Spotting, or atypical female bleeding: what it is and the diagnostic pathway

“Spotting” or “atypical bleeding” are the words that define the bleeding that can occur between menstrual cycles, after intercourse or during menopause

They occur occasionally and at different times in a woman’s life. In most cases they are not cause for concern, but they are a sign that should never be underestimated.

“Atypical bleeding” occurs outside the menstrual period and can occur at various stages of a woman’s life: prepubertal and adolescent, childbearing, pregnancy and post-menopausal

The discharge is a dark red drip or bleeding associated with blood clots that lasts for several days.

They may occur coinciding with the ovulatory period, after sexual intercourse, but also as a particularly heavy menstrual flow every month or during pregnancy.

It is important not to underestimate this sign because it could be an early symptom of a pathology affecting the vagina, the cervix, the body of the uterus (endometrial mucosa or the muscular part).

When the bleeding is repeated over time it is important to consult a gynaecologist

In particular: in the fertile age when the symptom occurs after sexual intercourse or when the menstrual flows are particularly abundant (metrorrhagia); in the postmenopause they should alarm the woman even more because the problem should not occur.

The most frequent causes of atypical uterine bleeding in childbearing age are hormonal imbalances, inadequate dosages of the contraceptive pill, the presence of an IUD that can cause inflammation of the endometrial mucosa, cervical or endometrial fibroids or polyps.

Blood loss is more rarely a sign of cervical or vaginal pre-tumour or tumour lesions.

In menopause, on the other hand, bleeding can be due to post-coital mucosal micro-lacerations in estrogen deficiency, the presence of endometrial polyps or uterine or vaginal tumours.

Bleeding is in fact the cardinal symptom of neoplasms of the uterus, endometrium and vagina

This is why, if spotting occurs again during the menopause, it is essential to visit a specialist doctor, as it could be the sign of a benign or neoplastic pathology that needs to be investigated.

During the examination, a pap test, transvaginal ultrasound, and biopsy are performed if a suspicious lesion is found, preferably under colposcopic guidance.

Colposcopy is an examination that consists of observing the cervix and vagina under an optical microscope, with the help of reagents that “colour” the mucous membranes, making pre-tumour or neoplastic lesions more obvious.

Ultrasound, thanks to an ultrasound probe that is introduced into the vaginal cavity, provides detailed information on the state of the vagina, uterus and ovaries and tubes and makes it possible to accurately assess and diagnose any fibroids or polyps, malformations or suspected neoplastic lesions.

Every woman, from a young age, should take care of herself and have a gynaecological examination when she starts her sexual life and have a Pap test (+/- HPV test) every 3 years until the age of 65.

Atypical bleeding should never be underestimated, but always reported to the gynaecologist.

Time is a crucial factor: it is important not to postpone visits and investigations because early diagnosis can favorably change the outcome of the disease.

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Istituto Tumori Milano

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