Bleeding or spotting between periods is also known as intermenstrual bleeding. Whether your bleeding between periods is light or heavy, it needs to be investigated by your doctor.
There are several different causes for bleeding between normal periods — some can be easily treated while others are more serious and need more involved treatment.
In either case, your doctor will discuss your symptoms and may need to refer you for tests to help diagnose the cause of abnormal bleeding between your periods. They will then discuss whether you need treatment and your treatment options.
Causes of bleeding between periods
Your menstrual cycle will usually last between 21 to 35 days and normal vaginal bleeding (your period) will last from a few days to seven days. Abnormal vaginal bleeding or spotting occurs outside of your period. There can be several reasons for this. Here are the five main causes of bleeding between periods:
1. Hormonal imbalances
Your menstrual cycle is regulated by two hormones, oestrogen and progesterone. Any imbalance in these hormones can cause bleeding between your periods. For some women, spotting may occur as a normal part of their menstrual cycle when they ovulate as this involves hormonal changes — however, this is not common and research suggests it only occurs in around one in 20 women.
If you are on the pill, bleeding between periods may occur when you start or stop taking it as your body adjusts to the hormonal changes. This can occur for both the combined oral contraceptive pill and the progestogen-only pill. Missing taking the pill, being sick or having diarrhoea while on the pill can cause irregular bleeding between your periods too.
Other female contraceptives can also cause bleeding between periods, particularly in the first three months of starting them, including:
- Contraceptive implant
- Contraceptive injection
- Contraceptive patch
- Intrauterine device (IUDs)
If you have a problem with your contraceptive patch or vaginal ring, you may also have bleeding between your periods.
Other causes of hormonal imbalances that lead to bleeding between periods include:
- Nearing the menopause
- Taking the emergency contraceptive pill
- Underlying medical conditions — this includes:
- Dysfunctional ovaries
- Polycystic ovary syndrome (PCOS)
- Thyroid gland problems
2. Pregnancy complications
If you’re pregnant and have vaginal bleeding or spotting, contact your GP or midwife immediately. Vaginal bleeding is common during pregnancy, especially during the early stages, however, it could also be a sign of something more serious that needs treatment.
Vaginal spotting or bleeding can be caused by an ectopic pregnancy — this occurs when a fertilised egg implants itself into one of your fallopian tubes, instead of your womb. Vaginal bleeding also occurs during a miscarriage.
If you have recently had an abortion and have heavy vaginal bleeding, you should also seek urgent medical attention.
3. Fibroids
Fibroids are non-cancerous growths in and around your womb. Around one in three women will have fibroids at some point in their life, usually between the ages of 30 to 50.
4. Infection
Infection of your reproductive organs can cause inflammation and vaginal bleeding. This may be caused by a sexually transmitted infection (STI), such as chlamydia. If you have had unprotected sex, you should get tested for STIs.
Other causes of infection include vaginal douching and pelvic inflammatory disease (PID).
5. Cancer
Although a less common cause, cancer can lead to intermenstrual bleeding, specifically cancer of your cervix, ovaries, vagina or womb.
If you are aged 25-64 you should attend regular cervical screenings to detect any abnormal changes in your cervix, which may suggest you have or are at a high risk of developing cervical cancer.
Even if you are up to date with your cervical screenings, if you have bleeding between periods, especially after sex, you should still see your GP to rule out cervical cancer.
Womb cancer is more common after menopause. If you are over 40 and have bleeding between periods, you should see your GP to rule out womb cancer.
Rare causes of bleeding between periods
There are other causes of bleeding between periods, which are much less common. They include:
- Diabetes
- Extreme stress
- Harmless changes to the neck of your womb (cervix) — this is known medically as cervical ectropion or cervical erosion
- Polyps in the lining of your womb lining — these are non-cancerous growths
- Thyroid problems
- Vaginal dryness
Significant changes in your weight or inserting an object into your vagina can also cause vaginal bleeding between your periods.
Diagnosing bleeding between periods
If you have intermenstrual bleeding, it is important to see your GP or visit a sexual health or genitourinary medicine (GUM) clinic. Although in some cases, bleeding can get better on its own, it can also be a sign of a serious underlying health issue.
