A woman's health is intricately linked to her menstrual cycle, which is an important sign of her overall well-being. Throughout puberty and menopause, hormonal changes affect not only fertility but also mood, energy, and long-term health. A normal cycle usually indicates balance, whereas abnormalities may suggest problems such as PCOS, endometriosis, or thyroid disease.

Our bodies do not always work in a perfect clockwork operation and unexpected vaginal bleeding can often confused us. Is it a mere spotting? A normal period? A symptom of something more concerning? Differences between spotting, menstrual bleeding, and intermenstrual bleeding should be understood is crucial for maintaining reproduction health.

Here is a short guide to help you differentiate while you are confused.

Spotting

Spotting is vaginal bleeding that doesn't happen as part of your regular menstrual period. It commonly manifests as fine droplets or smears of blood on clothing or toilet tissue. The intensity of the blood ranges from deep red (recent blood) to pink (having cervical mucus mixed in it) or brown (older, oxidized blood). Spotting is not very much and can't be seen in a way that needs either a tampon or a pad to absorb.

Common Causes of Spotting

Spotting is caused by numerous factors, and in the majority of instances, it is nothing to worry about. Some frequent causes are:

Hormonal Birth Control Transitions: New birth control technique, for instance, birth control pills, IUDs containing hormones, or implants, results in temporary spotting as the body adapts.

Ovulation Bleeding: A few individuals get spotting light around the time of ovulation as a result of hormonal changes. It normally happens in the mid-cycle and could be followed by slight cramping.

Cervical Ectropion: A harmless condition when cells from the inside of the cervical canal migrate to the outer cervix, causing the outer cervix to become more sensitive and prone to faint bleeding on coitus or physical activity.

Early Pregnancy (Implantation Bleeding): 15–25% of pregnant women experience light spotting around 10–14 days post-conception, which is confused with an early period.

When to See a Doctor

Spotting is usually harmless, but it's best to consult a doctor if:

• It continues after a few months of initiating new birth control
• Is accompanied by pelvic pain or abnormal discharge
• Occurs after frequent intercourse
• Occurs during pregnancy and is not verified as implantation bleeding

Menstrual Bleeding

There is a time, also known as a period or menstruation, when the uterine lining sheds due to changing hormone levels. It would last for approximately 2-7 days and is heavier initially. The hue and texture of period blood shift during the menstrual cycle:

Red: New active bleeding at the start of a period

Brown or dark red: Older, slower blood in leaving the uterus

Clots: It's normal to have small clots, but bigger clots may be a sign of heavy menstrual bleeding (HMB)

Why You Have a Period Essentially?

Menstruation is a part of the reproductive cycle, and it happens around every 21–35 days. When there's no pregnancy after ovulation, hormone levels fall, causing the uterine lining to be shed.

Signs Your Period May Be Abnormal

Though periods differ in different people, there are some signs that point towards probable underlying conditions:

• Prolonged bleeding (longer than 7 days)
• Heavy flow necessitating pad/tampon changes every 1–2 hours
• Severe cramps that disrupt daily life
• Irregular periods or absent periods

If you have any of these, conditions such as polycystic ovary syndrome (PCOS), endometriosis, or thyroid disease may be involved, and a medical visit is in order.

Intermenstrual Bleeding

Unlike spotting, intermenstrual bleeding is heavier and unexpected between regular periods. It may be from bright red to dark brown and can contain blood clots.

Possible Causes of Bleeding Between Periods

Sexually Transmitted Infections (STIs): Chlamydia and gonorrhea can lead to inflammation and abnormal bleeding.

Pelvic Inflammatory Disease (PID): A bacterial infection of the reproductive organs and can lead to abnormal bleeding.

Uterine Fibroids or Polyps: Benign growths in the uterus that may cause unexpected bleeding.

Endometrial Hyperplasia or Cancer: In some instances, abnormal bleeding may be a sign of abnormal cell growth in the lining of the uterus.

When to See a Doctor

See a doctor if intermenstrual bleeding is:

• Frequent or persistent
• Associated with pelvic pain or discomfort
• Associated with abnormal discharge, fever or painful sex

Recognizing your body's rhythms can assist you in identifying normal versus abnormal bleeding. Monitoring your menstrual cycle through an app or calendar may flag changes that should be checked with a doctor. If you have any questions regarding abnormal bleeding, visiting your health care provider is the way to go.

The NHS has issued fresh advice for people taking a widely prescribed medicine used to manage heart and circulation conditions. Across the UK, millions rely on beta-blockers to treat heart and blood vessel problems. Each year, more than 50 million prescriptions are written for these drugs, which help manage issues ranging from high blood pressure and abnormal heart rate to certain conditions affecting the brain and nervous system. Doctors most commonly prescribe bisoprolol, which NHS England lists as the seventh most prescribed medicine in the country.

