Causes of bleeding between periods

The pattern matters: a brief spot at a similar point in the cycle differs from bleeding that is new, persistent, heavy, follows sex, or comes with pain. Recurrent unexplained bleeding merits a clinical appointment.

Small hormonal shifts around ovulation can cause spotting. Starting, stopping, missing, or changing hormonal contraception may also disrupt bleeding. Clinicians consider infection, cervical irritation, benign growths such as polyps or fibroids, pregnancy-related causes, thyroid or clotting problems, and changes in the cervix or uterine lining.

Cycles can become less predictable as menopause approaches. Once periods have stopped because of menopause, any later bleeding is postmenopausal bleeding rather than a mid-cycle event and should be assessed.

Mark bleeding days against the first day of each period and record flow, clots, pelvic pain, bleeding after sex, discharge, odour, and urinary symptoms. Note contraception changes, missed tablets, pregnancy possibility, and medicines or supplements that may affect bleeding. If pregnancy is possible, take a pregnancy test at the appropriate time and seek medical advice for bleeding with pain.

At an appointment, assessment may include a pregnancy test, infection testing, examination of the cervix, blood tests, or pelvic imaging depending on your history.

Seek urgent help for heavy bleeding, fainting, marked dizziness, severe pelvic or abdominal pain, fever, or a possible pregnancy with pain or bleeding. Arrange a prompt clinic visit when bleeding keeps returning, lasts beyond the expected episode, begins after sex, or is accompanied by unusual discharge. Bleeding after menopause always requires medical evaluation.

Ask whether the bleeding pattern fits a contraception effect or needs tests for pregnancy, infection, anaemia, or a structural cause. Check whether cervical screening is due and whether ultrasound or another examination would change management. Request clear instructions for follow-up if the first tests are normal but bleeding continues.