Heavy periods and spotting between periods: what to know

Spotting between periods is bleeding outside the expected menstrual flow. Hormone changes, contraception, ovulation, infection, pregnancy, or irritation of the cervix can cause it. Heavy bleeding may also occur with fibroids, polyps, adenomyosis, endometrial overgrowth, or conditions that affect ovulation such as polycystic ovary syndrome. Perimenopause can make cycles less predictable. A symptom does not identify its cause: most people with this pattern need an assessment rather than a conclusion based on bleeding alone. Ongoing blood loss may contribute to iron deficiency anaemia.

Keep a simple diary of period dates, spotting days, flow, clots, pelvic pain, pain during sex, discharge, and medicines or contraception. Take a pregnancy test if pregnancy is possible, even when bleeding is present. Arrange a non-urgent appointment if the pattern repeats, follows sex, or affects everyday life. The clinician may offer a pelvic examination, pregnancy testing, infection testing, blood tests, or an ultrasound depending on your history. Do not douche or use vaginal products to try to stop the spotting.

Get urgent help for heavy bleeding with fainting, marked dizziness, severe or one-sided pelvic pain, shoulder-tip pain, fever, or a positive pregnancy test. These combinations can signal significant blood loss, infection, or an ectopic pregnancy. Seek prompt care if bleeding begins after menopause, follows a procedure, or becomes rapidly heavier. If you feel faint or short of breath, sit or lie down and arrange emergency help rather than travelling alone.

Ask: Could my contraception or medicines explain this? Do I need pregnancy or infection testing? Should we check for fibroids, polyps, adenomyosis, or endometrial changes? Could the bleeding be lowering my iron? Which symptoms should trigger urgent care?