Is bleeding between periods normal?

Bleeding between periods is something many women experience at some point. Periods typically come about every 28 days and last for five to seven days. Irregular bleeding is any bleeding outside that pattern: periods that come more or less often, spotting or bleeding between periods, or bleeding that is unusually heavy. It is common and often has a simple cause, but it should always be checked.

What causes bleeding between periods?

Irregular vaginal bleeding can be caused by many different conditions, including:

• fibroids, which are non-cancerous growths in the womb
• endometriosis
• polycystic ovary syndrome (PCOS)
• hormonal imbalances, including changes around puberty and the menopause
• pregnancy
• excessive exercise
• pelvic inflammatory disease or other infections
• polyps or, less often, tumours

Sometimes, conditions affecting other organs, or problems with blood clotting, can also cause bleeding between periods. Hormonal contraception can cause spotting too, especially in the first few months. Stress and significant weight change can also unsettle your cycle.

When bleeding between periods needs checking

Bleeding between periods is usually not serious, but it is always worth seeing a doctor, particularly if it is new for you or keeps happening. In addition, some types of bleeding should be checked promptly:

• bleeding after sex
• any bleeding after the menopause
• bleeding with pain, unusual discharge or a fever
• very heavy bleeding, or bleeding that leaves you tired and breathless

Make sure you are up to date with your cervical screening, too, because changes in the cervix can sometimes cause bleeding between periods.

How is it investigated?

Mr Jafaru Abu will carry out a careful, thorough assessment to find the cause of your bleeding, so that you receive the treatment that is right for you. He will talk through your symptoms, examine you and may arrange further tests. Blood tests and an ultrasound scan can both be done in clinic, and other tests, such as a hysteroscopy, can be arranged if needed.

Some bleeding problems run in families, so it is worth mentioning any family history of irregular bleeding or clotting problems. Keeping a diary of when you bleed, and how heavily, also helps.

What to expect at your appointment

At your appointment, Mr Abu will ask when the bleeding happens, how long it lasts, how heavy it is, and whether anything seems to trigger it, such as sex or exercise. He will also ask about your periods, contraception, any chance of pregnancy and your general health. An internal examination may be suggested, but it is always your choice, and you can bring someone with you or ask for a chaperone. Most women leave their first appointment with a clear plan, whether that is reassurance, further tests or treatment.

How is bleeding between periods treated?

Treatment depends on the cause. If an infection is found, it will be treated. If a growth such as a polyp or fibroid is found, it can often be removed. Hormonal changes can be treated with hormone therapy or the contraceptive pill. In some cases, no treatment is needed and the bleeding settles by itself.

Whatever the cause, Mr Abu will discuss your options with you at length, so that you can make an informed decision. Our bleeding between periods page explains the investigations and treatments in more detail.

The Royal College of Obstetricians and Gynaecologists publishes reliable patient information on gynaecological conditions, and NICE explains how heavy menstrual bleeding should be assessed. If you are worried about bleeding between periods, you can book an appointment with Mr Jafaru Abu at The Park Hospital, Nottingham.