Interim vaginal bleeding

Intermediate vaginal bleeding is bleeding at unexpected moments, between menstrual periods. Sometimes very intense and sometimes no more than a pink or brownish discharge. In more than half of the women, no cause is found for interim bleeding. Especially if you bleed on fixed days, it is usually due to fluctuations in the amount of hormones in the blood. The hormones estrogen and progestogen will probably work less regularly. However, this is harmless and often goes away on its own.

Irregular bleeding

When it is not really clear when your period starts or ends, this is called irregular bleeding. This phenomenon often occurs in the years after the first menstrual period and in the run-up to the menopause. Hormone fluctuations are usually the cause. Intermediate blood loss on alternating days can also be the result of these fluctuations.

In some cases there is a clear cause:

• use of medicines (the pill or spiral, but also corticosteroids)
• abnormally progressing pregnancy (miscarriage or ectopic pregnancy)
• abnormality of the vagina (e.g. inflammation)
• inflammation of the cervix (e.g. due to chlamydia)
• abnormality of the cervix (polyp, abnormal cells, (pre-stage of) cervical cancer)
• abnormality in the uterine cavity (polyp, myoma (fibroid), adhesion)
• conditions such as endometriosis or polycystic ovary syndrome

after sex

When some blood comes out of the vagina after sex, we call this a contact bleeding. Sometimes you bleed immediately after sex, but the blood loss can also follow a few hours afterwards. It can be little – just a few drops or a brownish or pink discharge – but also a lot more. Sometimes even heavier than menstruation.

Blood loss after sex can have various causes. The so-called ‘first time’ is perhaps the best known. It is certainly not the case that all women bleed during their defloration, but the edge at the beginning of the vagina – the hymen – can tear a bit. In addition, there may be ectropion: the inside of the cervix then lies on the outside. This is normal during the fertile period.

A wound in the vagina can also cause bleeding, just like an inflammation of the cervix, for example due to chlamydia. That same cervix can show abnormalities such as a polyp. Bleeding after sex can also indicate abnormal cells and therefore a (preliminary stage of) cervical cancer.

After the transition

Only when you have not had a period for more than a year, you will know for sure when the last period – the menopause – was. If you lose vaginal blood again afterwards, then you have vaginal bleeding after the menopause.

The mucous membrane of the uterus, cervix and vagina can be thinner, drier and more fragile after the menopause, causing bleeding earlier. For example after sex. Furthermore, polyps, fibroids or abnormalities of the cervix or cavity can also cause blood loss after the menopause. One in ten women with postmenopausal bleeding is diagnosed with a malignant condition: cervical cancer or cancer of the uterine cavity. The chance that the blood loss points to cancer increases with age. Nevertheless, even after the menopause, no cause is found for the bleeding in more than half of the women.

What to do?

It can be helpful to keep track of when you are losing blood. In addition to the bleeding, also record any medication you have taken, whether you have had sex and whether you had any bleeding during or after sex. All of these things can help identify the cause.

Vaginal bleeding is often caused by hormonal fluctuations that are harmless and will go away on their own. If you have a lot of pain, you may want to consider using contraception. Despite the often innocent nature, the unpredictability sometimes causes anxiety and tension. Prolonged blood loss can also cause anemia.

Are you worried, do the complaints last longer than three months or do you have blood loss after sex or menopause? Then it is advisable to consult with your doctor. It is also better to make an appointment with your GP if you have pain complaints or if the degree of blood loss increases. He can do a Pap smear, do an STI test, or refer you to a gynaecologist.

All kinds of follow-up examinations are possible at the gynecologist. For example, he can visualize the mucous membrane of the uterus using an internal ultrasound. Sometimes water is also introduced into the uterus using a tube (water ultrasound) to check for polyps and fibroids. A hysteroscopy (examination of the uterus) is also possible. Further treatment is highly dependent on the cause.