Bleeding between periods: what can cause it and when should you see a gynaecologist?

English version

Bleeding or spotting after one period has ended but before the next begins is called intermenstrual bleeding. It may be a few pink, red or brown spots or bleeding similar to a light period. A single episode is not always serious, but new, unexplained, persistent or recurrent bleeding should be checked.

What can cause bleeding between periods?

• Starting, stopping or missing hormonal contraception
• Irregular or absent ovulation, including with PCOS
• Pregnancy-related bleeding
• Cervical, vaginal or sexually transmitted infection
• Cervical or uterine polyps
• Fibroids or adenomyosis
• Thyroid or other hormonal conditions
• Perimenopausal changes
• Blood-thinning medicines or a bleeding disorder
• Less commonly, precancerous or cancerous changes

Very light spotting may occur around ovulation, but timing alone cannot confirm the cause. Pregnancy, contraception and infection can produce a similar pattern.

Could contraception be responsible?

Irregular spotting may occur during the first months after starting or changing hormonal contraception or when pills are missed. Do not stop effective contraception without considering pregnancy risk. Seek advice if bleeding is heavy, persistent, begins after a previously stable pattern, or occurs with pain or unusual discharge. An intrauterine device may need checking if there is pain or its threads feel different.

When should you arrange a consultation?

• Bleeding has occurred more than once or is becoming heavier
• Your usual menstrual pattern has changed
• There is pelvic pain, fever, painful sex or unusual discharge
• Pregnancy is possible
• You feel tired, weak, dizzy or breathless
• You take blood-thinning medicine
• Cervical screening is overdue or was previously abnormal
• Bleeding occurs after menopause

Depending on age, symptoms and history, assessment may include pregnancy testing, blood tests, examination of the vagina and cervix, infection testing, cervical screening when appropriate, ultrasound or selected assessment of the uterine lining. Not every patient needs every test.

What should you record?

Note the first day of your last normal period, when bleeding started, its amount and duration, whether it followed sex, associated pain or discharge, pregnancy possibility, contraception, missed doses and medicines. A diary helps identify the pattern but does not replace assessment.