Causes and Symptoms of Metrorrhagia

What is metrorrhagia?

Metrorrhagia is also known as dysfunctional uterine bleeding, which is a common gynecological complaint among women of reproductive age. This condition is also commonly experienced during the first few years of menarche. If abnormal bleeding occurs during menarche, then it is called as pubertal metrorrhagia. However, metrorrhagia also happens in women who are nearing their menopause. 

Generally, uterine bleeding occurs within the normal dates of menstrual bleeding, but in metrorrhagia, bleeding occurs outside the normal date. In most cases, spotting is observed, but in some cases, severe bleeding may occur. Bleeding may also occur anytime and in irregular patterns. Most women may simply call it spotting.

Menstrual spotting between periods may be a normal part of ovulation in some women. However, it may also indicate an underlying condition to some. For this reason, further investigation needs to be done when women frequently bleed in between their menstrual cycle. 

Metrorrhagia is not an illness by itself, but often a symptom of an undiagnosed medical condition sometimes caused by irregularities in hormones.

Anatomy

Hormones regulate the normal process of the menstrual cycle. This cycle, on an average, lasts for about 28 days but it may either be shorter or longer depending on the individual. As the uterine lining builds up extra blood and tissues every month, it also thickens, so that a potentially fertilized egg can implant itself and develop into a fetus.

However, if the egg is not fertilized, no implantation takes place, and the egg passes through the uterus. Prostaglandin, a hormone-like substance that is released during menstruation, causes the uterus to contract. When the uterus contracts, the lining sheds and through the vagina, blood leaves the body.

Causes of Metrorrhagia

Below are some of the causes of metrorrhagia:

• Endometrial hyperplasia - In this condition, the estrogen level is abnormally elevated while the progesterone level is abnormally decreased. In the hormonal level of the body, this causes imbalance and irregularity, which leads to metrorrhagia.

• Uterine cancer - One of the common causes of metrorrhagia is uterine cancer, which is mostly seen in women who are nearing their menopausal phase. Thus, postmenopausal women who experience metrorrhagia have an increased risk of developing uterine cancer. Another cause of metrorrhagia is the presence of ovarian cysts.

• Polyp rupture - Cervical or endometrial polyps may be present in females without them knowing. Moreover, these polyps can further cause metrorrhagia if they rupture. A common symptom is bleeding after sexual intercourse.

• Cervicitis - This condition happens when the cervix is inflamed due to infection. If this condition is left untreated, the infection may spread, which leads to complications that require immediate medical attention. 

• Miscarriage or abortion - Metrorrhagia may occur in females who had undergone an abortion or miscarriage. Such abnormal bleeding may occur when fetal remnants are still present in the body.

• Infectious cause - Unprotected sexual intercourse can cause the transmission of sexually transmitted diseases, which can further cause metrorrhagia. One example of a sexually transmitted infection (STI) that causes metrorrhagia is syphilis. Females who have a history of Lyme disease may also have a higher chance of frequent infections and metrorrhagia.

• Hormonal imbalance - Metrorrhagia may also occur due to hormonal imbalances such as thyroid disorders.

• Blood clotting abnormality - Females who are prone to metrorrhagia are those who have abnormal clotting problems. 

• Contraception - Certain methods of contraception may injure the vagina and uterine lining, leading to the occurrence of metrorrhagia. One method of birth control that commonly causes metrorrhagia is the use of an intrauterine device. 

Symptoms of Metrorrhagia

Light to heavy bleeding between menstrual periods is the main symptom of metrorrhagia. Some women may experience abdominal cramps while some may not. These cramps may also be accompanied by bleeding, especially when metrorrhagia is due to a miscarriage or an ectopic pregnancy. 

Diagnosis 

The doctor will examine the patient if there is irregular bleeding. Consult the doctor right away and do not delay an appointment. Keep a track of your periods and also keep a record of the irregular bleeding that occurs. Show the records during your doctor's appointment. 

The patient's medical history and symptoms will be reviewed by the doctor. Physical examination will also be performed. A sample may also be collected during a pelvic examination to identify any type of infection or sexually transmitted disease. To test the thyroid and hormone levels, blood may be collected for testing. Women may also be tested if they are pregnant or not. A Pap smear can be done to check for cervical cancer, as well. 

An imaging test, such as an ultrasound may be done to see any abnormalities in the female reproductive system. Cells can also be obtained through an endometrial biopsy to check for any abnormalities or hormonal imbalance. 

Treatment

Treatment usually begins as soon as the cause of the condition is identified.

• Medications - The patient may be given medications if the cause is more of an infection. Medications will help cure the infection as well as correct the condition. 

• Bed rest - A complete bed rest may be recommended by the doctor, especially in women who have become anemic due to blood loss. Observation and treatment may be shifted to an inpatient setting until the condition is completely treated.

• Dilation and curettage (D&C) - It is a procedure performed if abortion or miscarriage is the cause of metrorrhagia. This procedure helps remove fetal remnants, which could be the cause of bleeding.

• Oral contraceptives - If the patient has a hormonal imbalance, the patient may be given oral contraceptives to regulate the level of hormones. This form of treatment can also prevent the incidence of metrorrhagia. 

• Estrogen therapy - Menstrual cycle can be corrected by bringing back the levels of estrogen in the body. 

• Biopsy - A biopsy is done if cancer is suspected as the cause of metrorrhagia. 

It is very important that whatever treatment option is chosen, iron pills be given to patients, since women with metrorrhagia will have low levels of iron in the body due to blood loss.

While waiting for your doctor's appointment, you can ask family members if any of your relatives have bleeding disorders. You can also note down how much and how often you bleed in a month. You can monitor the volume of bleeding by counting the number of pads or tampons you have used during your menstrual period.