What causes bleeding between periods?

Spotting can happen when ovulation or a change in hormonal contraception alters the usual cycle. Chlamydia may inflame the cervix, while cervical ectropion or cervical polyps can produce contact bleeding. Endometrial polyps and uterine fibroids can affect the womb lining and cause irregular bleeding. Bleeding may also occur with cervical dysplasia, which is an abnormal change in cervical cells, or with womb cancer. Gestational trophoblastic disease is an uncommon pregnancy-related cause. The pattern, age, pregnancy possibility, medicines, and associated symptoms help guide the assessment.

Book an appointment if bleeding is unexpected, recurrent, happens after sex, or follows menopause. Keep a record of dates, amount, colour, cycle timing, contraception, and symptoms such as pain or discharge. A clinician may offer a pregnancy test, infection testing, cervical examination, screening review, blood tests, or imaging depending on your history. Do not stop prescribed contraception without advice, but mention any recent change or missed dose.

Get urgent help for heavy bleeding, severe pelvic pain, dizziness, fainting, fever, or bleeding during pregnancy. Seek prompt evaluation for bleeding after menopause, bleeding with a positive pregnancy test, or symptoms of anaemia such as unusual breathlessness and profound tiredness.

Could my contraception or cycle explain this pattern? Do I need pregnancy or infection testing? Are cervical screening or an ultrasound appropriate? Which changes should prompt urgent help?