Most of us have a period that lasts between 5 and 7 days. And the average menstrual cycle (counted from the first day of your last period to the first day of your next one) is about 28 days.
But, of course, our bodies don’t always follow the rules. And many people who menstruate experience things like:
- Unusual or irregular cycles
- Spotting or bleeding between periods
- Longer than normal periods
Because there are no absolute hard and fast rules, it can be difficult to tell what’s “normal” when it comes to menstrual cycles. And, so, many people are confused by their own periods and menstrual cycles.
This isn’t helped by the fact that some still find it uncomfortable to discuss these things. So, let’s try to clear up some of the confusion and to understand why you could experience bleeding after menses.
End of Period or Something Else?
If you’re bleeding *right* after your period. It might simply be one of the lighter days at the end of your period.
The light days at the beginning and end of a period can manifest more as “spotting” and can often confuse you whether your period has begun or is still ending, or if there’s something else happening. The blood at the beginning and the end of a period is often a brown color (as it’s older blooder).
But, if your period has ended and you start bleeding between periods, a good first step is to understand if you’re bleeding or spotting.
Are You Spotting or Bleeding Between Periods?
Monthly periods (menses) typically include lighter and heavier days. Some describe the lighter days at the start or end of their period as spotting. However, although it can be difficult to tell the difference, menstruation, spotting and non-period bleeding between periods are different.
In general, spotting is any kind of light bleeding that occurs outside of menstrual bleeding (i.e. the shedding of the lining of the uterus). While spotting has a lot of different causes (see below), it is generally lighter and does not require more than a panty liner.
If you experience heavy bleeding that is not your period, you should seek immediate medical care. Here’s an overview to help you tell the difference:
What Could Cause Bleeding After a Period Ends?
There can be many explanations of vaginal bleeding between periods. Some of these definitely warrant a visit to the doctor and others are less concerning. This list is not exhaustive, but includes the most common explanations for bleeding or spotting between periods (intermenstrual bleeding).
Birth Control / Hormonal Contraceptives Causes
- Birth Control Pills / Hormonal Contraceptives: According to Medical News Today, bleeding often occurs in the first 6 months of taking a new birth control pill. Doctors sometimes refer to this as breakthrough bleeding.
- Morning-After Pill: According to the Mayo Clinic, the morning-after pill can cause spotting between periods or heavier menstrual bleeding.
- Intrauterine Device (IUD): Some individuals with an IUD for birth control may also experience abnormal uterine bleeding.
- Trauma or Medical Examination: If you’ve experienced rough sex or a medical exam like a Pap test, you may experience abnormal vaginal bleeding.
- Medications: Certain medications may cause changes to hormone levels which cause abnormal vaginal bleeding. Your pharmacist should advise you of any side-effects of medications.
- Stress: Stress can trigger many reactions and changes in hormone levels.
The following infections can cause spotting between periods. It’s worth noting that most infections are treatable. However, infections can become more serious if ignored.
- Sexually Transmitted Infection (STI), including chlamydia, gonorrhea, and genital warts.
- Pelvic Inflammatory Disease (PID), an infection of the upper part of the female reproductive system.
- Ovulation: When the ovaries release the egg, a tiny follicle ruptures to allow the egg to be released. This can be a cause of bleeding or bloody discharge for a day or so.
- Implantation bleeding: After a sperm fertilizes an egg, the egg implants in the womb. Sometimes, implantation causes light bleeding known as implantation bleeding.
- Ectopic Pregnancy: Signs and symptoms of an ectopic pregnancy include abdominal pain and abnormal vaginal bleeding.
- Pregnancy: According to the American Pregnancy Association, 20% of women experience spotting during the first 12 weeks of being pregnant.
- Miscarriage: Heavy spotting is one of the symptoms of miscarriage.
- Breastfeeding: Depending on the frequency of breastfeeding and your own individual hormones, spotting may occur before full periods return.
