What does it mean when your bleeding but not on your period

Bleeding or spotting between regular monthly periods can be alarming. When this happens, you may see just a spot or two of blood on your underwear or toilet tissue, or you may be bleeding as if you’ve started your period.

I often get questions about spotting between periods from my patients. While most of the time spotting isn’t anything to worry about, it can point to a more serious issue that might need treatment.

Normal periods

Normal menstrual bleeding lasts about five to seven days. While your period usually occurs an average of every 28 days, anywhere from 21 to 35 days between periods is considered normal. About 14 days after the start of your period, you ovulate and release an egg from the ovary. This spotting can last for one to two days and is typically light bleeding.  It’s possible to have spotting during ovulation, which is normal, although it should be discussed with your doctor. The uterine lining is ready for the implantation of a fertilized egg, and there can be spotting at the time of implantation if that occurs and pregnancy begins.

What conditions might cause someone to bleed between periods?

Bleeding between menstrual cycles can be due to structural issues within the uterus or womb, including endometrial polyps or fibroids. Polyps are small abnormal tissue growths that can occur in a number of places, including the cervix and uterus. Most polyps are benign, or noncancerous.

Spotting can also be due to sexually transmitted infections that typically infect the cervix, such as gonorrhea or chlamydia. Learn the symptoms of sexually transmitted infections and contact your doctor if you suspect you have one.

Birth control 

Hormonal birth control pills, patches, injections, rings and implants can all cause spotting between periods.

• Birth control pills: Some women on the birth control pill may experience irregular bleeding if pills are missed.
• Injections: Women who use the Depo-Provera injection as their birth control method may experience irregular cycles or bleeding between cycles as a side effect of the medication.
• Hormonal IUD: Women who have a hormonal IUD in place may also experience irregular bleeding. However, this typically resolves itself within the first several months after placement. 

Changing the type of hormonal birth control you use can temporarily alter your progesterone levels, which could lead to spotting. As your system gets used to your new contraception, the spotting should stop.

When should a woman consider seeing her doctor?

If your spotting has been happening consistently for several months — or you’re worried about it for any reason — keep a menstrual diary to track irregular menstrual cycles or bleeding. If the irregularity persists for more than two months, I’d recommend making an appointment to see your ob/gyn for an exam.

Megan Quimper, MD, is a physician at The Ohio State University Wexner Medical Center who specializes in obstetrics and gynecology. She provides reproductive health care that includes pregnancy care, contraception, well-woman care, cancer screening and gynecologic care. She has a special interest in global women's health.

Overview

What is vaginal bleeding?

Vaginal bleeding is any bleeding from your vaginal area. It can refer to bleeding related to menstruation or bleeding unrelated to menstruation such as from trauma or a medical condition. In most cases, vaginal bleeding refers to bleeding that’s not related to menstruation (your period).

Bleeding between periods or bleeding outside of a normal menstrual cycle is abnormal (irregular) vaginal bleeding. This type of bleeding can be random, impossible to predict and may be accompanied by pain or other symptoms. Vaginal bleeding not caused by menstruation can be caused by many factors like:

• Health or medical conditions.
• Medications.
• Pregnancy.
• Hormones.
• Menopause.
• Injury or trauma.
• Infection.

You may experience spotting or vaginal bleeding at some point in your life. Usually, it’s not a cause for worry. However, you should be evaluated by a healthcare provider to be sure. In some cases, vaginal bleeding is a sign of a serious condition.

Who is more likely to experience vaginal bleeding?

Unusual vaginal bleeding may occur at any age. When a person first begins having periods, they may not always occur on a regular schedule. The same is true in the years leading up to menopause. During this time of perimenopause, the number of days between periods may change, be skipped altogether or bleeding may be unusually heavy or light.

Possible Causes

What causes vaginal bleeding?

There are many causes of vaginal bleeding other than menstruation. You should always work with a healthcare provider to determine the cause of your bleeding. Some of the more common causes are medical conditions, hormones and pregnancy complications.

Medical conditions

• Cancers of the female reproductive system: These can include cancers of your cervix, endometrium (lining of your uterus), ovaries or fallopian tubes.
• Bleeding disorders: A problem with normal blood clotting can result from an inherited condition such as hemophilia or von Willebrand Disease, a low red blood cell count (thrombocytopenia), a deficiency of Vitamin K (which helps the body make blood-clotting factors) or as a side effect of medications (such as blood thinners).
• Hypothyroidism: An underactive thyroid gland can interrupt normal menstrual cycles.
• Uterine fibroids: Non-cancerous growths that develop from the muscle tissue of your uterus. Their size, number, growth rate and location within your uterus can vary greatly.
• Adenomyosis: A condition where the lining of your uterus grows through the uterine wall.
• Uterine (endometrial) polyps: An overgrowth of cells on the lining of your uterus. Polyps are usually not cancerous, but some can develop into precancerous polyps.
• Severe cervicitis: Cervicitis is inflammation or infection of your cervix.
• Endometrial hyperplasia: The endometrium becomes too thick, usually due to a hormonal imbalance of estrogen and progesterone. This condition isn’t cancerous, but in some cases can lead to cancer of your uterus.

Hormones

• Anovulation: A disruption or failure of your ovaries can be due to a disorder of your ovaries themselves or from a problem in how the brain is signaling the glands that control ovulation.
• Hormonal birth control pills: Some people experience breakthrough bleeding while taking oral contraceptives. The problem tends to resolve on its own.
• Polycystic ovary syndrome: A type of hormonal imbalance that causes irregular periods, weight gain, acne and excess hair growth.

