Background: Metrorrhagia is defined as irregular uterine bleeding occurring between normal menstrual cycles. Unlike normal menstruation, metrorrhagia is irregular in frequency, duration, and volume. Understanding the etiology of metrorrhagia requires reviewing the hormonal regulation of the normal menstrual cycle. Purpose: This abstract provides an overview of metrorrhagia, including epidemiology, etiology, diagnostic evaluation, management approaches, and future directions. Main Body: Metrorrhagia has a variable prevalence depending on age and underlying causes. Etiologies include hormonal dysfunction leading to anovulatory cycles, uterine structural abnormalities like fibroids or polyps, systemic conditions affecting coagulation or thyroid function, and iatrogenic causes such as intrauterine devices. Diagnostic evaluation aims to elucidate the cause through history, physical exam, laboratory studies, and imaging like pelvic ultrasound or endometrial biopsy. Treatment targets the underlying etiology, using hormonal therapy to regulate ovulation or procedural interventions for structural abnormalities unresponsive to medical management. Traditional herbal medicines provide another historical approach to managing metrorrhagia, though most lack standardization. Looking forward, advances in genomics, biologics, and artificial intelligence may enable more personalized, targeted therapies. Conclusion: Metrorrhagia arises from diverse etiologies encompassing hormonal, structural, systemic, and iatrogenic causes. Diagnosis hinges on a thorough evaluation to direct appropriate treatment ranging from medications to surgery. Further research on individualized therapies promises progress in long-term management.