What is bleeding between periods?

After puberty and before menopause, most females experience vaginal bleeding during their periods.

Bleeding between periods is when you have vaginal bleeding at times other than during a normal period. It's also called 'intermenstrual bleeding'.

What are the symptoms of bleeding between periods?

Bleeding between periods may be:

• similar to a normal period
• heavier with more blood loss
• very light blood loss (also known as 'spotting')

Bleeding between periods may happen once or you may notice it more often. Vaginal bleeding after sex is called 'post-coital bleeding'.

What can cause bleeding between periods?

There are many causes of bleeding between periods, such as:

• changes to your hormone levels
• use of hormonal contraception
• an infection
• an injury to your genitals
• bleeding problems

Other causes of bleeding between periods may include:

• endometriosis
• polyps (growths) in your uterus or cervix
• fibroids
• an ectopic pregnancy (when a pregnancy grows outside the uterus) or a miscarriage (which can happen before you know you are pregnant)
• cancer

Changes to your hormone levels

You may spot, or bleed very lightly, during ovulation (when an egg is released from one of your ovaries).

If you have just started your periods or are in perimenopause (the time approaching menopause), you may have irregular periods. This can be confused with bleeding between periods.

Use of hormonal contraception

Bleeding between periods often happens when you start on hormonal contraception. This is sometimes called 'breakthrough bleeding'. It can happen with different types of hormonal contraception, such as:

• the pill (combined oral contraceptive pill)
• a vaginal ring
• the progestogen-only pill
• hormone-containing intra-uterine devices (IUDs)
• contraceptive injections
• contraceptive implants

Bleeding between periods can also happen if you forget to take one or more of your oral contraceptive pills.

Infections and injury

Vaginal bleeding between periods may be the result of an infection in your vagina, cervix or uterus. Some sexually transmitted infections, like chlamydia, can cause bleeding.

An injury to your vulva, vagina or cervix can cause bleeding between periods. Injuries can be from:

• rough sexual activity
• sexual assault
• incorrectly inserting something into the vagina, like a tampon

Bleeding problems

If you have a condition that affects blood clotting, you may have bleeding between periods. You may also notice bruising on your body.

Some medicines, such as anticoagulants ('blood thinners'), can cause bleeding problems, including bleeding between periods.

Talk with your doctor about any medicines you are taking and tests for bleeding problems.

Endometriosis

Sometimes bleeding between periods is caused by endometriosis. Endometriosis is when cells similar to those that line your uterus (womb), grow in other parts of your body.

Symptoms of endometriosis can include:

• heavy periods
• irregular bleeding or spotting
• painful periods
• ongoing abdominal (tummy) pain

If you think you may have endometriosis, talk to your doctor.

How is the cause of bleeding between periods diagnosed?

Your doctor will ask you about your vaginal bleeding, including:

• when it happens
• how often you notice it
• how heavy it is
• how long it lasts

Your doctor will also ask if you have any other symptoms, such as abdominal pain or pain or bleeding after sex.

They will check:

• your general health
• the nature of your normal periods
• whether you could be pregnant

Your doctor might feel your tummy. They may ask to do an internal examination and check your cervix using a medical device called a speculum.

Tests

Your doctor may recommend some tests to help diagnose the cause of your vaginal bleeding. These may include:

• a vaginal swab to test for sexually transmitted infections (STIs)
• a test for infection and abnormal cells in your cervix (called a cervical co-test)
• blood tests
• a pregnancy test
• an ultrasound scan, which may include a vaginal ultrasound

Your doctor may also refer you to a gynaecologist — a medical doctor who specialises in female health conditions.

When should I see my doctor?

There are many possible causes for bleeding between periods and a lot of them aren't serious. But you should speak to your doctor if you bleed between periods, as it can occasionally be something serious.

Bleeding after having sex should always be discussed with your doctor.

When to seek urgent care

How is bleeding between periods treated?

Treatment for bleeding between periods depends on the cause.

It's important to see your doctor if you have bleeding between periods, as some causes are serious and need immediate treatment.

Self-care at home

You may want to wear a light pad or period underwear if you have light bleeding between periods.

Treatment may not be needed if:

• a serious cause for the bleeding has been ruled out
• the bleeding is light and isn't bothering you

Medicines for bleeding between periods

If your doctor thinks that a medicine you are taking may be causing your vaginal bleeding, you may need to stop or change your medicines. This may include complementary medicines.

Talk to your doctor or pharmacist about the medicines you are taking, including any contraception.

Can bleeding between periods be prevented?

Practising safe sex can help prevent sexually transmitted infections. STIs can sometimes cause bleeding between periods.

Safe sex means using condoms and dams during any sexual activity.

Getting vaccinated against human papillomavirus (HPV) can help protect against genital warts and cervical cancer.

Complications of bleeding between periods

If you have regular vaginal bleeding between periods, you may become iron deficient, or possibly even develop anaemia.

Talk to your doctor about whether you need blood tests. They can recommend treatment if your iron or haemoglobin levels are low.

It's also important to find out the cause of the bleeding between periods, so that specific treatment can be started, if needed.

Resources and support

For more information on bleeding between periods, you can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.