Note: This information is for unusually prolonged or mid-cycle bleeding only, if you may be pregnant, have just given birth, or had abdominal surgery, are menopausal, or do not have a menstrual cycle, please consult a doctor about any unusual bleeding.

Bleeding mid-cycle, or at other ‘unexpected’ times–  It is fairly common to experience some light ‘spotting’ around ovulation, or in the week or so before menstruation. Spotting refers to very light bleeding, rather than the ‘flow’ experienced at menstruation, and if it occurs on a regular basis (which you will know if you track your symptoms!) it is unlikely to be a cause for concern, but do let your doctor know that you are experiencing it.

Prolonged or mid-cycle bleeding, usually involves heavier blood loss than spotting, and may be caused by hormonal medication; a hormone imbalance; Polycystic Ovary Syndrome; an internal growth e.g. a fibroid, or polyp; or physical injury e.g. through lack of vaginal lubrication, especially during penetrative sex.

Prolonged or Irregular bleeding, such as spotting, or bleeding between periods, is very common during the first three months of starting hormonal contraception [1]. You may also bleed between periods if you:

• miss any combined pills
• miss any progestogen-only pills
• have a problem with your patch or vaginal ring
• are on the pill and are also sick or have diarrhoea
• have taken certain prescription medicine or St John’s Wort (a herbal remedy) and you’re using the pill, patch, ring or implant
• miss out your pill-, patch- or ring-free week

Other causes;

• Taking the emergency contraceptive pill
• A possible bleeding disorder, such as von Willebrand’s Disease
• Injury of the vagina during sex/ vaginal dryness (the solution for both of these is to use a ph-balanced personal lubricant)
• Having a recent abortion – seek medical advice if you’re bleeding heavily
• Sexually transmitted infections (STIs) such as chlamydia – it’s a good idea to get tested if you’ve recently had unprotected sex with a new partner
• The menopause or polycystic ovary syndrome (PCOS)
• Cervical or endometrial polyps or Fibroids – benign or non-cancerous growths in the womb or the lining of the cervix
• Cervical cancer – if you’re aged 25 to 64, you should be having regular cervical screening tests to detect any changes to your cervix; even if you’re up-to-date with screening tests, you should seek advice about irregular bleeding, particularly bleeding after sex, to eliminate the possibility of cervical cancer
• Womb (uterus or uterine) cancer – this is more common in post-menopausal women, and most cases of endometrial cancer are diagnosed in women over the age of 50; see your GP if you’re over 40 and have bleeding between periods to eliminate the possibility of uterine cancer

Managing prolonged or irregular bleeding/ spotting (i.e. once alternative causes have been ruled out):

Note: The vast majority of prolonged or mid-cycle bleeding is caused by hormonal medications, or contraceptive devices- sometimes the bleeding will settle down after 3-6 months, but if it is affecting your quality of life, you might want to ask your doctor about your options. The following tips will only have a limited effect whilst you remain on the same medication.

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms. We highlight a key step that is especially relevant for those suffering from mid-cycle bleeding, below;

• Try nutritional supplements– Magnesium (100-300 mg daily) [2] and/ or Vitex Agnus Castus (200-500 mg of extract daily) [3] can prevent hormone-related mid-cycle bleeding. Note: Vitex Agnus Castus is not suitable for those who are under 18; using hormonal medication (or devices); are pregnant, trying to conceive, or breast-feeding; or have a pituitary problem.

If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any suggestions, or tips, for managing abnormal bleeding- please let us know– we can share them with others!

Further information:

• NHS page on mid-cycle bleeding- https://www.nhs.uk/chq/Pages/976.aspx?CategoryID=60
• Eve Appeal video – raising awareness of the 5 gynaecological cancers- some of which include mid-cycle bleeding as a potential sign of illness- https://youtu.be/b6211KtYmLk 

Page last reviewed and updated: June 2018

References:

1. NHS (2016) Irregular Periods. [ONLINE] Available at: http://www.nhs.uk/Conditions/Periods-irregular/Pages/Introduction.aspx. [Accessed 30 March 2017].
2. Mauskop A, Altura BT, Cracco RQ, Altura BM. (1997) ‘An open trial of magnesium supplementation for the treatment of migraines and symptoms of premenstrual syndromes in premenopausal women: Effect on serum ionized magnesium level’ Neurology. 1997;48:A261–2.
3. van Die MD, Burger HG, Teede HJ, Bone KM. (2013) ‘Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials’. Planta Med. May;79(7):562-75. doi: 10.1055/s-0032-1327831. Review. PubMed PMID: 23136064.