Bleeding Between Periods

Overview

Bleeding between periods means any vaginal bleeding that happens when you are not having your monthly period. Doctors call it 'intermenstrual bleeding'. It can be a few drops of blood on your underwear, a pink or brown stain on toilet paper, or a heavier flow that looks like a period. Sometimes it happens after sex, or in the middle of your cycle. Bleeding between periods is very common and most causes are not serious, but it is always worth checking with a doctor so the reason can be found.

Yes, it is common. Many people have light spotting between periods at some point in their lives, and most of the time the cause is easily treated.

It can affect anyone who has a womb and a vagina. It is most often seen in people of reproductive age, but it can also happen in teenagers whose periods have just started, in people using hormonal contraception, and in people going through the menopause. Bleeding in a child before puberty or in someone who has gone through the menopause is not expected and should always be checked.

Symptoms

Common symptoms

• Light spotting of blood, or pink or brown staining, between periods
• Bleeding that is heavier than spotting, like a light period
• Bleeding after sex
• Bleeding after a pelvic examination or a smear test
• Pain or cramping in the lower tummy at the same time as the bleeding
• Unusual discharge, which may have an odd smell or colour
• Bleeding that lasts a few hours or several days

Symptoms in children

• Any vaginal bleeding in a girl who has not started puberty is not normal and should be checked by a doctor
• Bleeding with itching, soreness, or discharge in the nappy or underwear area
• Bleeding after a fall or injury to the genital area
• Irregular or very heavy periods in a teenager, which can sometimes be linked to hormone problems or a bleeding disorder

Symptoms in older adults

• Any vaginal bleeding after the menopause, even a small amount or a single episode, should be checked promptly
• Bleeding during or after sex in later life
• Bloodstained discharge
• Bleeding in someone taking hormone replacement therapy (HRT) that is new or unexpected

Causes

Main causes

• Hormone changes, especially around ovulation, in the teenage years, or near the menopause
• Hormonal contraception, such as the pill, the implant, the injection, or a hormone-releasing coil, especially in the first few months of use
• Small growths on the cervix or the lining of the womb, called polyps, which are usually harmless
• Non-cancerous growths in the womb called fibroids
• Infections of the vagina or cervix, including sexually transmitted infections
• Conditions such as endometriosis, polycystic ovary syndrome (PCOS), or thyroid problems
• A sensitive or inflamed area on the surface of the cervix, which can bleed on contact
• Changes in the cells of the cervix, which are usually found and treated early
• Blood clotting problems or side effects of blood-thinning medicines
• Rarely, cancer of the cervix or the lining of the womb, which is why checking is important

Risk factors

• Being in your teenage years or going through the menopause
• Starting or changing hormonal contraception, or using a coil
• Having more than one sexual partner or not using condoms, which raises the risk of infection
• Smoking
• Being overweight
• Having PCOS, thyroid problems, or a bleeding disorder
• Taking blood-thinning medicines
• High levels of stress or sudden changes in weight or exercise habits
• Not keeping up with cervical screening tests

When to see a doctor

See a doctor urgently if:

• Any bleeding after the menopause
• Bleeding after sex that happens more than once
• Bleeding that is heavy or getting heavier
• Bleeding with fever, severe pain, or a bad-smelling discharge
• Any vaginal bleeding in a child who has not started puberty
• Bleeding during pregnancy with pain or cramping

Book a routine appointment if:

• Spotting between periods that happens more than once
• Bleeding that changes your usual cycle pattern
• Bleeding that lasts several days each time
• Bleeding that is causing you worry or affecting your daily life
• Bleeding that starts after you begin a new contraceptive

Diagnosis

Your doctor will start by asking questions about your periods, the bleeding you have noticed, your contraception, your medical history, and any pain or discharge. They may ask when you last had sex and whether you could be pregnant. You may be offered a gentle internal examination so the doctor can look at the vagina and cervix. They may also check your tummy. Based on what they find, they may arrange tests or refer you to a specialist clinic.

Tests that may be done

• A pregnancy test
• Blood tests to check hormones, thyroid, blood count, and clotting
• Swabs to look for infection
• A cervical screening test (smear test) if one is due
• An ultrasound scan of the pelvis, usually done on the tummy or inside the vagina
• A small procedure to look inside the womb, called a hysteroscopy, sometimes with a tiny tissue sample
• A biopsy, where a small sample of the womb lining is taken to be checked in a lab

What to expect at your appointment

Most tests are quick and can be done at your doctor's surgery or a local clinic. An internal examination or scan can feel a little uncomfortable, but it should not be painful, and you can ask for it to be stopped at any time. Results usually take a few days to a couple of weeks. Your doctor will explain what each test is for and talk you through the results.

