Reasons for random bleeding in between periods

Spotting can occur when ovulation or hormone levels change, after starting or missing hormonal contraception, or when the cervix is irritated after sex. Chlamydia and other infections can cause bleeding, particularly with discharge, pelvic pain or pain during sex. Endometrial polyps and uterine fibroids can alter bleeding by affecting the cervix or womb lining.

Cervical dysplasia and cervical cancer can present with abnormal bleeding, including bleeding after sex, although many episodes have less serious explanations. Womb cancer can also cause unusual bleeding, especially after menopause. The pattern, pregnancy possibility, age, medicines and accompanying symptoms guide the evaluation; bleeding alone cannot identify its cause.

Arrange a medical appointment if bleeding recurs, follows sex, happens after menopause or is not explained by a recent contraceptive change. Record dates, amount, colour, clots, pain, discharge, contraception and pregnancy possibility. A clinician may offer a pregnancy test, infection testing, cervical examination, blood tests or imaging. Treatment depends on the finding rather than the appearance of the blood.

Do not self-treat with leftover antibiotics. Tell the clinician about medicines that affect bleeding and any chance of pregnancy, because those details change the assessment.

Seek urgent care for heavy bleeding with weakness or dizziness, severe pelvic pain, fainting, fever, or bleeding during pregnancy. After menopause, arrange assessment for any vaginal bleeding, even if it is light or happens once. Emergency symptoms should not wait for a routine screening appointment.

Ask what causes fit your bleeding pattern, whether pregnancy or infection tests are needed, whether your cervix and womb lining need examination, and what changes should prompt urgent review.