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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 luteinizing hormone (LH) and secretion of progesterone from the corpus luteum. This may occur in high or low estrogen states and is the cause of most of the DUB; it 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.
Causes & Development
It can be caused by a hormonal imbalance (hyperthyroidism or hypothyroidism); pregnancy disorder; cervical lesions; medications (birth control pills, 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; IUDs or other trauma.
Diagnosis & Tests
Dysfunctional uterine bleeding is a diagnosis of exclusion.
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Signs, symptoms & indicators of Metrorrhagia:
Risk factors for Metrorrhagia:
Metrorrhagia suggests the following may be present:
Recommendations and treatments for Metrorrhagia: | | | | | Botanical |  Vitex / Chasteberry
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. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | Likely to help |
GLOSSARY
Anabolic (Anabolism)
Promoting anabolism: Allow the conversion of nutritive material into complex living matter in the constructive metabolism. Specifically, an agent or function that stimulates the organization of smaller substances into larger ones. Examples: making a starch out of sugars, a protein out of amino acids, or making triglycerides out of fatty acids are anabolic functions. Anabolic steroids are internal or external substances that will induce increased body size or mass. The opposite of catabolic.
Anovulatory
Not involving or accompanied by ovulation; suppressing ovulation.
Carcinoma
Malignant growth of epithelial cells tending to infiltrate the surrounding tissue and giving rise to metastasis: An invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body.
Cervix
The lower part of the uterus that opens into the vagina.
Corpus Luteum
Yellow endocrine body formed in the ovary that secretes estrogen.
Corticosteroid (Corticosteroids)
Steroid hormone produced by the adrenal cortex.
Dysfunctional Uterine Bleeding (DUB)
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.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Hormones (Hormone)
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.
Hyperthyroidism (Hyperthyroid)
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Hypothalamus (Hypothalmus)
Tucked deep inside the brain, this gland is an important supervisory center, regulating many body functions. It is important for longevity and coordinates the entire endocrine system, especially in connection with the pituitary. The hypothalamus is located immediately below the thalamus at the center of the brain, and controls many automatic functions of the body. This means it has the power to govern the autonomic (automatic or subconscious) nervous system. The hypothalamus also controls pituitary output by secreting specific chemicals to the pituitary's front lobe. Despite its importance in maintaining homeostasis, the hypothalamus in humans accounts for only 1/300 of total brain weight, and is about the size of an almond.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Lesion (Lesions)
Any damage to tissue structure or function; an abnormal change in body tissue caused by disease or injury. A scar is a lesion, as is cancer, a stomach ulcer or a pimple.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Luteinizing Hormone
Anterior pituitary hormone stimulating estrogen production by the ovary; promoting formation of progesterone by the corpus luteum in women and stimulating testosterone release in men.
Menopause (Menopausal)
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.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Metrorrhagia
Any irregular, acyclic bleeding from the uterus between periods.
Ovarian Cysts (Ovarian Cyst)
These occur in two forms, namely "functional" and "organic". Symptoms 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.
Ovary (Ovaries)
Ovaries are about the size of an almond and lie on either side of the lower abdomen beside the uterus. They usually produce one egg each month and whether the egg is fertilized or not, the reproductive process follows a monthly cycle, with constant changes in various hormone levels, preparing another opportunity for conception. The ovary is responsible for most of the estrogen production in women. At menopause (sometime after middle-age), egg production ceases and hormone levels drop significantly.
Pituitary (Pituitary Gland)
The pituitary gland is a small (half-inch), bean-shaped organ that hangs down from the lower center of the brain on a stalk attached to another gland, the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands. It regulates many body activities, and is partitioned into front and back lobes. The front lobe is stimulated by the hypothalamus, and produces any one of six different hormones that in turn stimulate the thyroid, adrenal and reproductive glands, and also breast milk production.
Polyp (Polyps)
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Steroid (Steroids)
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.
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.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Vitex
Vitex agnus castus. Common name: chaste tree berry.
Last updated: Jun 15, 2008
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