Metrorrhagia can be defined as ‘off schedule’ bleeding. The bleeding, usually of normal or slight amount, occurs at either irregular or regular intervals outside of the normal menstrual flow. Metrorrhagia is one of many conditions sometimes caused by hormone irregularities, which can be labeled by the more general term, Dysfunction Uterine Bleeding – DUB.
A cycle of 22 to 35 days can be considered of normal length. Irregularity is any deviation of more than seven days from your normal pattern of bleeding. Occasional irregularity of menses are very common and pregnancy is the most frequent cause of a late period. Irregular menstrual bleeding occurs most often in adolescents and in women approaching menopause.
Anovulatory or estrogen breakthrough bleeding is caused by the production of estrogen without normal surges of LH and secretion of progesterone from the corpus luteum. This may occur in high or low estrogen states. This is the cause of most of the DUB and occurs at the extremes of the reproductive cycle. Midcycle spotting is caused by a decrease in estrogen at midcycle following ovulation. A luteal phase defect is associated with premenstrual spotting or polymenorrhea. A prolonged luteal phase is caused by extended corpus luteal activity and prolonged progesterone production leading to prolonged cycles or long episodes of menstrual bleeding.Dysfunctional uterine bleeding is a diagnosis of exclusion. It can be caused by a hormonal imbalance (hyperthyroidism or hypothyroidism); pregnancy disorder; cervical lesions; medications (birth control pill’s, corticosteroids, hypothalamic depressants, anticholinergics, anticoagulants); uterine fibroids; functional ovarian cysts; polyps; carcinoma of the vagina, cervix, endometium or ovary; renal or liver disease; coagulation disorders; anabolic steroid use; IUD’s and other trauma.
Signs, symptoms & indicators of Metrorrhagia
Bleeding between periods
Irregular menstrual cycles
Counter Indicators
Absence of bleeding between periods
Risk factors for Metrorrhagia
Birth Control Pill / Contraceptive Issues
While birth contol pills can help with abnormal menstrual bleeding, irregular menstrual bleeding can be a side effect also.
Metrorrhagia suggests the following may be present
Recommendations for Metrorrhagia
Vitex
Vitex acts on the pituitary gland in the brain to adjust levels of LH (luteinizing hormone) and FSH (follicle stimulating hormone). Vitex indirectly promotes progesterone in cases of excess estrogen. Overall, it helps to restore normal rhythm to the reproductive hormones.
Lithosperma
Stoneseed (Lithosperma ruderale) and gromwell (L. officianale) have a progesterone-like effect that helps balance excess estrogen. Both species of lithosperma may act directly on the hypothalamus to improve hormonal regulation and promote a regular cycle.
Key
 | Weak or unproven link |
 | Strong or generally accepted link |
 | Proven definite or direct link |
 | Very strongly or absolutely counter-indicative |
 | Likely to help |
Glossary
Metrorrhagia
Any irregular, acyclic bleeding from the uterus between periods.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
DUB
Dysfunctional Uterine Bleeding (DUB) is any abnormality of menstruation or bleeding caused by a hormonal disorder. DUB is a diagnosis of exclusion. The following conditions should be ruled out in order to diagnose DUB: endometrial polyps, uterine fibroids, adenomyosis, endometrial or cervical cancer, pelvic infection including endometritis (infection of the lining of the uterus), endometriosis, polycystic ovarian disease, ovarian cyst or tumor, thyroid dysfunction or blood clotting abnormalities. Hormone testing may indicate abnormalities which replacement therapy would then resolve. If the dysfunctional bleeding disappears, then no further testing may be necessary. Failure to perform sufficient testing may result in an incorrect diagnosis of DUB because the true cause of the abnormal bleeding has been overlooked. A premature diagnosis of DUB may lead to improper and failed treatment. DUB accounts for approximately 20% of all hysterectomies in the U.S.
Menopause
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Anovulatory
Not involving or accompanied by ovulation; suppressing ovulation.
Estrogen
One of the female sex hormones produced by the ovaries.
Corpus Luteum
Yellow endocrine body formed in the ovary that secretes estrogen.
Hyperthyroidism
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Hypothyroidism
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Uterine Fibroids
Fibroids are the most frequently seen tumors of the female reproductive system. Also known as uterine myomas, leiomyomas, or fibromas, they are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. In more than 99% of cases they are benign (non-cancerous). They may range in size from the size of a pea to the size of a softball or small grapefruit. Some women never have symptoms, the most common of which are: heavy or prolonged menstrual periods; abnormal bleeding between menstrual periods; pelvic pain; frequent urination; low back pain; pain during intercourse; a firm mass, often located near the middle of the pelvis, which can be felt by a physician.
Ovarian Cysts
These occur in two forms, namely "functional" and "organic". may not be present but can include pressure or pain in the abdomen, problems with urine flow or pain during sexual intercourse. Rarely, a very large cyst can become twisted and stop its own blood supply, possibly causing nausea, fever or severe abdominal pain. Functional ovarian cysts form part of the normal functioning of the ovary and are always benign. They may be either "follicular cysts", produced by all menstruating women every month and reaching up to 2-3cm in diameter before they rupture at ovulation, or "corpus luteum cysts", which appear after ovulation and may grow to produce "hemorrhagic cysts" if ovulation does not occur or is delayed. Rupture of such a cyst can sometimes cause painful ovulation or bleeding, which is often moderate and resolves by itself. Organic ovarian cysts may be benign or malignant and are not linked to the functioning of the ovary. They occur as either "dermoid cysts", which are benign tumors that may nevertheless recur on either ovary and contain elements derived from the skin (hairs, sebum, teeth), or other organic cysts.
Polyp
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Carcinoma
Malignant growth of epithelial cells tending to infiltrate the surrounding tissue and giving rise to metastasis.
Cervix
The lower part of the uterus that opens into the vagina.
Anabolic
Anabolic compounds: Allow the conversion of nutritive material into complex living matter in the constructive metabolism.
Steroid
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
