Intermenstrual bleeding means bleeding or spotting between your regular periods. It may be as light as a few spots or heavy enough to need sanitary pads. Sometimes, it happens because of normal hormonal changes or contraception. At other times, it may be linked to PCOS, infections, fibroids,endometriosis or pregnancy-related problems.
Occasional light spotting may not be serious. However, repeated, heavy or unexplained bleeding between periods should be checked by a gynaecologist. Finding the cause can help your doctor choose the right treatment.
Intermenstrual bleeding is vaginal bleeding that happens between your expected menstrual periods. It is also commonly called bleeding between periods or spotting between periods. The bleeding may look different from person to person. You may notice:
The timing of the bleeding can also provide useful clues. For example, some women may experience light spotting around ovulation. Others may have bleeding after starting hormonal contraception or taking emergency contraception.
There are several possible causes of intermenstrual bleeding. These include hormonal changes, contraception, infections, PCOS, fibroids, endometriosis and pregnancy-related conditions. Less commonly, it can be related to precancerous changes or cancer.
Not always. Occasional light spotting between periods can happen and may not be a sign of a serious problem. It can occur around ovulation or after starting hormonal contraception. However, repeated, heavy or unexplained bleeding between periods is not considered normal and should be checked by a doctor.
Hormonal changes during puberty and perimenopause can also make menstrual bleeding less predictable. Other causes can include infections, PCOS, fibroids, endometriosis and pregnancy-related conditions.
You should see a gynaecologist if the bleeding:
Any vaginal bleeding after menopause should be checked by a doctor.
There are many possible intermenstrual bleeding causes. Your age, menstrual pattern, medicines, contraception and other symptoms can help your doctor identify the reason.
Some women experience light spotting around ovulation. This usually happens around the middle of the menstrual cycle and is generally brief.
Hormone changes can also affect menstrual bleeding during puberty and perimenopause. If spotting occurs regularly or becomes heavier, it is better to have it evaluated rather than assuming it is due to ovulation.
Hormonal contraception can cause breakthrough bleeding, especially when you first start using it or change your method.
This may happen with:
Missing birth control pills can also lead to unexpected bleeding. If bleeding continues or becomes heavy, speak with your doctor. Do not stop prescribed contraception without medical advice.
Intermenstrual bleeding after iPill or another emergency contraceptive pill can occur because emergency contraception may temporarily change your menstrual cycle.
You may notice:
These changes are usually temporary.
However, if your period is significantly delayed, unusually light, or you develop abdominal pain, take a pregnancy test and speak with a healthcare professional. If you may be pregnant and have severe abdominal pain, dizziness or fainting with bleeding, seek urgent medical care.
PCOS can cause irregular or unexpected bleeding because it can affect ovulation and hormone levels. People with PCOS may have periods that are irregular, unpredictable or absent. Some may also experience heavy or prolonged bleeding.
PCOS is common. According to the WHO, an estimated 10–13% of women of reproductive age have PCOS worldwide. WHO also estimates that up to 70% of affected women may not know they have the condition.
Other symptoms can include:
However, intermenstrual bleeding alone does not mean you have PCOS. A doctor needs to assess your symptoms and medical history.
Infections affecting the vagina, cervix or uterus can cause bleeding between periods. Some sexually transmitted infections (STIs), including chlamydia, may cause unexpected bleeding.
Other symptoms may include:
If you have these symptoms, your doctor may recommend testing before starting treatment.
Fibroids and polyps can cause abnormal bleeding, including bleeding between periods.
Fibroids are non-cancerous growths that develop in or around the uterus. Polyps are growths that can develop in the lining of the uterus or cervix. Depending on their size and location, they may cause the following:
An ultrasound can help your doctor look for fibroids and other structural causes of abnormal bleeding.
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus.
It may cause:
The WHO estimates that about 10% of women of reproductive age, or around 190 million women worldwide, have endometriosis.
If bleeding between periods occurs along with severe period pain or ongoing pelvic pain, your gynaecologist may consider endometriosis as one possible cause.
Bleeding between periods can sometimes occur during pregnancy. Possible causes include:
An ectopic pregnancy occurs when a pregnancy develops outside the uterus. It can become life-threatening if it causes internal bleeding.
If pregnancy is possible and you have bleeding with severe or one-sided abdominal pain, dizziness, weakness or fainting, seek urgent medical care.
Certain medicines can increase the risk of abnormal bleeding. Blood-thinning medicines, for example, can contribute to unexpected vaginal bleeding.
Bleeding disorders can also make you more likely to bleed or bruise easily. Tell your doctor about all medicines and supplements you take.
During perimenopause, hormone levels change and periods may become irregular, lighter or heavier.
This can sometimes lead to unexpected spotting or bleeding. However, bleeding after menopause is not considered a normal menstrual change.
If you have gone through menopause and notice vaginal bleeding, even if it is only light pink or brown spotting, see a doctor for an evaluation.
Cancer is not the most common cause of intermenstrual bleeding. However, persistent or unexplained abnormal bleeding should be checked because some cancers and precancerous conditions can cause abnormal vaginal bleeding.
