What to do when breakthrough bleeding will not stop

Arrange an appointment promptly rather than repeatedly changing or stopping prescribed hormones on your own. The urgency depends on the amount of bleeding and symptoms such as weakness, dizziness, or pain.

Hormonal contraception can make the uterine lining unstable, especially after starting a method, missing doses, vomiting, diarrhoea, or taking a medicine that interferes with it. Persistent bleeding can also have a separate cause. Chlamydia can present with bleeding between periods or after sex, and endometrial polyps can present with irregular or prolonged bleeding.

Other considerations include pregnancy-related bleeding, fibroids, changes around menopause, thyroid disturbance, and problems with blood clotting. A clinician uses the pattern, examination, and selected tests to distinguish these possibilities; flow colour by itself does not make the diagnosis.

Track the days of bleeding, how often you change period products, clots, pain, discharge, fatigue, and any bleeding after sex. List contraception, prescribed medicines, supplements, missed doses, and recent method changes. Take a pregnancy test if pregnancy is possible. Continue prescribed treatment unless its prescriber or an urgent-care clinician advises a change.

The visit may involve a pregnancy test, blood count, infection testing, pelvic examination, or ultrasound. Treatment is matched to the cause and your health history, so using leftover hormones or someone else's medicine can delay suitable care.

Go to urgent or emergency care if bleeding is heavy and ongoing, you feel faint or confused, you have marked weakness, breathing difficulty, chest discomfort, severe abdominal or pelvic pain, or shoulder-tip pain. Urgent assessment is also needed when bleeding occurs with a positive pregnancy test, or after a missed period together with pelvic pain.

You might ask whether the bleeding could be related to your contraceptive schedule, which tests are appropriate, whether iron deficiency or anaemia needs checking, and how to use your current method while being evaluated. Confirm what improvement should look like, when results will be reviewed, and which symptom would change the plan urgently.