Bleeding or spotting between periods is common and often harmless, especially if it is light and happens once. Bleeding that keeps happening, follows sex or appears after the menopause should always be checked.
When to get medical advice
See a GP or gynaecologist if you have:
- bleeding between periods more than once, or across more than one cycle
- bleeding after sex
- new bleeding on the pill, coil or implant, or bleeding that has not settled after the first three months
- any bleeding after the menopause (a year or more after your last period)
- bleeding with unusual discharge, pain during sex or pelvic pain
- missed cervical screening
When to get urgent help
Call 111, or go to A&E, if you have bleeding and:
- you are or could be pregnant, especially with pain on one side
- very heavy bleeding, soaking a pad or tampon every hour for more than two hours
- severe pain in your tummy or pelvis
- you feel faint or dizzy, or have a high temperature
Common causes
- Contraception: spotting is common in the first months of the pill, implant, injection or hormonal coil, and after missed pills.
- Ovulation: light spotting mid-cycle, around the time an egg is released.
- Pregnancy: implantation bleeding, miscarriage or ectopic pregnancy. Do a pregnancy test if there is any chance.
- The cervix: cervical ectropion, polyps or infection, which often cause bleeding after sex.
- The womb: endometrial polyps, fibroids or adenomyosis.
- Infections: chlamydia, gonorrhoea or pelvic inflammatory disease.
- Perimenopause: changing hormone levels in your 40s often make cycles irregular.
- Less commonly: thyroid problems or blood-thinning medicines.
Rarely, bleeding between periods is caused by cancer of the cervix or womb. This is more likely over 40 and after the menopause, and it is the main reason persistent bleeding should be checked rather than watched.
How it is investigated
Assessment usually starts with your history and a pregnancy test. It may include:
- an examination of the cervix
- swabs for infection
- cervical screening if you are due
- a pelvic ultrasound to look for polyps, fibroids and the thickness of the womb lining
If needed, you may be referred for a hysteroscopy, a camera examination inside the womb.
Treatment
Treatment depends on the cause:
- changing or adjusting contraception
- antibiotics for infection
- removing a polyp
- treating an ectropion that bleeds often
Many causes need reassurance rather than treatment once serious problems have been ruled out.
Common questions
Is spotting between periods normal?
Occasional light spotting, such as mid-cycle or when starting contraception, is common. Spotting that keeps coming back should be checked.
Can stress cause bleeding between periods?
Stress can upset the cycle and cause irregular bleeding. It should not be assumed to be the cause until other reasons have been ruled out. Read more about stress and your cycle.
Could it be cancer?
Rarely. Most causes are benign. Cervical and womb cancer can cause bleeding between periods, so repeated bleeding, bleeding after sex and bleeding after the menopause should always be assessed.
Irregular bleeding assessment in London
Dr Anastasia Mermigka, consultant gynaecologist, can assess bleeding and perform a pelvic ultrasound in the same visit. A consultation with ultrasound is £300 in Central London EC1, with same-day appointments and no referral needed. Irregular bleeding clinic.
Related care and reading
Book an assessment for irregular bleeding.