Increased spotting between periods: what to know

Spotting can occur around ovulation, after starting or changing hormonal contraception, or when hormones are unsettled. Infection such as chlamydia can cause bleeding between periods, especially with pelvic pain, unusual discharge or pain during sex. Polyps and fibroids can also contribute by affecting the cervix or womb lining.

Less commonly, changes in cervical cells or the womb lining can cause abnormal bleeding. Cervical dysplasia is a cell change that needs follow-up, while cervical cancer and womb cancer require prompt specialist assessment. Spotting alone does not identify the cause.

Arrange a gynaecology or primary-care appointment if spotting is new, increasing, recurrent, occurs after sex, or happens after menopause. Record dates, colour, amount, cycle timing, contraception, pain, discharge and any chance of pregnancy. A clinician may offer a pregnancy test, examination, infection testing, cervical screening review, blood tests or ultrasound depending on your situation.

Use pads if helpful while observing the pattern, and avoid self-treating with leftover antibiotics or hormone medicines. If an underlying polyp, fibroid or cervical problem is found, treatment will depend on its size, location, symptoms and test results.

Seek urgent help for heavy bleeding, severe or one-sided pelvic pain, faintness, dizziness, shoulder-tip pain, fever, or bleeding during a possible pregnancy. These symptoms can indicate significant blood loss, infection or an ectopic pregnancy.

Bleeding after menopause needs medical assessment even when it is light or happens once. Do not wait for routine screening if bleeding is accompanied by pain, unusual discharge or a new pelvic symptom.

Ask what causes are most relevant to your age and cycle, whether pregnancy or infection testing is needed, and whether your cervical screening is up to date. Ask whether examination, ultrasound or a womb-lining test is appropriate and when results should be reviewed.