It’s not my period—why am I bleeding?
Contraceptives, STDs, the onset of menopause—a variety of conditions can cause vaginal blood flow during any time of the menstrual cycle. An accurate diagnosis will point to the most suitable treatment for you.
Most often, vaginal bleeding between periods, or intermenstrual bleeding, is no cause for concern. The most common reasons are menopause and hormonal contraception (especially during the first three months). But these are not the only reasons for intermenstrual bleeding.
If you frequently experience intermenstrual bleeding, it is considered abnormal and should be checked.
Hormonal contraception
Hormonal contraceptives use hormones to prevent pregnancy. These include the intrauterine device (IUD), birth control patch, vaginal ring, birth control pill, and contraceptive implant.
Hormonal contraceptives are a common cause of vaginal bleeding between periods. However, this usually only happens during the first three months as your body adjusts to using contraceptives. If the bleeding is very heavy or lasts for more than 3 months, consult your doctor. Switching to another form of contraception can often remedy the problem.
Bleeding between periods can also occur if hormonal contraception isn’t being used according to instructions. For example, a missed birth control pill, or a problem with a contraceptive patch can sometimes cause spotting.
Menopausal irregularities
Menopause, or the end of menstruation, marks the cessation of a woman’s reproductive ability. This is a natural process that occurs as the ovaries age and produce fewer reproductive hormones. The body begins to undergo changes. One of the most noticeable being the loss of active ovarian follicles (ovarian follicles are the structures that produce and release eggs from the ovary, stimulating menstruation and ensuring fertility). When the ovaries are no longer active, periods no longer occur.
The time when your hormones begin to change in preparation for menopause is called perimenopause. This phase of life can last anywhere from a few months to several years. During this time, many women experience some of the following symptoms:
- irregular menstrual periods
- late periods (you may skip one or more cycles)
- heavier or lighter bleeding than what is normal for you
- hot flashes and night sweats
- insomnia
- vaginal dryness
What actually happens?
Your ovaries are a source of oestrogen and progesterone—the two key hormones regulating the reproductive system—which includes the menstrual cycle and fertility in women. Two additional hormones are involved in regulating reproduction— LH (luteinizing hormone) and FSH (follicle stimulating hormone). As the ovaries age and release less of these hormones, LH and FSH no longer regulate oestrogen, progesterone, and testosterone as they once did.
First, the production of progesterone decreases. As a result, the menstrual cycle begins to change—bleeding becomes less regular and can be heavier and last longer. Profuse bleeding can cause anaemia—a low number of red blood cells—which can cause feelings of weakness and fatigue. Iron supplements can help redress this condition.
Later, oestrogen cycles also change. Production increases sharply, then suddenly drops. During hypoestrogenism (the sharp increase of oestrogen) women may experience tender breasts and feel tension in the lower abdomen, much like before menstruation, accompanied by irritability and sensitivity.
These hormonal changes can cause heavy periods and even bleeding between periods. This time of life can be difficult to manage because, in addition to the significant emotional charge of the end of reproductive life, it leaves women uncertain about their cycles—there is no clarity when menstruation will occur.
After some time, as the production of oestrogen stops, periods disappear completely. Menopause is determined when there has been on menstruation for 12 months—the transformation of perimenopause is complete. However, some other symptoms, such as hot flashes, may continue for several years.
Endometriosis
When a girl goes through puberty and her hormones have stabilized, her periods become more regular. Menstrual bleeding occurs once per cycle, with cycles lasting an average of 28 days (but this differs from woman to woman). Cycles lasting between 21 and 40 days are still considered normal. Typically, periods lasting anywhere from 3 to 6 days are considered normal, but here there may also be variations.
If you are experiencing bleeding that isn’t consistent with the guidelines for the average menstrual cycle, consult your doctor or gynaecologist. This could indicate a disorder called endometriosis in which the endometrium—tissue normally found inside your uterus—grows outside of it.
Endometriosis most often affects the ovaries, fallopian tubes, and internal pelvic tissues. In rare cases, endometrial tissue can spread even beyond the pelvic organs. If this happens, it acts just like endometrial tissue: it thickens, then degrades and bleeds away with each menstrual cycle. If this tissue is not where it’s supposed to be and has no way out of your body, it becomes trapped.
This disorder can also involve the ovaries. When this happens, cysts called endometriomas form. The surrounding tissue can become irritated, possibly causing scars and adhesions, or abnormal bands of fibrous tissue that can cause the pelvic tissues and organs to stick together.
Symptoms include bleeding between periods, pain following sexual intercourse, and heavy bleeding during your period. However, endometriosis doesn’t always involve noticeable symptoms, which is why regular check-ups allow your doctor to monitor changes and/or problems with your reproductive health. Endometriosis can’t be cured, but it can be managed. There are multiple treatment options—pain medication, hormonal treatments, and, if necessary, surgery. Your doctor or gynaecologist will be able to advise you on the best course of treatment for you specifically.
STDs and intermenstrual bleeding
Sexually transmitted diseases (STDs) manifest variously in women, and the symptoms can be discreet. Sometimes they are so discreet as to be easily confused with common physical processes. One of the symptoms is intermenstrual spotting.
