Bleeding Between Periods

Why Am I Bleeding Between Periods?

Otherwise known as breakthrough bleeding, bleeding between periods is very common, but it’s always a good idea to try to find out the reasons why it’s happening. 

Dr Hemant Vakharia, consultant gynaecologist at London Gynaecology, told us,

 “Bleeding between periods or inter-menstrual bleeding can be due to a number of causes and is a common reason for patients to seek medical advice. It can vary from being slight spotting to being very heavy. In some cases the bleeding can be sign of a worrying cause, which is why it is crucial you keep up to date with your smears and seek medical advice when there are features of concern.”

Causes of Bleeding Between Periods

So, bearing in mind that there can be a number of reasons why you’re experiencing breakthrough bleeding or spotting, what are the causes of bleeding between periods? Before you do anything, it’s important to rule out pregnancy first- as Dr. Vakharia explains:

“In some cases, spotting before your period is due can be a sign of pregnancy and is thought to occur when the embryo implants.  If your period is late, you should do a pregnancy test and if negative, repeat this after a few days if your period still does not arrive. “

If your test still comes up negative, there could be another reason why you’re experiencing seemingly random bleeding between periods. Read on to find out more.

Hormonal Contraceptives

Dr. Vakharia points out that many different methods of hormonal birth control can cause breakthrough bleeding, including the combined oral contraceptive pill, progesterone-only pill, contraceptive patch (transdermal patch), contraceptive implant or injection and intrauterine system (IUS). 

Dr. Vakhira also goes on to say, 

“Breakthrough bleeding or spotting before periods is very common in patients that are on hormonal contraception, especially in the first few months after starting it. It is thought that this is due to changes in the womb lining that occur in the first few months after starting the medication.”

And adds. “It can also happen if you miss a dose, are taking any other medication or have been unwell.”

So if you’ve forgotten to take your pill (even just the once) or you’ve been ill with vomiting or diarrhoea, this could be the reason why you’re bleeding between periods.

Emergency Contraceptive Pill

The emergency contraceptive pill is also known as the ‘morning after pill’ and is used to prevent pregnancy after unprotected sex. It does this by stopping or delaying ovulation, and is most effective if taken as soon as possible after sex. 

Common side effects of taking an emergency contraceptive pill include headache, stomach pain, nausea and changes to your period. 

For some women, their next period arrives sooner, for some later, and for others it’s heavier and more painful. Some women experience irregular bleeding between periods as a result of taking the morning after pill, and this is normal- but if you’re concerned, then speak to your doctor for advice.

You can read more about the emergency contraceptive pill via the NHS website. 

Injury to Vagina

Bleeding between periods can occur if there has been an injury or trauma to the vagina. Such injuries may occur as the result of a rough sexual activity or inserting an item (such as a tampon) incorrectly. 

If you need to speak to someone regarding injury as the result of a sexual assault, you can do this in confidence. The NHS has lots of information on the services available to help you.

Abortion or Miscarriage

Abortion or miscarriage can also cause bleeding between periods, and your first period following either event can also be irregular. Lots of women experience changes to their cycle, with many experiencing spotting for around 4-6 weeks. 

If you’re concerned about bleeding heavily following either a termination or a miscarriage, you should always seek medical attention.

STIs

According to a government report, Chlamydia makes up 49% of all new sexually transmitted infections (STIs) diagnosed in the UK. STIs can also cause breakthrough bleeding, which should not be ignored, as Dr. Vakharia explains:

“STIs can cause inflammation in the cervix and vagina and as a result some patients with an STI can experience bleeding between periods and after intercourse. If left untreated, STIs can cause damage to the reproductive tract and therefore, if you are at risk of an STI or think you may have one, you should seek medical advice and get tested.”

If you think that you may have an STI, visit a sexual health clinic or speak to your GP for advice on treatment options available to you.

Reproductive Hormones Working Incorrectly

Some women experience bleeding between periods due to an imbalance in reproductive hormones. As a woman approaches the menopause, dropping hormone levels can cause irregular periods and spotting, and this is all completely normal. 

Likewise, some women who suffer from PCOS may experience breakthrough bleeding too, as Dr. Vakharia points out:

“PolyCystic Ovarian Syndrome (PCOS) is a common condition characterised by irregular or absent periods, a polycystic appearance of your ovaries on scan and features consistent with an excess in certain hormones which lead to acne and greasy skin.  Patients with PCOS can experience erratic bleeding between periods. “

If you have PCOS or you suspect you may have it, speak to your doctor about bleeding between periods so that you can discuss suitable treatment options.

Stress

Stress is another major reason why many women experience bleeding between periods, as again the delicate balance of hormones is disrupted. Try to reduce stress as much as you can if you think this is the reason why you’re bleeding between periods.

Vaginal Dryness

According to Dr. Vakharia, vaginal dryness can also cause bleeding between periods, as he explains: 

"In some women approaching the menopause or on certain medication, the vaginal skin can be thin and friable. As a result, it can bleed very easily and cause bleeding between periods, on wiping or after sex.”

And Dr. Vakharia adds: “If you suffer with vaginal dryness and pain with intercourse, you should see your doctors as often a simple course of medication can help relieve symptoms.”

Changes to Cervix

Harmless changes to the cervix (cervical ectropion) may also be one of the reasons for bleeding between periods. Dr. Vakharia explains more:  

"A cervical ectropion is another common cause of bleeding between periods and after intercourse.  It is a benign condition and occurs when cells commonly found on the inside of the cervical canal are exposed to the inside of the vagina.  These cells bleed very easily.  A cervical ectropion is commonly seen in women who are on medication containing oestrogen which is found in the combined oral contraceptive pill. “

Cancer

Bleeding between periods may also be the result of cancer of the vagina, cervix, vulva or uterus. For this reason, Dr. Vakharia advises that it’s never a good idea to ignore vaginal bleeding, especially if you’re overdue for a routine smear test.

“Bleeding between periods can be a sign of cervical cancer.  In the UK, the national screening programme which is aimed at detecting Human Papilloma Virus (HPV) and changes to cells in your cervix before they become cancerous is very effective, which is why it is imperative that you do not skip a smear.  If you are experiencing bleeding between periods and have not had a smear or missed a smear, you should see your doctor as soon as possible.”

Fibroids

Some women suffering from fibroids may also experience spotting or irregular bleeding between periods. Dr. Vakharia told us,

“Fibroids are very common growths in the womb muscle and can be in varying locations in the womb. They can cause irregular bleeding, heavy periods and pain. In some instances, a fibroid can grow and pass down through the cervix causing erratic bleeding and bleeding with intercourse."

Polyps

Another common cause of bleeding between periods: polyps. Dr. Vakharia told us,

“Endometrial or cervical polyps are also a common cause of bleeding between periods. They are growths of the womb lining or cervix and can also bleed very easily. Polyps may be picked up incidentally during an examination such as a smear test or be found on a scan. Where found, patients will often be referred to a gynaecologist to have them removed and inspected under a microscope.”

When to see a doctor 

While breakthrough bleeding is very common, if you’re concerned about bleeding or spotting between periods, it’s always a good idea to speak to a doctor. 

Dr. Vakharia told us that there are some signs that should always warrant a visit to the GP, including persistent bleeding, heavy bleeding and bleeding with a fever or vaginal discharge. 

He also advises that bleeding after the menopause should never be ignored either:

“Although not technically bleeding between periods, any bleeding after the menopause should always be reported to your doctor and investigated. Sometimes, bleeding from the urinary tract can appear to be coming from the vagina as the urethra is in very close relation. If you notice blood in your urine you should speak to your doctor.”