What Is Metrorrhagia?

What is metrorrhagia?

Dysfunctional uterine bleeding is also called as metrorrhagia. In the first few years of menstrual onset, females commonly experience this problem. Also, women close to their menopausal phase tend to have metrorrhagia. In this condition, women have bleeding episodes outside their menstrual period. Vaginal bleeding usually comes as spotting, but it can become severe.

In this condition, the amount and pattern of vaginal bleeding are irregular. Normally, the normal vaginal bleeding during a menstrual cycle is on an average of four days. Some women may experience menstrual spotting during the time of ovulation. 

Metrorrhagia means uterine bleeding in between menstrual cycles. Irregular bleeding should not be taken lightly since it can indicate an underlying health threat. Metrorrhagia could have a number of underlying causes, so seek medical advice as soon as possible. You can consult a gynecologist for proper diagnosis and treatment.

In metrorrhagia, your menstrual period seems normal, but occurs at unusual intervals or at unpredictable intervals or a combination of both.

How to Know If You Have Metrorrhagia

If you are finding it difficult to conceive, bothered because of heavy periods, and you are not able to track your cycle, then the doctor may suggest a treatment plan for you. The treatment options available are various hormonal therapies such as certain types of IUDs or birth control pills. These methods of treatment will help you achieve and maintain a regular menstrual cycle. 

Medical Examination: What to expect?

The doctor will take your medical history by asking about the following:

• History of recent abortion (if any)
• Use of contraceptives such as pills or IUDs
• Occurrence of bleeding (if after sexual intercourse) 
• Pregnancy
• Details about your menstrual cycle
• History of sexual activity
• Diet
• Any medical conditions in the past

To determine any uterine problem, the doctor will perform a pelvic or vaginal examination. Imaging tests such as transvaginal sonography or ultrasound can also be performed. Tumors that are not quite visible through sonography can be identified through magnetic resonance imaging (MRI). To identify the presence of sexually transmitted infections, a Pap smear can also be done. In some cases, a biopsy may be needed.

Symptoms of Metrorrhagia

The most common symptom of metrorrhagia is irregular vaginal bleeding. Usually, excessive menstrual bleeding is associated with bleeding puberty. In the two years following menarche (first menstruation), irregular menstruation occurs in 2-5 percent of adolescents. It occurs because of cycles without ovulation. Hence, in the first part of the cycle under the influence of estrogen, the growth of the endometrium that took place is not balanced with that of the second part of the cycle, wherein there is an increase in progesterone.

Women may or may not experience the following symptoms:

• Abdominal pain or cramps
• Light to heavy menstrual bleeding
• Severe abdominal cramps (in the case of ectopic pregnancy or miscarriage)

Causes

• Endometrial Hyperplasia - Low levels of progesterone and abnormal levels of estrogen results in a condition called endometrial hyperplasia. In this condition, the hormone levels are abnormal, which causes prompt excessive endometrial cells.

• Ruptured Polyps - Sometimes, when women have cervical polyps, they are usually unaware of it. However, it can be noticed somehow after sexual contact. Bleeding after sexual intercourse should not be taken lightly as it may indicate the presence of polyps in the cervix or endometrium.

• Uterine Cancer - One of the common symptoms of uterine cancer is metrorrhagia. Advanced age also increases the risk of uterine cancer. Thus, women in their postmenopausal stage are more at risk of developing uterine cancer. An abnormal menstrual bleeding can also be due to ovarian cysts.

• Cervical Dysplasia - Vaginal spotting is a symptom of cervical dysplasia, which is actually a precancer stage. This condition indicates that there is a progress in the development of cancer.

• Abortion or Miscarriage - Another common cause of vaginal bleeding is abortion or miscarriage. Sometimes, vaginal bleeding or infection may occur due to left behind fetal parts.

• Cervicitis - In this condition, there is inflammation in the cervix. There may also be a progression of a chronic problem if there is bleeding during infection. Prompt medical attention is required for this condition.

• Hormonal Imbalance - There are some underlying conditions that can cause a hormonal imbalance. They include hyperthyroidism and hypothyroidism.

