A few traces of blood between two periods, bleeding after intercourse, or unexpected blood loss can have many causes.
Some are common and benign, notably when changing contraception. Others require assessment: a gynaecological infection, a polyp, a fibroid, an ovulation disorder, pregnancy, or, more rarely, a lesion of the cervix or endometrium.
Unusual bleeding is therefore neither automatically serious, nor something to dismiss.
The context is essential: age, contraception, possibility of pregnancy, frequency of bleeding, amount of blood, associated pain, and whether it occurs after intercourse.
What is meant by bleeding between periods?
This refers to vaginal bleeding occurring outside the expected menstrual period.
It can take different forms:
- a few pink or brown traces;
- light "spotting";
- red bleeding;
- repeated episodes between periods;
- bleeding after intercourse;
- sometimes heavier bleeding.
In modern medical terminology, these situations fall under abnormal uterine bleeding, when a uterine origin is confirmed.
The historical term "metrorrhagia" remains commonly used.
What are the possible causes?
In a woman who is not pregnant, the Assurance Maladie cites among the common causes of bleeding between periods:
- hormonal imbalances;
- gynaecological infections;
- uterine polyps and fibroids;
- lesions or cancer of the cervix;
- endometrial cancer.
Other situations are possible, notably hormonal contraception, certain medications, or ovulation disorders.
Above all, when pregnancy is possible, it must be taken into account in the diagnostic reasoning.
Is bleeding on the pill necessarily worrying?
No.
Irregular bleeding or spotting can occur with hormonal contraception, particularly at the start of a method or after certain changes.
A missed pill can also disrupt cycle control.
But bleeding should not be automatically attributed to contraception if it:
- appears after a long period of stability;
- becomes frequent or persistent;
- becomes heavy;
- occurs consistently after intercourse;
- is accompanied by pain, fever, or other symptoms.
It may then be necessary to look for another cause.
Can you bleed with an IUD?
Yes.
Changes in bleeding depend notably on the type of intrauterine device.
The copper IUD can be associated with heavier periods, particularly after insertion.
Hormonal intrauterine devices can, on the contrary, cause irregular bleeding or spotting at the start of use, before periods often become lighter.
Unusual bleeding associated with significant pain, a possible pregnancy, or other symptoms nevertheless requires assessment.
Can a polyp cause bleeding between periods?
Yes.
Polyps of the cervix or uterine cavity are generally benign but can cause irregular bleeding or bleeding after intercourse.
When the clinical history suggests an abnormality of the uterine cavity, ultrasound or hysteroscopy may be proposed depending on the situation.
NICE guidelines notably consider that persistent intermenstrual bleeding may warrant investigation of the uterine cavity when a polyp, a submucosal fibroid, or endometrial disease is suspected.
Can fibroids cause bleeding?
Yes.
Fibroids are benign tumours developing from the uterine muscle.
They can be asymptomatic or cause notably:
- heavy or prolonged periods;
- irregular bleeding;
- a feeling of pelvic pressure;
- pain, depending on their size and location.
Not all fibroids therefore cause the same symptoms, and the discovery of a fibroid does not necessarily mean it alone explains the bleeding.
Can an infection cause bleeding?
Yes.
Certain genital infections, particularly those affecting the cervix, can cause bleeding between periods or after intercourse.
Depending on the context, the doctor may notably look for a sexually transmitted infection.
Unusual vaginal discharge, pelvic pain, burning, fever, or pain during intercourse are important pieces of information to report.
Why can you bleed after sexual intercourse?
Bleeding after intercourse can have different causes:
- irritation or a small local lesion;
- vaginal dryness;
- infection or inflammation of the cervix;
- a cervical polyp;
- certain changes of the cervix;
- more rarely, a precancerous or cancerous lesion.
A single episode can have a minor cause.
However, recurrent post-coital bleeding deserves a gynaecological examination to determine its origin.
Can bleeding between periods be related to pregnancy?
Yes.
In a woman of reproductive age, pregnancy should be considered whenever it is possible.
Bleeding can occur in early pregnancy for various reasons.
But the combination of a late period or possible pregnancy + bleeding + pelvic pain should draw particular attention, as an ectopic pregnancy is among the diagnoses to be ruled out.
Significant pain, feeling faint, marked weakness, or heavy bleeding require prompt assessment.
Can you bleed around ovulation?
Light bleeding can sometimes be observed around ovulation.
But it is impossible to conclude that bleeding is "simply ovulation" based solely on the day of the cycle.
When bleeding recurs, becomes heavier, or has unusual characteristics, it is best to look for the cause.
Can stress cause irregular bleeding?
Stress can influence the functioning of the hormonal axis and disrupt ovulation or the cycle in some people.
But gynaecological bleeding should not be automatically attributed to stress before other possible causes have been considered.
Saying "it's stress" is not a diagnosis.
