Bleeding between periods
Many women experience bleeding or spotting between periods sometime in their lives. Common causes include:
- Hormonal contraception
- An undiagnosed sexually transmitted infection or pelvic inflammatory disease
- Polycystic ovary syndrome (PCOS)
- An intrauterine device (IUD or IUS)
- Cervical or uterine polyps
- Cervical erosion (also called an ectropion)
- Retained tampon
- Emotional stress
- Cancer of the cervix, uterus, ovaries or vagina
In the first month or two after starting combined hormonal contraception (oestrogen and progestogen) – either a pill, patch or ring – spotting or bleeding is normal. This should then stop and bleeding only happens in the hormone free interval each month. Sometimes women using pills with low levels of oestrogen may need to take pills with slightly higher levels to stop bleeding in between periods.
Missing pills or taking them at different times every day can cause bleeding. Being late taking the pill for more than 12 hours may mean your contraception is not working and you may need to use condoms for the next 7 days. Check the instruction leaflet on your pack or telephone the clinic for advice.
Women on the pill who start smoking or increase the amount they smoke may find that they get bleeding. This is because pills are broken down, metabolised, in the liver and smoking increases the rate at which the breaking down process happens.
An undiagnosed sexually transmitted infection or pelvic inflammatory disease
Sexually transmitted infections are often silent i.e. there are no symptoms so getting tested is the best way to know that you are clear. BUT one of the few signs of an STI is bleeding in between periods or bleeding after intercourse. A simple swab test can show whether or not there is an infection.
An intrauterine device (IUD or IUS)
Bleeding is common for the first month or so after you have an intrauterine coil fitted. Copper coils can make periods heavier but usually do not cause bleeding in between periods. Coils with hormones on them –Mirena, Kyleena, Jaydess – can cause bleeding in between periods but this gradually settles over a few cycles. However, if tests for infection are clear and cervical smear tests are up to date and a pelvic scan rules out other causes then sometime the only solution is to remove the coil.
Midcycle bleeding is seen in women in their mid 30 ‘s to mid 40’s. It may be just spotting or a bleed for a day or two but the key is that it is always in the middle of the cycle, around the time of ovulation, each month. It is thought to be due to the temporary drop in oestrogen that happens at ovulation. No investigations are needed.
The blood supply to fibroids is different to the normal lining of the uterus so bleeding can happen at any time. For a full explanation of Fibroids please click here.
Cervical or uterine polyps
Polyps are soft fleshy swellings that are almost always benign but they are more likely to bleed than normal tissue. Occasionally a cervical polyp may be noted when taking a routine smear test. Sometimes they can cause bleeding after intercourse. When a polyp is present it is best to have a referral to a hospital gynaecology unit to have it removed. Uterine polyps may be seen on ultrasound scan however a scan can miss a small polyp. If a pelvic ultrasound scan is normal but bleeding continues then a hysteroscopy to look directly into the uterus is advisable.
If you have forgotten to remove a tampon after the end of a period, you may notice some spotting or bleeding and there is usually also a strong odour. If you cannot remove the tampon yourself, it should be removed as soon as possible by a nurse or a doctor to reduce the risk of bacteria going into your uterus. When the tampon is removed you may also need to take a course of antibiotics to avoid an infection.
Any type of stress can interrupt the menstrual cycle and stop ovulation happening. This will often cause irregular bleeding. Travel, exams, bereavement all can change normal hormone production.
Cancer of the cervix, uterus, ovaries or vagina
It is very important to have regular smear tests taken and the national screening programme Cervical Check provides free smear tests to all women between age 25 and 60. However even if you are going for these checks it is important that you see a doctor if new symptoms develop. The smear programme checks the cervix which is the neck of the uterus but problems in the rest of the uterus and ovaries and vagina may go unnoticed.