Spotting vs Bleeding
Spotting and bleeding are in the same spectrum. While bleeding is significant, spotting refers to a scanty amount of bleeding. The differences between the two are the causes, the amount, and the treatment. This article will talk about both spotting and bleeding in detail, highlighting the clinical features, causes, symptoms, investigation and diagnosis, prognosis, treatment, and finally the differences between them.
Causes of spotting include, implantation bleeding, inter-menstrual bleeding, post-menopausal bleeding, cervicitis, vaginitis, endometritis, and cervical cancer. Irregular menstruation may also present as scanty bleeding in most days of a week. The patient sees this as spotting. It is important to note that all these incidences may feature heavy bleeding. But they usually do not. In the preparation of the implantation, the inner lining of the uterus increases its blood supply. During implantation, the fertilized ovum burrows into the inner lining of the uterus resulting in a small amount of bleeding. Some women may bleed a bit during ovulation, around day 14 of the cycle. Soon after menarche and around menopause women may experience episodes of bleeding in between the regular normal episodes.
Post-menopausal bleeding is an important presentation because it may be due to cervical or endometrial cancer. Vaginal examination, colposcopy, and biopsy are essential steps in diagnosing cervical cancer. Dilatation and curettage provide an endometrial sample for histological examination if endometrial cancer is a possibility. Treatment methods change according to the spread of cervical cancer. If it is localized without the involvement of the surrounding tissue, removal of the uterus is curative. If there is significant spread, chemotherapy and radiotherapy come into the scene. Hormonal imbalances may also cause post-menopausal bleeding. After menopause, vagina and uterus degenerates due to lack of estrogen. This is called atrophy. One of the signs of atrophic changes is scanty bleeding. Hormone replacement therapy provides some relief, but it is inadvisable to continue long term because of the increased risk of breast cancer. Cervicitis and vaginitis can be the result of atrophy as well as infection. There is an acute inflammation of the area making it susceptible to bleeding. Antibiotics and antifungals treat infections while atrophic changes do not need any treatment unless symptoms are overwhelming.
Causes of heavy bleeding (menorrhagia) include dysfunctional uterine bleeding, hormonal imbalances, adenomyosis, uterine fibroids, polycystic ovarian syndrome, hormonal contraceptive methods, and systemic diseases of bleeding. Dysfunctional uterine bleeding is a diagnosis of exclusion. If all other causes of bleeding are unlikely, this diagnosis becomes a possibility. Some theorize that bleeding is due to an abnormality of the increased vascularity of the endometrium. Tranexamic acid is an antifibrinolytic drug, and it stops dysfunctional uterine bleeding. Progesterone modifies the vasculature and stops bleeding, but there is withdrawal bleeding once progesterone is stopped.
Adenomyosis is the presence of the endometrium like tissue inside the uterine muscle. This tissue is under the control of cyclical hormonal changes and may cause severe pain and bleeding. Uterine fibroids, which increase the surface area of the endometrium and fibroids interfering with uterine contraction, give rise to heavy periods. Polycystic ovarian syndrome is a complex disease where there is incomplete maturation of multiple follicles resulting in cyst formation. There is increased estrogen and testosterone formation. Male hair distribution, obesity, irregular periods and subfertility are the salient features of polycystic ovarian syndrome. Hormonal contraceptives interfere with the hormonal cycles and can result in heavy bleeding. Bleeding disorders like hemophilia and thromobocytopenia also cause heavy periods.
What is the difference between Spotting and Bleeding?
• Spotting is scanty while bleeding is significant.
• Causes of spotting are different from those causing heavy bleeding. Cervicitis, vaginitis, cancer does not normally cause heavy bleeding.
• Treatment methods differ according to the origin of the bleeding.