What should you know about long breakthrough bleeding?

Breakthrough bleeding is often used for spotting or bleeding outside the expected withdrawal bleed or period. Hormonal contraception can alter the lining of the uterus, particularly after starting, stopping, missing, or changing a method. Bleeding can also follow emergency contraception or occur when hormones are not taken consistently.

Other possibilities include irritation of the cervix, a sexually transmitted infection such as Chlamydia, pregnancy-related bleeding, thyroid or other hormonal changes, fibroids, or a growth in the uterine lining such as an endometrial polyp. A cervical screening abnormality is another reason a clinician may examine the cervix. The bleeding pattern alone cannot identify the cause.

A clinician may ask about contraception, pregnancy possibility, sexual health, medicines, pain, discharge, and the amount and pattern of blood. Assessment can include a pregnancy test, infection testing, blood tests, a pelvic examination, or an ultrasound, depending on your history.

Record when the bleeding began, whether it is spotting or flow, how often you change period products, and whether it follows sex, missed contraception, or a new medicine. Note cramps, pelvic pain, fever, unusual discharge, dizziness, or a possible pregnancy. This information helps a clinician choose the right tests.

Take contraception exactly as directed and check the product instructions before making changes. Do not stop a prescribed hormonal method without advice if pregnancy prevention matters to you. Arrange a medical appointment if bleeding persists, repeatedly returns, happens after sex, or is accompanied by pain or unusual discharge. Avoid vaginal douching, which can irritate the vagina and does not treat an infection.

Seek urgent medical help for heavy bleeding, fainting, severe weakness, severe or one-sided pelvic pain, shoulder-tip pain, fever with pelvic pain, or bleeding during a possible pregnancy. These symptoms can need prompt assessment, especially if you feel unwell or the bleeding is increasing.

Contact a clinician soon if you have bleeding after sex, repeated bleeding between periods, new pelvic pain, bleeding after menopause, or symptoms of anaemia such as unusual tiredness, breathlessness, or a racing heartbeat. A healthcare professional can distinguish a medication effect from infection, pregnancy-related problems, or a condition affecting the uterus or cervix.

You could ask: Could my contraception or another medicine be contributing? Do I need a pregnancy test, infection testing, blood tests, or an ultrasound? What symptoms should make me seek urgent help? If the bleeding continues, when should we review the diagnosis or treatment?