Metrorrhagia

Metrorrhagia is uterine bleeding that occurs at irregular intervals, typically between expected menses. It is a form of intermenstrual bleeding and is distinct from menorrhagia (heavy, regular periods) and from amenorrhea. The term broadly describes bleeding that is unpredictable in timing and duration.

Causes are varied and include pregnancy-related factors (implantation bleeding, miscarriage), structural lesions such as cervical polyps, endometrial polyps, fibroids, and adenomyosis, and infections like cervicitis or endometritis. Hormonal and ovulatory disorders (anovulation, polycystic ovary syndrome, thyroid disease) can disrupt the menstrual cycle. Coagulation disorders, liver or kidney disease, and medications (anticoagulants, certain antiplatelet drugs, or excessive NSAID use) may contribute. In perimenopausal or postmenopausal individuals, metrorrhagia raises concern for endometrial pathology and cancer risk.

Diagnosis involves a careful history and physical examination, followed by targeted testing. A pregnancy test is essential. Laboratory work may include complete blood count, iron studies, and coagulation profile. Thyroid testing may be indicated. Imaging typically begins with transvaginal ultrasound to assess the uterus and adnexa. Endometrial sampling or biopsy is considered in women with persistent bleeding, risk factors for endometrial cancer, or postmenopausal bleeding; hysteroscopy may be used for direct evaluation of intrauterine lesions.

Management aims to treat the underlying cause and control bleeding. Acute management may involve fluids, iron supplementation for anemia, and hemostatic agents such as tranexamic acid. Hormonal therapies, including combined oral contraceptives, progestins, or a levonorgestrel-releasing intrauterine device, can regulate cycles. Structural lesions may require surgical intervention (polypectomy, myomectomy, endometrial ablation, or hysterectomy) if conservative measures are ineffective or not appropriate.