• Infection - Another probable cause of metrorrhagia is an infection. Vaginal bleeding can also be caused by syphilis. Women suffering from Lyme disease are susceptible to infections, so they might also become prone to metrorrhagia.

• Coagulation Problems - Women prone to bleeding may have an underlying coagulation problem. It makes them more susceptible to experiencing metrorrhagia.

• Use of Contraception - The vaginal or uterine lining can get traumatized by certain devices, which can cause bleeding. Another cause of metrorrhagia is the use of IUDs.

Other causes:

• Presence of fibroids 
• Cervical ectopy or erosion
• Endometriosis
• Uterine adhesions
• Dry vaginal walls due to decreased estrogen from menopause 
• Thyroid and blood clotting problems 
• Taking blood thinners
• Cancer of the cervix, vagina, or uterus
• Stress

The doctor may ask you to maintain a diary to keep track of your menstrual period, nonbleeding days, and to note down how heavy the bleeding was.

Diagnosis 

Certain medical procedures or blood tests may be required to know what causes metrorrhagia. They include:

• Endometrial Biopsy - In this procedure, a tissue sample from the uterus will be collected by the doctor. The tissue sample is sent to the laboratory and further examined under the microscope.

• Ultrasound Scan - Sound waves are used to get a picture of the uterus, ovaries, and pelvis. An ultrasound probe may be used on the lower abdomen or inside the vagina.

• Hysteroscopy - In this procedure, a thin metal tube with a tiny camera (hysteroscope) is inserted into the vagina to check the cervix and uterus. 

• Sonohysterogram - A kind of ultrasound, wherein a fluid is injected into the uterus through the cervix. The fluid can help visualize better details through sound waves than using ultrasound alone. It can detect any problems in the uterine lining such as fibroids. 

Treatment 

Check first that the source of bleeding is not from the urine or rectum, but from the vagina. This can be confirmed with the help of a tampon.

• A bed rest is a must in case of heavy bleeding. Don't forget to take note of the number of tampons or pads you have used.
• Avoid taking aspirin. Excessive vaginal bleeding may be caused by aspirin intake. 
• Hormonal treatment may be needed in case of hormonal imbalances.
• Antibiotics are required for bacterial infection.
• Hysterectomy (surgical removal of the uterus) may be required in some cases.

Once the root cause of metrorrhagia is identified, the next main focus is its treatment. The basic goal of any treatment is to provide comfort and cure to the affected person. Treatment may include the following:

• Hospitalization - When bleeding progresses to hemorrhage or becomes uncontrolled, the doctor will recommend hospitalization to monitor and observe the patient along with carrying out diagnostic tests.

• Oral Contraceptives - These can help in providing a regular menstrual cycle. They can help maintain women's hormonal levels. 

• Dilation and Curettage - The doctor performs this procedure when the cause of bleeding is an incomplete abortion. The components left behind in the body can harm the mother, so they are removed through D&C.

• Iron Supplements - Women who suffered severe blood loss should be given iron supplements.

• Estrogen-Gestagen Therapy - For 10 days, estrogen-gestagen therapy may be given to treat hormonal problems. When estrogen levels are corrected, menstrual cycles are corrected as well.

• Hysteroscopy - For polyp removal.

• Hysterectomy - For the removal of the uterus.

• Surgery, radiation, and chemotherapy - If cancer is detected, surgery, radiation, chemotherapy, or a combination of these treatments is done.

Risk Factors

The following factors may contribute to the occurrence of metrorrhagia:

• Excessive physical activity
• Drug and alcohol abuse
• Anorexia and bulimia
• Diabetes
• Thyroid problems

Vaginal bleeding is common in the first three months of taking oral contraceptives. Estrogen and progestin are the oral contraceptives that can cause bleeding. Sometimes, the risk is also increased due to progesterone, but the situation can be improved by the addition of estrogen.

Outlook

Metrorrhagia occurs outside the normal menstrual flow either at regular or irregular intervals. Hormone irregularities are one of the main causes of metrorrhagia. It is also called as dysfunctional uterine bleeding. Significant iron deficiency anemia may also develop if the bleeding is heavy and frequent.

If you are experiencing metrorrhagia in multiple cycles, see a doctor immediately and discuss the possible causes and treatment options.