In some women, menstrual spotting between periods occurs as a normal and harmless part of ovulation. Some women experience acute mid-cycle abdominal pain around the time of ovulation (sometimes referred to by the German term for this phenomenon, mittelschmerz). This may also occur at the same time as menstrual spotting. The term breakthrough bleeding or breakthrough spotting is usually used for women using hormonal contraceptives, such as IUDs or oral contraceptives, in which it refers to bleeding or spotting between any expected withdrawal bleedings, or bleeding or spotting at any time if none is expected. If spotting continues beyond the first three cycles of oral contraceptive use, a woman should have her prescription changed to a pill containing either more estrogen or more progesterone.
Metrorrhagia may also be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids, or cancer of the reproductive organs.