Cervical cancer remains an important global health concern. WHO's latest global estimates report around 660,000 new cases and 350,000 deaths from cervical cancer in 2022.
Regular cervical screening and HPV vaccination can help reduce the risk of cervical cancer.
Dark red or brown blood does not necessarily mean that something is wrong.
Blood can become darker when it takes longer to leave the uterus or vagina. This can make it appear brown or dark red. So, intermenstrual bleeding with dark blood cannot be diagnosed by colour alone.
Instead, pay attention to:
If dark spotting keeps returning, speak with a gynaecologist.
Bleeding between periods may happen on its own or with other symptoms.
You may experience:
The combination of symptoms can help your doctor identify the possible cause.
For example, bleeding with unusual discharge may suggest an infection. Bleeding with severe period pain may point towards endometriosis. Bleeding with a missed period and abdominal pain may require a pregnancy test and urgent assessment.
There is no single test that can identify every cause of intermenstrual bleeding.
Your gynaecologist will first ask about your menstrual cycle, the pattern of bleeding and any other symptoms. The tests you need will depend on your age, medical history and possible cause.
Your doctor may ask:
Keeping a record of your periods and unexpected bleeding can help your doctor understand the pattern.
If pregnancy is possible, your doctor may recommend a pregnancy test. This is particularly important if bleeding occurs with abdominal or pelvic pain.
Your doctor may examine the vagina and cervix to look for signs of infection, injury, polyps or other changes.
If an infection is suspected, your doctor may recommend a vaginal or cervical swab or other STI tests.
Blood tests may be recommended to check for:
A pelvic or transvaginal ultrasound can help examine the uterus and ovaries.
It may help identify:
If the cause is still unclear, your gynaecologist may recommend additional tests.
These may include:
Not everyone needs all these tests. Your doctor will recommend them based on your symptoms and risk factors.
Differential diagnosis means the different conditions your doctor considers when trying to find the cause of your bleeding.
Doctors may consider several groups of conditions.
Your doctor may use your symptoms, examination findings and test results to narrow down these possibilities.
Treatment depends on the underlying cause. There is no single treatment for every type of intermenstrual bleeding.
See a gynaecologist if bleeding between periods is repeated, heavy, painful or unexplained. You should also seek medical advice if:
Getting checked does not mean that you have a serious condition. It simply helps identify the cause and ensures that you receive the right treatment.
Heavy bleeding with severe pain, fainting or severe dizziness requires urgent medical attention.
The American College of Obstetricians and Gynaecologists advises emergency care if you are changing a pad or tampon every hour for more than two hours in a row and also have symptoms such as shortness of breath, chest pain or light-headedness.
If pregnancy is possible, seek urgent care if bleeding occurs with:
These symptoms can occur with an ectopic pregnancy and should not be ignored.
Not every cause can be prevented. However, some steps can reduce the risk of certain causes and help you notice changes early.
You can:
Tracking your cycle can help you notice when bleeding occurs and can give your doctor useful information during your appointment.
Intermenstrual bleeding is bleeding or spotting between your regular periods. It can happen because of ovulation, hormonal contraception or emergency contraception. It can also be caused by PCOS, infections, fibroids, endometriosis, pregnancy-related problems and other gynaecological conditions.
Occasional light spotting may not be serious. But repeated, heavy, painful or unexplained bleeding should be evaluated by a gynaecologist.
The colour of the blood alone cannot tell you the cause. What matters is the pattern of bleeding and any other symptoms you have.
If you have very heavy bleeding, severe abdominal pain, fainting or severe dizziness, seek urgent medical care.
No. Occasional light spotting can happen around ovulation or after starting hormonal contraception. However, repeated, persistent or unexplained spotting should be evaluated by a doctor. Bleeding after sex should also be checked.
Stress can affect your menstrual cycle and may contribute to irregular periods or spotting. However, repeated bleeding between periods should not automatically be blamed on stress. Other causes may need to be ruled out.
Yes. Birth control pills and emergency contraception can cause temporary changes in menstrual bleeding. Breakthrough bleeding is more common after starting or changing hormonal contraception. Emergency contraception can also affect the timing of your next period.
If your period is significantly delayed or you have symptoms of pregnancy, take a pregnancy test and speak with your doctor.
Yes, PCOS can cause irregular or unexpected bleeding because it can affect ovulation and hormone levels. However, bleeding between periods alone does not diagnose PCOS.
WHO estimates that 10–13% of women of reproductive age have PCOS worldwide.
Yes. Both fibroids and endometriosis can cause abnormal bleeding, although their symptoms can differ. Fibroids may cause heavy or prolonged bleeding, while endometriosis is often associated with severe period pain and pelvic pain.
The tests depend on your age, symptoms and medical history. Your doctor may recommend a pregnancy test, pelvic examination, STI testing, blood tests and pelvic or transvaginal ultrasound. Some women may need hysteroscopy or an endometrial biopsy.
Written and Verified by:
Dr. Namrata Gupta is a Senior Consultant of Obstetrician & Gynaecologist Dept. at CK Birla Hospital, Jaipur, with over 17 years of experience. She specializes in high-risk obstetrics, painless delivery, advanced laparoscopic surgeries, and infertility treatments.
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