What is the PALM-COEIN classification?
Gynaecologists use an international classification proposed by FIGO to organise the causes of abnormal uterine bleeding in non-pregnant women of reproductive age.
It notably distinguishes structural causes:
- P: polyp;
- A: adenomyosis;
- L: leiomyoma, meaning fibroid;
- M: malignancy and hyperplasia;
and non-structural causes:
- C: coagulation disorder;
- O: ovulatory dysfunction;
- E: endometrial cause;
- I: iatrogenic cause, notably certain treatments;
- N: not yet classified causes.
This classification is above all a reminder that the same symptom can have very different causes.
Why is age important?
The likely causes change over the course of life.
In adolescence, cycles can be irregular during the first years following the first period.
During reproductive life, contraception, pregnancy, ovulatory disorders, polyps, fibroids, or infections may notably be considered depending on the context.
In perimenopause, cycles frequently become irregular, but this does not mean every episode of bleeding should be automatically attributed to the menopausal transition.
After menopause, the rule is different.
Can you bleed after menopause?
Bleeding occurring after menopause must be medically assessed.
There are benign causes, notably related to atrophy of the genital tissues or to certain polyps.
But post-menopausal bleeding can also reveal an endometrial or cervical condition.
You should not wait for it to happen again before speaking to a doctor.
How is the assessment carried out?
The assessment is adapted to the situation.
The doctor notably seeks to clarify:
- age;
- the date of the last period;
- the usual regularity of the cycles;
- the amount and duration of the bleeding;
- how often it recurs;
- the contraception used;
- medications;
- whether unprotected intercourse has occurred;
- the possibility of pregnancy;
- pain;
- infectious symptoms;
- personal and family history.
A calendar of periods and bleeding episodes can be very useful.
What examinations might be proposed?
Depending on the context, the assessment may include:
- gynaecological examination;
- pregnancy test;
- full blood count if blood loss is significant or repeated;
- infection or STI screening;
- pelvic ultrasound;
- examination of the cervix;
- hysteroscopy;
- endometrial sampling or biopsy in certain situations.
Not all of these examinations are necessary for every patient.
The choice depends on risk profile and symptoms.
Why might anaemia be checked for?
Significant or repeated blood loss can cause iron deficiency and sometimes anaemia.
Unusual fatigue, breathlessness on exertion, palpitations, dizziness, or pallor may notably lead to a blood test being requested.
When should you consult quickly?
Prompt assessment is necessary notably in the event of:
- very heavy bleeding;
- feeling faint, significant dizziness, or loss of consciousness;
- breathlessness or marked weakness;
- intense pelvic pain;
- possible pregnancy associated with pain or bleeding;
- fever associated with pelvic pain;
- bleeding after menopause.
The ACOG recommends urgent care when very heavy bleeding — for example, requiring you to change protection every hour for several hours — is notably accompanied by dizziness, breathlessness, or chest pain.
Key points to remember
Bleeding between periods has many possible causes.
Contraception, hormonal disorders, infections, polyps, and fibroids are among the common situations. Other causes, notably related to pregnancy, the cervix, or the endometrium, sometimes need to be investigated.
Unusual bleeding does not mean cancer, but its recurrence should not be dismissed.
Bleeding after intercourse that recurs deserves a consultation.
In a woman who could be pregnant, the combination of bleeding and pelvic pain requires particular attention.
After menopause, any new bleeding must be assessed.
Medical information: this article provides general information and does not replace a consultation. In the event of heavy bleeding, feeling faint, significant pain, or a possible pregnancy associated with pain or bleeding, prompt medical assessment may be necessary.
Medical and Scientific Sources
Assurance Maladie. Saignements entre les règles ou règles très abondantes : quelles causes ? Mise à jour 2026. https://www.ameli.fr/assure/sante/themes/saignements-gynecologiques-anormaux/saignements-entre-les-regles-ou-regles-abondantes-longues-les-causes
Brun JL, Plu-Bureau G, Huchon C, et al. Prise en charge des ménorragies : recommandations pour la pratique clinique du Collège national des gynécologues et obstétriciens français (CNGOF). Gynécologie Obstétrique Fertilité & Sénologie. 2022;50:345-373.
American College of Obstetricians and Gynecologists (ACOG). Abnormal Uterine Bleeding. Patient FAQ. https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding
American College of Obstetricians and Gynecologists (ACOG). Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women. Committee Opinion. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/management-of-acute-abnormal-uterine-bleeding-in-nonpregnant-reproductive-aged-women
National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management — NG88. https://www.nice.org.uk/guidance/ng88/chapter/Recommendations
Consult Dr. Yasmine Maazouzi at the Hôpital Privé Beauregard (23 Rue des Linots, Bât. B5 ICOGM, Marseille 13004) for an assessment tailored to your situation.