A lot of bleeding between periods: what to know

Bleeding between expected periods can come from the vagina, cervix, or uterus. The amount and timing alone cannot identify the cause. A clinician may need to exclude pregnancy-related problems, infection, medication or contraceptive effects, and changes within the cervix or uterus.

Hormonal contraception can produce irregular bleeding. Chlamydia may present with bleeding between periods or after sex, while uterine fibroids and endometrial polyps can present with abnormal uterine bleeding. Cervical cancer and womb cancer can also present with unusual vaginal bleeding, so recurrent or unexplained bleeding should be examined rather than attributed to a single cause.

Blood loss can contribute to anaemia. Tiredness, weakness, dizziness, breathlessness, a racing heartbeat, or looking unusually pale are clues that the bleeding may be affecting your circulation or red blood cells.

Contact a gynaecology, primary-care, or sexual-health clinician for assessment. Record when the bleeding began, how quickly pads or tampons become soaked, clots, pain, discharge, bleeding after sex, your last normal period, contraception, medicines, and whether pregnancy is possible. Do not stop prescribed medicine without advice.

Assessment may include a pregnancy test, blood tests for anaemia, testing for sexually transmitted infections, and examination of the vagina and cervix. Depending on your history and findings, the clinician may discuss ultrasound, colposcopy, or hysteroscopy. Treatment is chosen for the underlying cause and the severity of blood loss.

Go to an emergency department or call local emergency services if bleeding is rapidly soaking through period products and you feel faint, confused, severely weak, short of breath, or have collapsed. Severe abdominal or pelvic pain, shoulder-tip pain, or dizziness with a missed period or possible pregnancy also requires urgent assessment because an ectopic pregnancy must be ruled out.

Seek prompt same-day advice for ongoing heavy bleeding, worsening pelvic pain, fever, unpleasant-smelling discharge, or symptoms of anaemia even if you do not feel in immediate danger. Any bleeding after menopause should be assessed promptly.

You could ask: Do I need a pregnancy test or blood count today? Could my contraception or medication be contributing? Should I be tested for infection? Does my cervix need examination? Which scan or procedure would clarify the cause? What can safely reduce the bleeding while results are pending?