Bleeding between periods: causes and when to see a gynaecologist

The NHS advises making a non-urgent appointment with a doctor if you bleed between periods or after sex, if your periods are heavy enough to affect your daily life, or if you have severe pain during your period.

A heavy period is not always a problem, but there are practical signs to look for: changing a pad or tampon every one to two hours, needing two products at once, bleeding for more than 7 days, passing clots larger than about 2.5 cm, bleeding through to clothes or bedding, or often feeling tired or short of breath.

The causes vary. Sometimes the body is simply changing: during adolescence, after a pregnancy or as menopause approaches, it is common for the pattern of your periods to shift.

At other times there is a condition of the womb or ovaries that can be identified and treated. The NHS lists, among others:

• Polycystic ovary syndrome.
• Fibroids.
• Endometriosis and adenomyosis.
• Pelvic inflammatory disease.
• Conditions that make you bleed more easily, such as von Willebrand disease, and some medicines, such as certain blood thinners.

Rarely, bleeding outside your period can be a sign of womb cancer. It is uncommon, but it is the reason we do not advise getting used to it or waiting for months. If you have been through the menopause and the bleeding returns, book an appointment as soon as you can.

A first visit starts with a detailed conversation: when the bleeding happens, how long it lasts, which contraception you use, whether there is pain. Then comes an examination and a gynaecological ultrasound scan, which lets us see the womb and ovaries straight away. If needed, blood tests are requested, for example to rule out iron-deficiency anaemia.

When an ultrasound is not enough, a hysteroscopy is the next step: a test in which a very thin camera lets the doctor look inside the womb. The NHS lists it among the tests for unexplained vaginal bleeding, heavy periods or bleeding between periods, bleeding after the menopause, fibroids and polyps. It can be diagnostic, to find the cause, or operative, to take a sample or remove a polyp or fibroid during the same procedure. It usually takes 10 to 15 minutes.

They depend on the cause and on what you need. The NHS mentions contraception (such as the hormonal coil or the combined pill), medicine to reduce bleeding such as tranexamic acid, and anti-inflammatory painkillers. If these do not work or there is an underlying condition, specialist treatments such as removing fibroids are considered. The decision is made with you, once the diagnosis is known.

At our consulting rooms in Murcia, Dra. Alejandra Madrid treats gynaecological conditions and performs diagnostic and operative hysteroscopies, and Dra. Leonor Guerrero heads the Hysteroscopy Unit at La Arrixaca, a reference centre in the Region of Murcia. You will have your ultrasound scan during the same visit and a clear explanation of what it shows.