traumatized much less than in diagnostic scraping. After such operations, patients recover faster, but hysteroscopy, as a rule, is not used if there are suspicions of malignant process. In this case, only diagnostic resection is performed.

In case of extensive lesions of the inner uterine mucosa, electrosurgical ablation of the endometrium, a minimally invasive intervention to burn out the endometrium, may be prescribed. Such operations are usually performed on menopausal patients with prolonged bleeding and/or contraindications to hormonal therapy. Since the endometrial layer as a result of ablation is practically unrecoverable, this intervention is performed on strict indications in patients of fertile age.

If histology shows the presence of malignant changes in the cells of the sexual organ, then surgical treatment is usually indicated. Gynecologic cancer includes malignant neoplasms of the body of the uterus, its cervix and ovaries. The amount of surgery depends on the extent of the process and the localization of the tumor. Women of fertile age try to preserve their fertility as much as possible. Preference in all cases is given to laparoscopic operations as less traumatic. In modern clinics with the help of laparoscopy even very extensive interventions are performed, for example, in endometrial cancer, when not only the body of the uterus, but also its appendages and pelvic lymph nodes are to be removed.

In cervical cancer without local spread, not only the tumor-affected part but also the body of the uterus must be removed. The next target organ is the ovary. Therefore, women who do not plan to have children will have them removed as well. However, young patients try to save the ovaries, performing their transposition on their vessels in the upper abdominal cavity to prevent their death during radiation therapy sessions. If the tumor has grown, for example, into the bladder or rectum, then all pelvic organs must be removed.

Ovarian cancer does not always involve complete removal of the organ either. In the initial stages, patients of childbearing age are laparoscopic resection of the ovary. In the case of a widespread process, all foci of the tumor are removed. Currently, many clinics have the ability to perform total laparoscopic surgery. Surgery is followed by chemotherapy and/or radiation therapy as indicated.

Sexual infections and inflammatory diseases of non-infectious genesis are treated conservatively. In each specific case, a course of treatment is prescribed, depending on the results of the examination and the causes found.

In non gynecological pathologies treat the underlying disease, compensate for blood loss and eliminate the violation of hormonal balance.

In cases of iatrogenic bloody discharge in the middle of the cycle, treatment is prescribed individually, depending on the nature of the identified pathological influence. They change the dose of the drug or the drug itself to another, change the method of contraception, etc.

Complications and consequences

Given that the reasons that cause bloody discharge in the middle of the cycle can be very diverse, then the consequences of ignoring the symptom can even be fatal.

Abnormal bloody discharge from the genital tract, caused by hormonal restructuring of the body, stress, life collisions, physical overload do not leave complications in the normalization of the trigger situation. The same applies to contraception, both intrauterine and hormonal.

Pathological causes of bloody discharge in the middle of the cycle are mostly treatable or the condition can be medically compensated, especially if timely help is sought.

If a woman takes a wait-and-see attitude and does not intend to be examined in any way, this tactic can lead to complications. The most likely consequence of untreated pathology is an increase in the frequency of discharge, the development of bleeding (in this case, usually already turn to the ambulance).

When a woman does not pay attention to abnormal bloody discharge for a long time, the consequences can be general weakness, dizziness to unconsciousness, hypotension, nausea, anemia.

However, intermenstrual discharge is not always increased, it may not even appear every time, and the pathology will progress and complicate. It should be considered:

1. If an untreated STI is present, the genital area is primarily affected, and the infection can also spread to other organs. Some possible consequences are:
   • dysbacteriosis of the vaginal mucosa;
   • inflammation of the mucous membrane of the uterus, its appendages, endocervical canal → infertility; polyp, erosion and endometriosis → precancer;
   • tubal obstruction → infertility;
   • atrophic changes in tubal epithelial tissue → ectopic pregnancy;
   • ovarian inflammation → ovarian dysfunction;
   • complications of pregnancy: placental disorders → miscarriage, incompletion, etc.;
   • cystitis, pyelonephritis;
   • inflammation of the peritoneum etc.
2. In the presence of benign neoplasms:
   • uterine bleeding;
   • possibility of malignization;
   • problems with conception and pregnancy.
3. In the presence of malignant neoplasms, a fatal outcome is possible.
4. Endocrinological pathologies, neuroses are aggravated, they are more difficult to compensate. This has a pathological effect on the whole organism.
5. Bloody discharge in pregnant women in the early stages can turn into bleeding. Complications of such symptoms in the future mother can be spontaneous abortion, rupture of the fallopian tube in undiagnosed ectopic pregnancy; in late pregnancy - premature labor, fetal hypoxia.

Prevention

1. As healthy a lifestyle as possible: a nutritious diet allows you to naturally give the body all the necessary ingredients for quality functioning; avoidance of bad habits; feasible physical activity (fitness, Pilates, yoga); promote the release of adrenaline, which strengthens blood vessels and stimulates blood circulation; strengthen mental health and stress resistance.
2. Observance of culture and hygiene of sexual life, since in most cases many gynecological pathologies originate from sexually transmitted infections. Prevention of unplanned pregnancy. In particular, it is necessary to use barrier contraception, especially in casual contacts.
3. Women with chronic diseases of the genital sphere are periodically recommended to undergo courses of physical procedures (hydromassage, circular shower, mineral baths and other types of hydrotherapy, mud, electrical procedures, light therapy, massage, acupuncture, etc.). Health resort treatment has a favorable effect on the condition.
4. Regular visits to the gynecological office (1-2 times a year), especially for women with unfavorable gynecological history, personal and family.
5. Inculcating from childhood the basics of sexual culture and intimate hygiene.
6. In the presence of diagnosed pathologies, it is necessary to undergo timely treatment, clearly following all the prescriptions of the attending physician.

Forecast

Most of the reasons for which a woman may have bloody discharge in the middle of the cycle, can be eliminated without consequences for the health and life of the woman, especially when timely seeking professional help.

The prognosis depends on the factors that caused intermenstrual discharge. If the cause was a neglected inflammatory process, myoma of large size, cancerous tumors, then as a result of treatment, the woman's life will be preserved, but not reproductive function. Disseminated malignant neoplasms with metastases can lead to premature death of the patient.

But still, timely medical assistance usually leads to a favorable outcome.