What can cause bleeding in women when they are not menstruating?

Most women of a childbearing age have, on occasion, experienced bleeding when they are not menstruating. This is a very common occurrence and it does not necessarily mean that the woman has a health issue.

Why do women experience this type of bleeding?

The reasons for bleeding of this kind are usually linked to issues with ovulation, administration of hormonal contraceptives, a uterine pathology or pregnancy.

Ovulation issues are most frequent at each end of the age spectrum (very young patients or patients who are going through the menopause). Patients who have polycystic ovary syndrome or issues with thyroids can also have problems of this kind.
Hormonal contraceptives. It is common for women who are taking hormonal contraceptives to experience bleeding, particularly during the first two months of treatment. Should bleeding continue following several months of treatment, specialist gynaecological advice should be sought so that the option of changing to an alternative method can be assessed.
Uterine pathology. It is important to rule out the most common forms of benign pathologies such as polyps and uterine fibroids.
Pregnancy. Occasional bleeding can happen throughout a pregnancy and particularly during the first trimester.

When should this be a cause for concern?

Detecting symptoms or warning signs is key. Specialist advice should be sought when women experience pain with the bleeding that does not recede when common pain relief is administered; when the bleeding is heavier than usual; when it occurs following sexual intercourse; or when the woman also experiences a high temperature, vomiting or discomfort when urinating.
When bleeding occurs and the patient is going through the menopause.
When the woman is pregnant, particularly if the bleeding is similar to or in excess of a period. This applies to any trimester.

Dr Ruth Romero, a gynaecologist at Instituto Bernabeu.

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