STDs are caused by unprotected intercourse with a person who has an STD. Risk factors for contracting STDs include unregulated drug use and multiple sex partners.
If you think you have an STD (and even if you don’t), it is best to seek the advice of your doctor and go for regular screenings at a designated centre. Once they are diagnosed, most sexually transmitted diseases can be successfully treated. However, it is essential that both partners complete the treatment to avoid repeated infections and infecting others. If it turns out that you don’t have an STD, receiving a reliable negative test result is safer and more helpful than not knowing.
Bleeding linked with pregnancy
Intermenstrual bleeding is sometimes associated with early pregnancy, ectopic pregnancy, miscarriage, or molar pregnancy.
One in four pregnant women experience abnormal bleeding from the uterus (metrorrhagia) in the first trimester of pregnancy. Metrorrhagia in early pregnancy can have multiple causes, which lead to different consequences throughout the pregnancy, so getting a proper diagnosis is the safest course of action.
When a fertilized egg implants in the uterine lining (about 7–8 days after fertilization), slight bleeding is not uncommon and has no effect on the course of the pregnancy.
An ectopic pregnancy occurs when the egg implants and develops in one of the fallopian tubes instead of the uterine cavity. This usually causes blackish blood loss accompanied by severe pain in the lower abdomen, which can occur before the expected date of menstruation and may be mistaken for menstruation.
Ectopic pregnancy is a very dangerous condition for the mother, so do not hesitate to call the ambulance! Do not expect the situation to resolve itself. Unfortunately, ectopic pregnancy endangers the life of the mother and never results in childbirth.
Miscarriage is the spontaneous termination of pregnancy, which results in the loss of the foetus before the 20th week of pregnancy. About 15% of pregnancies end in miscarriage, often without the woman even knowing she was pregnant. They generally manifest through blood loss accompanied by pain in the lower abdomen. Miscarriages occur for a variety of medical reasons, many of which cannot be controlled. Even so, educating yourself about risk factors can help prevent miscarriage or at least help you understand why it happened.
Dark brown to bright red vaginal bleeding during the first trimester might also be caused by a molar pregnancy, also known as hydatidiform mole. This is a rare complication of characterised by the abnormal growth of trophoblasts—the cells that normally develop into the placenta.
There are two types of molar pregnancy:
Complete molar pregnancy (or complete hydatidiform mole), where the placental tissue is swollen and appears to form fluid-filled cysts. In such pregnancies there is no embryo—only the placenta, which develops into multiple cysts.
Partial molar pregnancy (or partial hydatidiform mole), where normal placental tissue develops along with the abnormal tissue. In such pregnancies a foetus may begin to develop but cannot be viable and is usually miscarried early in the pregnancy.
In both cases the egg does not have complete genetic material, so the pregnancy ends in a miscarriage.
After an abortion
Irregular bleeding may also be a consequence of abortion, either medical or surgical.
Bleeding is normal after an abortion. It may look like your monthly period, but it’s not the same—the uterus is expelling the remaining tissues of pregnancy.
A medical abortion consists of taking two pills. The first is usually taken at a hospital or clinic under the supervision of a gynaecologist; it causes the lining of the uterus to break down so that a pregnancy can no longer develop. Some women bleed after taking the first pill.
The second pill is usually taken at home. This pill causes the uterus to release its contents. Bleeding starts anywhere from 30 minutes to 5 hours after taking the second pill. The bleeding gradually becomes more intense and can contain clots. After a few hours the bleeding decreases and should look more like a normal period.
Many women experience bleeding immediately after a surgical abortion. For others the bleeding only starts 3–5 days after the procedure. In general, the flow is lighter than during menstruation. The bleeding may stop by itself or continue until your next period. If it continues, it should become lighter over time.
It is common to bleed for a week or two after either type of abortion. If you have any concerns, reach out to your doctor for more information.
Cervical cancer
Although slight spotting is normal and not uncommon, it should not be overlooked, as intermenstrual bleeding may also be a sign of cervical cancer. Unusual among young people, cervical cancer is most often found in middle-aged women (35 years +).
If the cancer becomes more advanced, other warning signs appear, including:
- heavier and/or longer menstrual periods
- bleeding after intercourse
- bleeding after menopause
- bleeding after a pelvic exam
- bleeding that causes anaemia, dizziness, and fatigue
The earlier precancerous or cancerous cells are discovered and treated, the better the chances of preventing or curing the cancer.
Other causes
Polyps, fibroids and other benign uterine tumours can also cause extra-menstrual bleeding, as can drastic weight loss or weight gain, falls, injuries, and even intense and violent sex.
Changes in the menstrual cycle can also be provoked by certain chronic conditions, such as diabetes or even intense stress. In adolescents, the menstrual cycle has not yet stabilised, so bleeding during puberty does not occur at the same rhythm and according to the same regular schedule.
It is important that you get to know your body and have an idea about what a normal menstrual cycle is for you. Use our application to track you cycle—WomanLog makes it easy to notice changes and unusual symptoms. If you find that the symptoms don’t resolve themselves, you will have solid information to share with your doctor or gynaecologist, which will help them find the best solution for you.
You can track your period using WomanLog. Download WomanLog now:
