Why am I bleeding?

Why am I bleeding without my period?

Bleeding between periods (intermenstrual bleeding) occurs when you bleed from your vagina at any time other than your normal period. Unscheduled bleeding can happen when you bleed unexpectedly, such as when taking hormone medication.

There are several reasons why you might experience intermenstrual or unscheduled bleeding.

Changes to hormone levels

You may notice some very light bleeding or spotting during ovulation (when an egg is released from one of your ovaries). This normally happens at the same time in your cycle each month. It can be caused by a drop in the hormone oestrogen just before the egg is released. Bleeding during ovulation can be normal for some people. But it’s important to let your doctor know, so they can check to rule out any underlying problems.

You might also get some bleeding during the perimenopause, while your hormones are still adjusting. If this happens, seek advice from your GP or gynaecologist.

Certain infections

Infections in the vagina, cervix or womb (uterus) can sometimes cause intermenstrual bleeding. These include sexually transmitted infections (STIs), such as chlamydia or Gonorrhoea. If you suspect you could have an STI, visit your GP or local sexual health clinic. They can give you a test to find out if you have an infection. They’ll also provide a course of medication to treat it.

Injury

Bleeding can result from a tear or injury to your cervix or vagina. This may occur from sex, inserting a tampon incorrectly, or from a trauma to the area.

Injury can also be caused by vaginal delivery childbirth, which might lead to bleeding. Bleeding should normally stop once the tear or injury has healed.

Hormonal contraception

You might experience irregular bleeding when you start on hormonal contraception. This is also known as ‘breakthrough bleeding’.

You may get this if you take any type of hormonal contraception. These may include the following.

• Combined oral contraceptive pill
• Progesterone-only pill
• Contraceptive injections
• Intrauterine devices (IUDs) or implant

When you start any hormonal contraception, your doctor will discuss what bleeding pattern to expect. This can vary in the short and long term, as the hormones may override your natural menstrual cycle. You may be told that your periods will likely stop, and you can expect some occasional light bleeding.

With any hormonal contraception there can be breakthrough bleeding in the first few months. This is usually nothing to worry about. If the bleeding continues past three months of starting the contraception, speak to your doctor or clinician.

Hormone replacement therapy (HRT)

When you start HRT, you’ll be told whether to expect no bleeding at all, or a monthly predictable bleed. This depends on which type of HRT you’re taking.

You may get some breakthrough bleeding in the first few months after starting HRT or if your dosage changes. If the bleeding persists after three to six months, discuss this with your clinician.

If you are at an increased risk of cancer of the lining of the womb (endometrial cancer) you may be advised to make an earlier appointment if you experience any unscheduled bleeding while taking HRT.

Pregnancy

Light bleeding in early pregnancy is common. This can happen if the fertilised egg (embryo) plants itself to the wall of your uterus (implantation bleeding). Changes to your cervix and hormones can also make bleeding more common during the first trimester of pregnancy. If you’re pregnant and notice bleeding, make sure to get checked by a doctor or early pregnancy unit.

Underlying conditions

In some cases, intermenstrual bleeding can be a sign of an underlying problem or condition. These may include the following.

• Endometriosis. This is a condition where cells similar to those in your uterus grow in other places of the body.
• Fibroids. Fibroids are benign (non-cancerous) tumours that develop along the wall of the uterus.
• Polyps. These are growths in your uterus or cervix.
• Cancer. Bleeding can occur with several types of cancer.

Visit your GP if you have concerns. They can arrange for tests or refer you to a gynaecologist, to make sure you get the right help.

Why am I bleeding after sex?

Bleeding after you have sex (postcoital bleeding) can be caused by:

• infection, including sexually transmitted infections (STIs)
• polyps in the cervix or uterus
• vaginal dryness
• trauma to the vagina
• endometriosis

Rarely, bleeding after sex can be a symptom of vaginal or cervical cancer. It’s normal to be concerned about unexpected bleeding. Make sure to see a GP and tell them your symptoms. They can help find out the cause to put your mind at ease.