What Is Bisoprolol Used For?

Bisoprolol, sold under brand names such as Zebeta, Bisotab, and Concor, belongs to a group of medicines called beta-blockers. It is mainly used to treat various heart-related conditions by slowing the heart rate and relaxing blood vessels. This reduces strain on the heart and helps it pump blood more efficiently, according to the CDC. The NHS also explains that bisoprolol is used to prevent chest pain caused by angina and to manage atrial fibrillation and other irregular heart rhythms. By slowing the heart, it allows the heart muscle to work more effectively.

Data from 2024–25 shows that bisoprolol was dispensed around 32 million times in England alone. The NHS notes that for people with high blood pressure, taking bisoprolol can help lower the risk of future heart disease, heart attacks, and strokes.

Bisoprolol Side Effects: Why Is NHS Warning Against Bisoprolol?

Like most medicines, bisoprolol can cause side effects, and patients are advised to stay alert to them. People starting the medication are often told to take their first dose at night, as it can make some feel dizzy. There are several common side effects that affect more than one in 100 people. According to the NHS, these are usually mild and tend to settle over time. They include:

• feeling dizzy or sick
• headaches
• cold hands or feet
• constipation
• diarrhoea

However, there are less common but more serious side effects that should not be ignored, as they may require urgent medical attention. The NHS advises contacting a doctor or calling 111 if:

• you experience shortness of breath with a cough that worsens during physical activity, swelling in the ankles or legs, or an irregular heartbeat, as these can point to heart problems
• the whites of your eyes or your skin turn yellow, which may be harder to notice on darker skin tones, as this can signal liver issues

Bisoprolol Warning: When Should You See Medical Emergency

The NHS also urges people to seek immediate help if certain symptoms appear. These include:

• chest pain, which could indicate heart trouble
• shortness of breath, wheezing, or tightness in the chest, which may suggest lung-related problems

Emergency services should be contacted straight away if there are signs of a severe allergic reaction, known as anaphylaxis. The NHS says to call 999 immediately if:

• your lips, mouth, throat, or tongue suddenly swell
• you are breathing very fast or struggling to breathe, with wheezing or a choking sensation
• your throat feels tight or you have difficulty swallowing
• your skin, lips, or tongue turn blue, grey, or pale, which may be more visible on the palms or soles in people with darker skin
• you suddenly feel very confused, extremely drowsy, or dizzy
• someone collapses and cannot be woken
• a child becomes limp, floppy, or unusually unresponsive, with difficulty holding their head up or focusing

The NHS stresses that while bisoprolol is effective and widely used, knowing when side effects are harmless and when they signal an emergency is key to staying safe.

Rabies is a fatal viral disease that spreads to humans through the saliva of infected animals. It targets the central nervous system, and nearly 99 percent of human cases are linked to infected dogs. A recent *Lancet* study found that about 5,726 people still die from rabies each year, even though overall deaths have declined over time. This is why prompt medical care after a dog bite or scratch is critical. Most people believe the rabies vaccine taken after a bite is enough. What many do not realise is that a pre-exposure prophylaxis vaccine is also available and can be taken even before a bite occurs. So why does this vaccine matter, and how does it actually protect you?

What Is A Rabies Pre Exposure Prophylaxis Vaccine?

A rabies pre-exposure prophylaxis, or PrEP, vaccine involves a set of shots given before any possible contact with the rabies virus. It is mainly recommended for people at higher risk, such as veterinarians, animal handlers, laboratory workers, and travellers visiting regions where rabies is common. While PrEP does not remove the need for treatment after a bite, it makes post-exposure care simpler. People who have received PrEP need fewer follow-up injections and do not require rabies immunoglobulin, which can be hard to access in emergencies and may save crucial time.

How Can Rabies Pre Exposure Prophylaxis Vaccine Protect You?

According to Dr Deepa Aggarwal, who shared insights on her Instagram account, the rabies pre-exposure prophylaxis vaccine prepares the immune system in advance. It helps the body develop antibodies before any exposure occurs. If a vaccinated person is bitten later, they need only two booster shots and no immunoglobulin. The immune response is quicker, lowering the risk of the virus spreading to the brain. This is especially important for people at high risk or in situations where medical treatment may be delayed.

Rabies Pre Exposure Prophylaxis Vaccine: How It Works?

• Introduces Antigens: The vaccine contains an inactivated form of the rabies virus, which safely exposes the body to its antigens.
• Builds Memory: The immune system learns to recognise these antigens and creates antibodies along with memory cells.
• Rapid Response on Exposure: If exposure happens later, these memory cells act fast, producing antibodies that stop the virus before it can cause infection.

