Bleeding between periods

(Intermenstrual bleeding and Post coital bleeding)

This Clinician Blogging section is about non-menstrual bleeding, bleeding from the vagina that is not related to periods, in women under the age of 40 years.  The points that will be covered in this section includes:

• What is non menstrual bleeding?
• What are the causes of non menstrual bleeding?
• What is my GP likely to ask?
• What examinations will my GP perform?
• What happens next?
• Further information

• What is non menstrual bleeding?

Non-menstrual bleeding is the term used for bleeding from the vagina that is not as a result of a period.  It can be divided in to 2 catergories:

1. 'intermenstrual' – bleeding from the vagina between periods
2. 'postcoital' – bleeding from the vagina after sexual intercourse

• What are the causes of non-menstrual bleeding?

Non-menstrual bleeding is a common symptom and can have many causes.  Some of these causes include:

1. Cervical lesions
2. Oral Contraceptive Pills
3. Hormone Replacement Therapy
4. Infection
5. Fibroids
6. Polyps
7. Pregnancy
8. Cervical cancer

Serious problems such as cancer are very rare in women under the age of 40 years, but it is important to see your GP for a general assessment if you experience these symptoms.

• What is my GP likely to ask?

Your GP will ask you more about the bleeding to determine the possible cause.  Your GP will want to know how long you have been experiencing the problem, at what point in your cycle does it occur and if there is any associated pain or discharge.  They will then ask you some more questions about your own medical history to help establish the cause, some of the questions that may be addressed include

1. Menstrual history (your cycle length, last period, age of onset of periods)
2. Sexual history (contraception, sexually transmitted infections)
3. Drug history
4. Current Medications
5. Date of last cervical smear-any problems with smears in the past

• What examinations will my GP perform?

Your GP may wish to examine you to help with the diagnosis.   This would include an examination of the abdomen, cervix (using a speculum) and a pelvic examination.  During the speculum examination swabs may be taken to check for infections such as Chlamydia. If your smear is due it may be taken at this time

• What happens next?

If your bleeding is found to be due to hormonal contraception, this often settles with time. However it may be worth discussing with your GP and considering a different pill or different method of contraception. 

It is very common to have intermenstrual bleeding in the first few months after starting a hormonal contraceptive. These include the combined pill, the progesterone only pill, depo injection, Implanon implant and Mirena intra-uterine system. The copper coil has no hormones, but can also cause intermenstrual bleeding in the 1st month. 

If your bleeding is due to infection, this is easily treated with antibiotics. 

If clinical examination is normal and a trial of treatment does not work then your GP may refer you to the gynaecology clinic for further tests which may include an ultrasound scan, a biopsy of the womb lining or cautery to the cervix.

Further information

If you would like further information about non-menstrual bleeding please click on one of the links below or speak to your health care practitioner.

http://www.patient.co.uk/doctor/Intermenstrual-and-Post-coital-Bleeding.htm

http://www.nhs.uk/chq/pages/976.aspx

http://www.nhs.uk/chq/pages/977.aspx

Ref:  The Obstetrician and Gynaecologist 2004;6:153-158

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