MENSTRUATION: BLEEDING BETWEEN PERIODS
Sometimes the bleeding will occur after having sex, maybe a day later. This may give the impression of having bleeding fairly often, depending on how often you have sex. Another common story is light bleeding in the week or so before the period is due to arrive, particularly in women on the oral contraceptive pill.
Some women may naturally have a light bleed, more like a Wood-stained discharge, around the time of ovulation. However there are important causes which need exclusion.
Infections may cause intermenstrual bleeding. Women who have never had sex arc unlikely to have a significant infection, but it should be considered in women who are sexually active. There may or may not be other symptoms of infection, such as vaginal discharge or pelvic pain. Infection with chlamydia, in particular, is often associated with intermenstrual bleeding. As some infections can affect fertility it is important to diagnose and treat them.
Endometriosis is another condition which may be associated with light, sometimes painful, intermenstrual bleeding.
Bleeding may be corning from the cervix. Pre-cancerous and cancerous lesions, or even a ‘normal’ variation like a large erosion may lead to bleeding between periods. Smear tests and closer examination of the cervix will help to identify abnormalities.
In older women, particularly, there is a need to exclude a more sinister cause of abnormal bleeding; cancer of the uterus. This is incredibly rare in younger women (under 40 years), and not all that common in older women (about one in a hundred women will develop it), but you would not want to miss it. Most women over 35 who have abnormal bleeding will be offered a curette or hysteroscopy in order to help with the diagnosis, and exclude cancer as a cause.
‘Breakthrough bleeding’ is a fairly common occurrence in women taking the oral contraceptive pill. It may be light bleeding, or more like a period. If the level of hormone floating around the blood stream happens to be lowered bleeding may occur. The level may drop if you miss a pill, or you are late taking it, have gastro, or because other medicines, like antibiotics, interfere with the absorption of the pill. This is usually no cause for alarm. You should continue the pill and, as the hormone level has dropped, you may be at risk of getting pregnant. To avoid this you should take extra precautions, like using condoms, or not having intercourse, for the time of risk (during the course of antibiotics, or gastro), and for at least seven hormone tablets later.
Some people have breakthrough bleeding on some pills, even without missing any. These women will often be offered a slightly different pill preparation (there are several different dosages and types). A different pill may not cause the same problem. However, it is important that other causes for intermenstrual bleeding are ruled out.
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Tags: Women’s Health