CDC Guidelines On Rabies Pre Exposure Prophylaxis Vaccine

The Advisory Committee on Immunization Practices, or ACIP, has updated its recommendations for rabies PrEP.

• A two-dose PrEP schedule has now replaced the earlier three-dose schedule and offers protection for up to three years. Options for maintaining protection beyond three years are also outlined on their website.
• The minimum antibody level used to decide whether a booster is needed has been revised and standardised.
• Many people who previously needed antibody testing every two years now require only a one-time titer check, followed by a booster if levels are low, or in some cases, just a one-time booster.

Who Should Get The Rabies Pre Exposure Prophylaxis Vaccine?

While the vaccine can benefit anyone, rabies pre-exposure prophylaxis is mainly advised for people with frequent or high risk of exposure. This includes veterinarians, animal handlers, wildlife workers, laboratory staff, and travellers to areas where rabies is widespread. The vaccine makes treatment after a bite easier by reducing the number of shots required. However, health authorities stress that while PrEP offers protection, it does not replace full post-exposure treatment after a confirmed bite, as advised by the CDC and WHO.

Air quality in Delhi remains toxic, despite the GRAP !V measures implemented in the national capital. Today, Delhi recorded an AQI of 358, this remains under 'very poor'. As per the Central Pollution Control Board (CPCB), the AQI was recorded at 442 in Ghazipur, 409 in ITO, and 447 in Palam, all under 'severe' category.

While we have long known that pollution impacts lung and respiratory health, but it can impact beyond that, including causing severe menstrual cramps.

What Proves That Air Pollution Impacts Menstrual Cramps?

A study published in Frontiers in Public Health, explored the data of 2,96,078 women and girls between the age of 16 to 55 years in Taiwan and correlated it with the long-term air pollution data between 2000 and 2013. None of these women had any history of dysmenorrhea before the survey had began. Dysmenorrhea is a common gynaecological condition that impacts 16 to 91% of people in their reproductive age. The signs and symptoms include painful and severe periods that are results of hormonal imbalances.

The results showed that during the 13 years, 4.2% women and girls were diagnosed with dysmenorrhea for the first time. The study concluded that risk of developing dysmenorrhea was up to 33 times higher among women and girls who lived in areas with the highest levels of air pollutants.

Professor Hsu, who conducted the study said, "Our results demonstrate the major impact of the quality of air on human health in general, here specifically on the risk of dysmenorrhea in women and girls."

The pollutants in questions are nitrogen oxide, nitric oxide, nitrogen dioxide, carbon monoxide, and particle smaller than 2.5 µm in diameter (PM2.5).

Also Read: Delhi Is a Gas Chamber Where Nothing Comes In or Goes Out, Says Expert; Neighboring States Not to Blame for AQI

How Air Pollution Shapes Menstrual Health - Its Impact

The public health impact of air pollution is more layered and gendered than it often appears. Over the years, a growing body of research has begun to link polluted air with menstrual health problems. A 2018 study found that teenage girls exposed to higher air pollution were more likely to experience irregular periods and took longer to develop regular cycles during adolescence and early adulthood. Other studies have connected air pollution with longer menstrual cycles, increased stress, reproductive health issues, and even changes observed during lockdown periods. Conditions such as infertility, metabolic syndrome, and polycystic ovary syndrome have also been associated with prolonged exposure to polluted air.

These findings challenge the idea that menstrual health is purely biological. Instead, it is deeply influenced by social and environmental conditions, including income levels and where a person lives. In the present study, researchers observed that younger women, women from lower-income backgrounds, and those living in highly urbanised areas faced a higher risk of developing dysmenorrhea or painful periods. Among all factors studied, long-term exposure to high levels of PM2.5 emerged as the strongest contributor. PM2.5 refers to fine, inhalable particles commonly found in polluted air that can penetrate deep into the body.

The concern becomes sharper in the Indian context. In 2019, India recorded the highest PM2.5 levels globally. The study highlights clear differences in menstrual experiences between women and girls living in urban versus rural areas. Those in low-income and densely populated urban regions, where exposure to air pollution is often highest, showed a significantly greater risk of dysmenorrhea.

This health burden is further compounded by period poverty, which continues to affect large sections of rural India and many other countries. Limited access to sanitary products, lack of awareness, and social stigma mean that many girls and women already miss school and work during their periods. Increased menstrual pain linked to environmental factors like air pollution only deepens these challenges.

A 2017 study underlined the importance of identifying environmental influences on the menstrual cycle from a public health perspective, noting potential long-term consequences such as infertility, reproductive cancers, osteoporosis, and metabolic disorders.