A doctor or nurse will ask you about your symptoms, so you may find it helpful to note down the following details before your appointment:
- When your periods start and end
- How heavy your menstrual bleeding is and for how long
- Medications and supplements you’re taking
- Other symptoms aside from bleeding between your periods
They may need to carry out a physical examination. This may involve inserting a gloved finger into your vagina to examine it and/or a speculum examination, where a smooth, tube-shaped tool (a speculum) is inserted into your vagina to examine it and your cervix.
They may also recommend tests, such as:
- A biopsy — collection of tissue from your cervix or womb lining that is sent to a lab for testing
- A cervical screening test — only if you are aged 25-65 and are not up to date with your regular screenings
- A pelvic ultrasound scan
- A pregnancy test
- Blood tests to check your hormone levels
- Tests for STIs
Depending on the underlying cause of your bleeding, you may need treatment.
Intermenstrual bleeding treatments
Treatment for bleeding or spotting between periods will depend on the underlying cause. If you are also in pain, you can try over-the-counter painkillers, such as ibuprofen or low-dose naproxen — these drugs can also reduce your intermenstrual bleeding. Do not take aspirin as this can increase your risk of bleeding.
How to prevent bleeding between periods
It isn’t always possible to prevent intermenstrual bleeding as it depends on the cause. However, in some cases, you can reduce your risk of bleeding between periods by maintaining a healthy weight — being overweight can cause irregular or abnormal periods. Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can also help by reducing your stress levels. Also, if you are taking birth control pills, make sure you follow the instructions to prevent hormonal imbalances.
Bleeding between periods Q&A
Why am I bleeding two weeks after my last period?
Depending on the length of your menstrual cycle, ovulation may occur about two weeks after your last period. Around one in twenty women experience spotting or bleeding when they ovulate due to the hormonal changes that naturally occur. However, if you do not normally experience spotting or bleeding when you ovulate, you should see your GP. Abnormal bleeding between periods can be caused by other conditions or issues with birth control.
Is bleeding in between periods a sign of cancer?
Bleeding between periods can occur for a variety of reasons, including cancer, specifically cancer of your cervix (neck of your womb), ovaries, vagina or womb. If you are bleeding between your periods, see your GP.
Should I worry about bleeding between periods?
Bleeding between periods is not always a sign of a serious health condition and it can sometimes get better on its own. However, it should always be investigated to rule out certain health conditions and to get treatment for any symptoms that are causing you concern or discomfort.
Can you have a period two weeks apart?
A menstrual cycle usually lasts between 21-40 days, with an average of 28 days. It's therefore unusual to have a period two weeks after your last one. You may instead be having intermenstrual bleeding (bleeding between your periods) and should see your GP to have your symptoms investigated.
When should I go to the doctor for bleeding between periods?
Around one in twenty women routinely experience some vaginal bleeding or spotting when they ovulate ie between their periods. However, if this is not normal for you, you should see your GP to have your intermenstrual bleeding investigated.
Can stress cause bleeding between periods?
Although not common, extreme stress can cause bleeding between periods.
Should I go to hospital for heavy periods?
If you have heavy periods, see your GP. They will discuss your symptoms with you and recommend whether you need further tests and/or treatment.
What does ovulation bleeding look like?
Ovulation bleeding is usually light and is often described as spotting. Some women describe their vaginal discharge as pink instead of clear when they are ovulating.
How do I know if I'm haemorrhaging during a period?
It can be hard to tell if you are losing too much blood during a period. However, in general, if you soak through your sanitary product within an hour, have to use more than one sanitary product at the same time or notice large blood clots (about the size of a 10p coin or bigger), then you have heavy periods.
What do miscarriage clots look like?
A miscarriage before eight weeks of pregnancy may look like a heavy period, with large blood clots the size of a 10p coin or bigger. If you have a miscarriage after eight weeks, more tissue will pass out of your body and clots may therefore be larger. If you think you are having a miscarriage contact your GP or midwife.
