Bleeding between menstrual periods

Hormonal contraception, ovulation, pregnancy-related bleeding, infection, polyps and fibroids are among the possible explanations. Changes affecting the cervix or womb can also present with abnormal bleeding, so a persistent change should not be attributed to hormones without assessment.

Light spotting after starting, stopping or missing hormonal contraception can reflect a change in hormone exposure. Bleeding after sex may come from the vagina or cervix. Discharge, pelvic pain, urinary discomfort or pain during sex raises the need to check for inflammation or infection, including chlamydia.

Endometrial polyps and uterine fibroids may present with bleeding between periods and changes in menstrual flow. Cervical dysplasia, cervical cancer and womb cancer can also present with abnormal bleeding. None can be identified from the bleeding pattern alone, and many episodes have other causes.

Keep a calendar of bleeding days and mark whether the flow was spotting, light or heavier than expected. Include your usual period dates, clots, pain, bleeding after sex, discharge, contraception changes and medicines. Take a pregnancy test if pregnancy is possible, including when bleeding seems period-like.

Book an appointment if the bleeding is new, repeats, lasts, or follows sex. Depending on age, pregnancy possibility and symptoms, a clinician may suggest an examination, pregnancy test, blood count, infection testing, review of cervical screening, ultrasound or sampling of the womb lining.

Get urgent medical care for bleeding that rapidly soaks protection, large clots with weakness, severe pelvic pain, fainting, marked dizziness, fever or feeling acutely unwell. When pregnancy is possible, bleeding with one-sided pain, shoulder-tip pain or collapse requires immediate assessment.

Any vaginal bleeding after menopause needs prompt evaluation. Also arrange timely review when bleeding repeatedly follows sex, accompanies unusual discharge, or continues despite taking hormonal contraception as directed.

Ask whether your contraception or medicines could contribute, which tests match your symptoms, and whether the cervix or womb needs closer assessment. Clarify how to manage the bleeding meanwhile, when to return if tests are normal, and which new symptoms would change the urgency.