Heavy menstrual bleeding between periods

Bleeding outside the expected menstrual window can follow hormonal contraception, a change in contraception, infection, irritation of the cervix, or pregnancy-related causes. Polyps and fibroids can also cause irregular or heavy bleeding. Cervical dysplasia, cervical cancer, or womb cancer are less common possibilities that clinicians may need to rule out, especially when bleeding follows sex, occurs after menopause, or keeps returning. Chlamydia and other infections may cause bleeding with pelvic pain, unusual discharge, or pain during sex.

Note the dates, amount, colour, clots, triggers, pain, discharge, and any missed period. Take a pregnancy test if pregnancy is possible, and arrange a clinical review for unexplained or repeated bleeding. The assessment may include an examination, infection testing, cervical screening review, blood tests, or ultrasound. Do not self-start hormonal treatment without discussing pregnancy, medicines, and your bleeding pattern with a clinician.

Get urgent help if bleeding is heavy and worsening, you feel faint or weak, have severe pelvic or one-sided pain, shoulder-tip pain, fever, or shortness of breath. Bleeding during a possible pregnancy needs prompt medical advice. Seek emergency care for collapse, severe pain, or bleeding that is difficult to control.

Ask what tests fit your symptoms, whether infection or a structural cause needs checking, and whether your cervical screening is up to date. Ask how to manage bleeding while the cause is being investigated and which changes require same-day care.