In this article we’re going to look at bleeding after sex, between periods or after the menopause.
What are the symptoms of non-menstrual bleeding?
This sounds like an odd question, but let’s be clear on what we’re talking about. Some women have very light or erratic menstrual periods. For example if you’re nearing the menopause, are very underweight/have anorexia or have polycystic ovary syndrome (PCOS), it can be confusing to know if bleeding is a period or not. So keep a chart or diary of when this bleeding is happening. Also note on the chart when you’re having sex, because bleeding may be related to that.
What causes non-menstrual bleeding?
It can have a number or causes, which often depend on your age/life stage.
Bleeding in young women before the menopause, bleeding between periods or after sex is quite common and can be caused by:
- Cervicitis – inflammation of the cervix (neck of the womb – see the picture). This may be from an infection or from a non-infection cause.
- Vaginal dryness, which may be caused by lack of lubrication or foreplay. The friction during sex can tear the vaginal walls and cause a little bleeding.
- Sores in the vagina or vulva – often caused by sexually transmitted infections.
- Cervical polyps. Polyps are non-cancerous growths that can occur in many places, including the cervix.
- Cervical ectropian. This is when the inner lining of the cervix protrudes through the cervical opening (see the diagram) and grows on the vaginal side of the cervix.
- Trauma from sexual assault.
- Trauma from rough, consensual sex.
- Vaginitis – an inflammation of the vagina. This may be caused by infection or an irritation from an allergy to spermicide, condom material, douches, sprays etc.
- Breakthrough bleeding if you’re on the contraceptive pill. This is quite common in the first few months of taking the pill or when switching brands. It should settle on its own.
The only way to know what’s causing the problem is for your healthcare professional to check the vagina and cervix for any obvious problems.
In the majority of cases of bleeding between periods in young and otherwise healthy women there is no need to worry.
Bleeding in peri-menopausal women – that’s women nearing the time of menopause – can be mistaken for a menstrual period, or the other way about.
In addition to some of the causes above, it can be caused by cervical cancer. If your Pap smear tests have been normal then there should be nothing to worry about and the bleeding is probably from a non-cancerous cause.
Keep a note of when you’re bleeding, how heavily and for how long, and when you have sex. Talk to your healthcare practitioner during a routine appointment if the episodes of bleeding persist.
Bleeding in post-menopausal women. Women who have not had a period for 12 months are said to be post-menopausal.
Doctors take a much more cautious approach to vaginal bleeding in women in this group. They will assume a serious (cancerous) cause until there is proof that it is not. Talk to your physician sooner rather than later but remain calm. Non-cancerous causes of vaginal bleeding include:
- Vaginal dryness and lack of lubrication during sex. The friction during sex can tear the vaginal walls and cause a little bleeding.
- Using Hormone Replacement Therapy.
- Endometrial hyperplasia – the lining of the womb thickens. There are 4 categories. It will be diagnosed by your gynaecologist after tests (see below).
- Cervical polyps or endometrial polyps. These are non-cancerous growths on the cervix or in the lining of the womb.
- Bleeding from sores caused by sexually transmitted disease.
- Trauma or bleeding disorders can also cause vaginal bleeding in any age group.
Types of cancer that cause vaginal bleeding in post-menopausal women:
- Cancer of the cervix.
- Cancer of the lining of the womb (endometrial cancer).
- Ovarian cancer.
- Vaginal cancer (this is quite rare).
- Cancer of the vulva (area around the vagina. A sore area may be obvious when you look).
Remember to talk to your doctor sooner rather than later so that a diagnosis can be made and to give you answers.
What tests will the doctor do for non-menstrual bleeding?
Tests will depend on your age and life stage.
In a young and otherwise healthy woman the doctor may listen to your history of bleeding and menstrual cycle, examine the vagina and cervix using a speculum (see the picture) and take a swab to exclude a yeast or other infection.
She may also suggest swabs and blood tests for sexually transmitted diseases.
In older women, women who are nearing the menopause, who are post menopausal or who have a history of cancer, tests may include:
- Trans-vaginal ultrasound scan – an ultrasound similar to those used during pregnancy is used. The probe is put into the vagina and can then look at the thickness of the walls of the womb. They are thicker in menstruating women than in women who have gone through the menopause.
- Endometrial biopsy – this means taking a sample cells of the wall of the womb. It is sent to the lab and examined under the microscope to look for abnormal cells.
- Hysteroscopy (say hiss-terro-scoppy) – a flexible camera put into the womb via the vagina to physically see inside. Biopsies may also be taken at the same time.
If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault in some way, read this page now: How to talk to a doctor about an embarrassing problem.
For more information about bleeding after sex, look at this page from the Mayo Clinic.