Pregnancy complications

• Ectopic pregnancy: A pregnancy in which a fertilized egg grows outside your uterus, usually in your fallopian tubes.
• Placental abruption: Detachment of the placenta (the sac that contains a fetus) from the wall of your uterus.
• Placenta previa: When the placenta lies low in your uterus and partly or completely covers your cervix (the opening to your uterus).
• Preterm labor: Labor that occurs before the 37th week of pregnancy.
• Miscarriage: Loss of pregnancy before the 20th week.

Other possible causes

• Birth control devices: Using birth control devices such as the intrauterine device (IUD) can cause spotting.
• Hormone replacement therapy: A treatment used to relieve symptoms of menopause.
• Infection: This can occur in the pelvic cavity or urinary tract. It can also include bleeding caused by sexually transmitted infections (STIs).
• Injury: Injury to or a foreign object in your vagina.
• Cervical or endometrial biopsy: A biopsy is a procedure where tissue is removed from your cervix or uterus and examined for problems.

Can stress cause vaginal bleeding?

Yes, stress can affect your hormone levels and contribute to irregular vaginal bleeding or irregular menstruation.

What does it mean when you're bleeding but not on your period?

If you’re bleeding but not on your menstrual period, it can be caused by several factors. Some reasons you may be bleeding could include infection, an underlying medical condition, medication or hormonal imbalance.

It’s best to keep a record of your symptoms and contact a healthcare provider for an exam and any necessary tests.

Care and Treatment

How do doctors diagnose vaginal bleeding?

Your healthcare provider will ask you questions about your symptoms and health history. They’ll perform a physical exam and pelvic exam. You can expect your provider to ask some of the following questions:

• When did the bleeding start?
• When does it occur in relation to your period?
• Do you bleed during sex?
• How many pads are you soaking per day?
• How long does your menstrual period last?
• How long between each menstrual cycle?
• What medications are you taking?
• Have you had any recent procedures or surgeries?
• Is there a chance you’re pregnant?

Your provider may order the following tests to help them find the cause of your vaginal bleeding:

• Pap test.
• Urinalysis.
• Thyroid functioning tests.
• Complete blood count (CBC).
• Pregnancy test.
• Ultrasound.
• Magnetic resonance imaging (MRI).
• Hysteroscopy.

How is vaginal bleeding treated?

Treatment for vaginal bleeding depends on the cause of the bleeding, your age and if you wish to become pregnant. If a hormonal imbalance is the cause, your provider may recommend lifestyle changes such as eating a healthy diet, reducing stress and losing weight.

Other times, medication or surgery is needed to treat vaginal bleeding.

Medications for vaginal bleeding

• Hormonal birth control methods (pills, patch or vaginal ring): These forms of birth control may reduce menstrual flow and help periods become more regular.
• Intrauterine device (IUD): Certain types of IUDs can be used for both birth control and to minimize or stop bleeding.
• Gonadotropin-releasing agonists (medications that reduce the release of gonadotropin, a hormone that stimulates your ovaries): Used to stop menstrual flow and reduce the size of fibroids.
• Tranexamic acid: Used to stop excessive menstrual bleeding.
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen: Can help control heavy bleeding.
• Antibiotics: Used when bleeding is caused by an infection.

Surgical treatment for vaginal bleeding

• Endometrial ablation: Destroys the lining of your uterus, which reduces or stops the bleeding. Discuss this procedure with your provider if you want to become pregnant in the future.
• Dilation and curettage (D&C): Scraping away or suctioning tissue from your uterus.
• Uterine artery embolization: Used to treat fibroids by blocking blood vessels in your uterus that fibroids use to grow.
• Myomectomy: Removes fibroids but not your uterus.
• Hysterectomy: Removal of your uterus. It may be used when other treatments have failed or to treat endometrial cancer.
• Surgical removal of benign (non-cancerous) growths.

What do I do to prevent or avoid vaginal bleeding?

Some vaginal bleeding is necessary, such as with your menstrual period. However, abnormal vaginal bleeding can be inconvenient and negatively impact your life. Most often, vaginal bleeding is beyond your control and not caused by anything you’re doing wrong.

It’s best to schedule an appointment with your healthcare provider to discuss your symptoms. Talking to them about when your bleeding is happening, what it looks like and how it feels can help them figure out the problem.

When to Call the Doctor

When should vaginal bleeding be treated by a healthcare provider?

The following symptoms of vaginal bleeding should be brought to the attention of your healthcare provider:

• A change in the regularity of the menstrual cycle (a notably shorter or longer time between cycles than the normal pattern).
• A noticeable change in the amount of blood during a menstrual cycle (either much more or much less bleeding than usual).
• Bleeding after sexual intercourse.
• Any bleeding (even a slight amount) before puberty or after menopause.
• Bleeding in association with douching.
• Bleeding after beginning a new medication or hormone treatment.
• Bleeding during pregnancy (bleeding that’s more than spotting).
• Any bleeding accompanied by severe pain (especially when not menstruating).
• You have a fever, feel weak or dizzy or have pain in your pelvic area.

A note from Cleveland Clinic

Vaginal bleeding is usually defined as any bleeding from your vagina that’s not part of a menstrual period. There are many reasons you may be bleeding. In most cases, it’s not life-threatening and not a cause for concern. Most vaginal bleeding can be attributed to medical conditions, pregnancy or hormonal changes. Talk to your healthcare provider if you’re bleeding from your vagina and not on your menstrual period. They can evaluate your symptoms, perform an exam and order additional tests to determine a cause for your bleeding.