Treatment

Treatment depends on the cause. Many people do not need any treatment at all, and the bleeding settles on its own. If a cause is found, your doctor will explain the options and help you choose what suits you.

Self-care at home

• Keep a note of when bleeding happens, how heavy it is, and how long it lasts, using a calendar or a phone app
• Note anything that seems linked to the bleeding, such as sex, exercise, or a change in contraception
• Use pads or period underwear if you prefer to see how much you are bleeding
• Carry spare pads or tampons with you so you feel prepared
• Take care of your general health with sleep, regular meals, and gentle exercise
• Avoid smoking, as it can affect hormone balance and bleeding patterns

Medical treatments

The treatment your doctor suggests will match the cause. If an infection is found, they can prescribe treatment for it. If hormones are the cause, they may suggest changes to your contraception or hormonal treatment. Small polyps can often be removed in a simple procedure. Fibroids and conditions such as endometriosis or PCOS have their own treatment options, which your doctor can discuss with you. Your doctor may also recommend iron supplements if you have become low in iron from bleeding. Always ask your doctor or pharmacist before starting any medicine, and follow their advice about what is right for you.

When is surgery considered?

Surgery is only needed for some causes. A small operation may be offered to remove polyps, to treat fibroids, or to take a sample of the womb lining if other tests are not clear. In a small number of cases, other procedures are discussed, such as treatment to thin the womb lining or, rarely, removal of the womb. Your specialist will explain the benefits and risks of any operation and help you decide.

Living with this condition

Bleeding between periods can be annoying and worrying, but it is usually manageable. Tracking your cycle helps you feel more in control and gives your doctor useful information. Keep spare supplies in your bag, and let work, school, or college know if you need extra breaks or access to toilets.

Lifestyle tips

• Aim for regular sleep and try to keep stress levels manageable
• Stay active with gentle exercise you enjoy
• Keep to a healthy weight, as weight changes can affect hormones and bleeding
• Limit alcohol and avoid smoking
• Go for cervical screening when invited
• Use condoms to lower the risk of infections if you are not in a long-term monogamous relationship

Diet and exercise

There is no special diet that stops bleeding between periods, but eating regular balanced meals with plenty of iron-rich foods, such as beans, lentils, leafy greens, and meat if you eat it, can help if you have been losing blood. Drinking enough water and staying active are good for your general health and can help with hormone balance and stress.

Mental health and emotional wellbeing

It is very normal to feel worried or anxious when you notice unexpected bleeding. Some people also feel embarrassed or stressed about managing bleeding at work or in social situations. These feelings are understandable, and talking to someone you trust or to your doctor can really help. If your worry is affecting your sleep, mood, or daily life, tell your doctor. If you ever feel overwhelmed or in crisis, contact your local crisis service or your local emergency number straight away.

Prevention

Not all causes of bleeding between periods can be prevented, but there is a lot you can do to lower your risk. Attending cervical screening when invited, using condoms to reduce infection risk, not smoking, and keeping to a healthy weight all help. If you notice that a particular contraception makes you bleed, speak to your doctor about other options rather than stopping it suddenly.

Vaccines

The HPV vaccine helps protect against the types of virus that cause most cervical cancers. It is offered to young people in many countries, usually through school programmes. Ask your doctor or local health service if you are unsure whether you have had it.

Screening programmes

Cervical screening (often called a smear test) checks the cells of the cervix for early changes before they become cancer. In the UK, the NHS invites people aged 25 to 64 for regular screening, and other countries have similar programmes. Going for screening when invited is one of the best ways to catch problems early. Ask your local health service when your next screening is due.

Complications

If left untreated

• Low iron levels or anaemia from losing blood over time, which can cause tiredness and breathlessness
• An infection going untreated and spreading to the pelvis
• An underlying condition, such as a hormone problem, continuing without treatment
• In rare cases, a serious cause such as cancer being found later than it could have been
• Ongoing worry and stress about when bleeding will happen

Long-term outlook

The outlook is good for most people. The great majority of causes of bleeding between periods are harmless or easily treated, and many settle by themselves. Checking early means any problem can be found and sorted out quickly. If you notice bleeding between periods, book an appointment with your doctor. It is a common reason to visit, and you deserve clear answers and support.

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