Abnormal bleeding - don’t ignore it
If your bleeding changes at all from your usual pattern, it is time to talk to a doctor and check that there is nothing underlying it.
Most women and older girls will be very familiar with their ‘‘normal’’ cycle. There can be a huge variation in this – some people bleed very lightly for only one or two days, others get heavy loss for over a week; some will have a period every three weeks, others every six weeks; and some have such irregular periods it is hard to predict when they will come.
These can all be normal, and if your bleeding is the same as it has always been (unless it is excessively heavy or prolonged), then there is probably little to worry about.
However, if your bleeding changes at all from your usual pattern, it is time to talk to a doctor and check that there is nothing underlying it. Abnormal bleeding can be due to a wide range of things, and rarely can signify something serious such as cancer, so don’t delay – these things are definitely better diagnosed sooner rather than later.
The following list includes some of the things to think about if you are experiencing abnormal bleeding:
❚ Bleeding after the menopause – if your periods have stopped for 12 months or longer, any bleeding at all is considered to be abnormal, even if it is just a few spots. Older women are more at risk of cancers in the womb, ovaries and cervix, so it is really important to rule these out. More common causes of bleeding in this age group include polyps (little growths) of the womb or cervix, vaginal atrophy or dryness associated with low levels of oestrogen, HRT usage, and a condition known as endometrial hyperplasia which causes thickening of the womb lining. If your doctor is concerned about your symptoms, they will organise an ultrasound scan, and perhaps a test known as an endometrial biopsy where a small sample of tissue from the womb lining is taken to test for abnormalities.
❚ Bleeding during pregnancy – spotting or light bleeding can be really common for some women when they are pregnant, but it can signify that something is wrong with your pregnancy so always get it checked out. Bleeding in the first 12 weeks can indicate a possible miscarriage or ectopic pregnancy, and bleeding later on can be due to a serious condition known as placenta previa. A scan and blood test will help your midwife and doctor figure out what is going on, and will hopefully reassure you that all is well.
❚ Bleeding after sex – known as post-coital bleeding, this can be normal for some people, so if you have had it investigated before and all was well, you don’t need to panic. But if this is a new symptom, I would encourage you to get it looked at. The most common reason for getting bleeding after sex is if you have an ectropion (a fragile area on your cervix). Ectropions bleed more easily than normal cervical tissue, and the pressure on the cervix from sex can trigger it off – this is not dangerous and doesn’t indicate any type of cancer, but can be treated if it is troublesome. Women on the contraceptive pill are more likely to develop ectropions. Other causes of postcoital bleeding include infection (especially sexually transmitted ones such as chlamydia), trauma, or polyps on the cervix. Your GP will want to make sure your smear test is up to date as early precancerous changes can present in this way, and need further treatment to ensure they don’t progress. ❚ Bleeding due to contraception – lots of different methods of contraception can lead to abnormal bleeding, including IUCDs, injectables, the implant and the pill (especially if you are a little erratic about the time you take it). This bleeding is usually light, and can occur at any time of your cycle. Even if you are using one of these contraceptive methods, it is safest to get a full check-up to exclude other possible causes. This will include getting swabs done to look for infection, possibly a smear test if you are due one, and a scan if your symptoms don’t settle.
❚ Irregular bleeding – sometimes it is hard to know if ‘‘abnormal’’ bleeding is simply very irregular periods, or is truly abnormal bleeding on top of your normal period. You are more likely to get irregular periods at either end of your ‘‘fertile life’’ – so soon after your periods start, and as you are approaching the menopause. If you are not in these age groups, but have very irregular bleeding, it is worth getting your hormones checked to rule out things like polycystic ovaries or an early menopause.
❚ Bleeding in between your periods – if there is no other reason at all for your bleeding (ie, you are not on a contraceptive that could be causing it, and it’s not related to having sex), you could just be one of many women who get some spotting at the middle of their cycle. This is usually associated with ovulation and isn’t at all dangerous – but you do need to get it checked out to make sure you don’t have anything else going on.