Intermenstrual Bleeding

Dr. Lissa Rankin answers a reader's question on what to do about Intermenstrual Bleeding.

OB/GYN On-Call

Intermenstrual Bleeding

Dear Lissa: My daughter got her period at age 11 and up until now (she’s 15) she has had a regular menstrual cycle. After she turned 15, she would spot lightly in between periods, usually 6-8 days after her period ended. She is still a virgin. She’s concerned and I am wondering why this is happening to her and if it’s normal?

-Ms. Normal

Dear Ms. Normal: It can be confusing when periods get whacked out, especially when there have been regular cycles previously. What your daughter is experiencing is something we call intermenstrual bleeding, or midcycle spotting. Because we know she’s a virgin, we can assume she’s not pregnant, which is good. Pregnancy is the most common reason for irregular bleeding after a period. But many other things can cause this type of bleeding.

Reasons For Intermenstrual Bleeding

1. Immature hormones due to youth
2. Thyroid hormone disorders
3. Anatomic causes such as polyps or fibroids in the uterus or on the cervix (very uncommon at that young age)
4. Cervical dysplasia (abnormal pap smear), which would be highly unlikely if she’s a virgin
5. A sexually transmitted disease, such as gonorrhea or chlamydia (again, unlikely if she’s a virgin)
6. Spotting during ovulation, which can be normal and is generally very light
7. Anovulation (lack of ovulation) which can make bleeding irregular
8. Side effect from medication (such as birth control pills)
9. Stress

If the intermenstrual bleeding persists, please take your daughter to see a gynecologist. Chances are it’s nothing serious, but you want to make sure you’re not missing something. We applaud your daughter for being mature about seeking guidance, but remember that an internet doctor is never as thorough as a real live one who can touch and talk to your daughter. I wish you and your daughter all the best in sorting this out.

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0 thoughts on “Intermenstrual Bleeding

  1. Dr Lissa,

    I am saddened that in the above comment about intermenstrual bleeding, you would FIRST refer a young, virginal woman, with such a sensitive and embarrassing (to her) problem to a specialist right off the bat. Why not refer her to her family Dr or pediatrician, with whom she already has an established trusting relationship and would feel more comfortable talking with about this kind of problem??
    The Primary care Dr aka Family Dr, would be able to quickly see her and do a basic evaluation ruling out the most common causes like you listed above and if they were unable to diagnose or handle the problem, then a referral could be made to the proper type of specialist.
    As a Family Dr. myself, it is unfortunately a common battle for me and my Primary care peers to have our patients be referred from one specialist to another directly. The patient is commonly told by one of the specialists they see that “Well I don’t deal with that kind of problem” and off they go to another type of specialist. It’s more frustrating when the patient then comes back to their Primary Doc requesting an explanation of what has gone on. Because “they did not understand the specialist” or “I trust you more” are the most common statements I hear in these cases.
    Many times a properly trained Primary Care Doc will have been able to diagnose and treat the problem in a prompt and timely manner. This “fixes” the problem and there is not a need to refer on to a specialist.
    We need to get back to using the front line Primary Care Docs like Family Docs, Pediatrics, Internists, (and Gynecologists in some cases) as the backbone of our medical care system. Especially if we want to have a chance at controlling our health care costs. Also by using Primary Docs for the more common issues and initial evaluations, it helps to “triage” patients and “free up” the Specialists to more quickly see patients that really need their additional training, instead of tying up their schedule with patients that did not need to be there or where sent to the wrong type of specialist. The other bonus of this system is that the patient sees the right type of specialist, instead of bouncing around from specialist to specialist. Also there is a “ring master” to keep on top of what is going on with the different Doctors involved in the case.
    In the above case of the young girl with the vaginal bleeding, the Family Doc can examine her and do some lab work and determine if they can diagnose and “fix” the problem or the patient needs to be referred on to a specialist and then determine the proper kind of specialist the patient may need. In this case a gynecologist or a hormone specialist.
    Thank you for allowing me me time on the soapbox, and I agree that the internet is a good resource, but NOTHING beats talking with the real thing, a Doctor or Advanced Care Provider to help figure out what is going on with your health.

  2. I am 24 years old and still a virgin. I have a a regular period since I was 10(so regular you could put a time on it). They have always been heavy and I always had very extreme cramps(to the point where one my legs collapsed under me). I also have constant cramps in between peopds ( not as bad though) and for about a year now I have been getting ‘mini periods’ or spotting inbetween periods it started out a week and a half after my period ended and lasted for one or two days and now it is to the point where it is almost every week (usally lasts for less than a day) anyway my doctor has done tons of tests on me but will not do an ‘internal’ search, I was scelduled for one twice and both time they told me they sill would not do it. I am getting to my breaking point beacuse I do not know what to do and i am getting scared beacause what if something is VERY wong? I just don’t know what to do can anyone help?

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