- Fibroids or Polyps: These benign tumours can cause irregular or heavy periods and vaginal bleeding between periods.
- Endometriosis: According to the Mayo Clinic, women with endometriosis may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
- Polycystic ovary syndrome (PCOS): PCOS can cause cysts in the ovaries and make it difficult to get pregnant. It can also cause irregular vaginal bleeding.
- Blood clotting disorders, like von Willebrand disease.
- Other health conditions, like hypothyroidism, liver disease, or chronic kidney disease.
- Cancer: Cancer or pre-cancer of the cervix, uterus, or (very rarely) fallopian tube can cause spotting or abnormal vaginal bleeding.
Perimenopause & Menopause
- Perimenopause: The time before menopause is known as perimenopause. During perimenopause, hormones fluctuate greatly. These hormonal shifts can have an effect on ovulation and your entire menstrual cycle. Some women notice irregular or skipped periods and abnormal vaginal bleeding between periods during perimenopause.
- Vaginal dryness, especially due to lack of estrogen after menopause, can cause bleeding.
- Cancer: According to the Dana-Farber Cancer Institute, spotting in post-menopausal women can, in some cases, be an early sign of cancer and should always be investigated further.
When to Seek Medical Advice: Signs & Symptoms
If you’re experiencing significant bleeding after your period, you should definitely schedule a visit to the doctor. Significant vaginal bleeding may increase the risk of anemia so it’s wise to monitor how much you’re bleeding.
Keep track of the number of pads or tampons used when you’re bleeding. Abnormal blood loss can be estimated by tracking the number of pads or tampons used and how quickly they become soaked.
If you’re taking pain medications, aspirin should be avoided, as it may prolong bleeding.
If irregular vaginal bleeding is is accompanied by any of the following symptoms, it warrants a trip to the doctor:
- Heavy periods with a lot of clotting
- Irregular periods
- Abdominal pain or cramping
- Pain or a burning sensation when peeing
- Unusual vaginal discharge and/or redness and itchiness
Even if you don’t have any of the above symptoms, don’t ever ignore abnormal vaginal bleeding or abnormal uterine bleeding in the following situations:
- If you think you’re pregnant: You should always see a doctor as soon as you think you may be pregnant to be administered a pregnancy test.
- When it happens inconsistently: If spotting between periods seems to happen frequently and randomly, you should definitely look into it.
- It begins after unprotected sex: Unprotected sex can put you at risk for STIs and other infections. If you notice spotting after unprotected sex, it’s wise to visit a doctor.
- You are on medication that may also cause bleeding: If spotting can be a side-effect of any medication you are on, you should seek out professional help.
- Spotting occurs post-menopause: It is never considered normal for anybody post-menopause to experience spotting or vaginal bleeding.
Questions the Doctor Might Ask
It’s very natural to be nervous about seeking medical advice. But it’s also smart to remember that a doctor may be able to quickly resolve a concern that’s causing you much stress and many sleepless nights.
So, if there’s anything about your cycle that’s causing you concern, we definitely recommend biting the bullet and booking that doctor’s appointment.
When you see your doctor, she may need to know:
- How long this has been happening: Is it something you’ve always experienced or did it start recently etc.
- How often it happens: Is it monthly or irregular? Is this the first time it’s happened?
- If there’s a pattern to the bleeding: Have you observed the bleeding happens certain days in your menstrual cycle or seemingly at random?
- How long did the bleeding last: 1-2 days or more?
- How heavy was the bleeding: Did you use any protection? Was a panty liner insufficient?
- Was there anything unusual about the blood: Color, texture or odor?
- Did you also experience pain or other symptoms while you were bleeding?
- Did the bleeding coincide with any increased physical exertion (sex, exercise etc.)?
- Was there anything you did that seemed to make the spotting worse or better?
Based on your answers, the doctor may need to perform certain tests etc. Treatment and outlook will always depend on the cause. But you’ll have taken a step in the right direction by seeking medical advice.