Why Am I Bleeding After My Period?

You’ve just finished your period, feeling relieved and ready to move forward. However, you notice a fresh stain on your underwear a few days later. You may wonder, “Why am I bleeding after my period?” This unexpected bleeding can be unsettling, but it’s essential to understand that it’s not always a cause for concern.

Abnormal post-period bleeding is one of the most common reasons women seek gynecologic care. Women with this complaint may have one or more conditions contributing to their symptoms, like pain or unusual discharge. These symptoms could be the body’s signal to seek appropriate care. Understanding the potential causes and common symptoms of abnormal post-period bleeding among women of reproductive age can impact their overall well-being.

Understanding Post-Period Bleeding

It’s not uncommon to experience post-period bleeding. Vaginal bleeding not associated with a woman’s menstrual cycle is also known as ‘spotting.’ Unlike a menstrual period, it can just require a panty liner. Spotting is usually not as heavy as your regular period, involving only small amounts of pink or dark brown blood. 

What Is Post-Period Bleeding?

Bleeding after a period ends but before the next one begins can occur because of natural processes in the body, such as the drop in estrogen that occurs after ovulation or due to old blood shedding from the uterus after menstruation. No matter the cause, post-period bleeding, also known as intermenstrual bleeding (IMB), is a common occurrence. 

Spotting or IMB is also called abnormal uterine bleeding, or metrorrhagia, which is the medical term for bleeding that happens in between your periods. The average menstrual cycle is 28 days, although it can vary from 21 to 35 days. Spotting between periods occurs when you have uterine bleeding at times outside of the normal menstrual cycle. 

Menstruation, or period, is the regular discharge of blood and tissue formed by the uterine lining through the vagina as part of a woman’s monthly cycle. Most women will experience menstruation from puberty to menopause. It is a natural process in women that occurs when the levels of hormones, including progesterone and estrogen, drop and show that pregnancy has not taken place. While it can be alarming to have IMB since many people can confuse it with being pregnant. However, spotting after period is often a harmless sign. 

How Does It Differ from Normal Menstrual Bleeding?

One key difference between spotting and a period is the quantity of blood. Even when light, period blood is usually more consistent and lasts several days. However, spotting in between menstruation is irregular, and you rarely have other signs of your period, such as bloating, breast tenderness, or change in appetite. 

It is usually a different color from a woman’s regular menses. It can be small pink or dark red spots on your underwear, pad, toilet, or toilet paper. It could also be brown blood or lighter, have a different texture, or smell odd.

Signs of menstrual bleeding include:

• A predictable bleeding pattern
• Time spent not bleeding
• A regular schedule
• Associated symptoms such as breast tenderness, bloating, and menstrual cramps
• Menstrual blood is often red and may have clots or strings of blood.

Signs of spotting include:

• An unpredictable bleeding pattern
• Irregular timing.
• Unexplained spotting is often irregular.
• It may be associated with other symptoms, such as abdominal pain.
• It may be related to hormonal birth control.

Common Causes of Bleeding After Your Period

Scientists are still determining how the bleeding stops at the end of menstruation, and these mechanisms need to be better understood. However, research shows several interconnected processes are necessary to stop menstrual bleeding.

IMB usually happens among women of reproductive age, with spontaneous bleeding between periods being a regular occurrence in 5% of women. Along with heavy menstrual bleeding and irregular menstrual bleeding, IMB falls under the umbrella term abnormal uterine bleeding (AUB). A third of outpatient visits to the gynecologist are for AUB, accounting for more than 70% of all gynecologic consults. 

AUB is bleeding from the uterus that is longer than usual, or that occurs at an irregular time. It is abnormal in regularity, volume, frequency, or duration. Bleeding between periods is a common experience that can arise from various causes, including hormonal changes, contraceptive use, uterine abnormalities such as polyps and fibroids, and, in some cases, certain cancers, as seen with certain AUB. 

Hormonal Imbalances

One of the most frequent reasons for light blood in discharge but not period showing is often due to hormonal fluctuations. These symptoms are not typically a cause for concern, such as when they occur due to adjustments in birth control methods.

A normal menstrual cycle relies on a balance between estrogen and progesterone hormones. Still, if a hormone imbalance occurs, this cycle may be interrupted. These can occur naturally during ovulation (mid-cycle) or due to factors like stress or weight changes. Several conditions can cause hormone imbalances, including: 

• polycystic ovary syndrome (PCOS)
• ovarian insufficiency
• starting or stopping birth control
• thyroid gland problems
• obesity
• insulin resistance

The first step to understanding post-period bleeding is familiarity with your menstrual cycle. Fluctuations in hormones, especially estrogen and progesterone, can cause spotting or light bleeding throughout your cycle. Consider using the Mira app to track your period, symptoms, hormonal patterns, and cervical fluid. This information can be invaluable in identifying patterns and potential causes of bleeding.   

Uterine Fibroids and Polyps

Uterine fibroids and uterine polyps are noncancerous tumors that grow in the external lining of the uterus or the uterine wall or under the uterine lining and can lead to irregular bleeding, spotting, and bleeding after your period. Risk factors include race, age, early puberty, genetic factors, lifestyle, and other factors, such as obesity and high blood pressure.  

Ovulation Bleeding

One out of ten women experience light spotting during ovulation. Some women experience a day or two of light spotting every month. Certain women develop sharp manifests of mid-cycle lower abdominal pain, particularly at the time of ovulation or what is known in the German word as mittelschmerz. 

It can happen due to a brief decline in estrogen levels just after ovulation or when an egg is released from an ovary. The decrease in estrogen causes women to experience symptoms such as brown or pink vaginal discharge or spotting.

The Mira Hormone Monitor helps you differentiate between ovulation bleeding and post-period bleeding. It analyses four essential fertility hormones to get a complete view of your fertility and identify your fertile window and ovulation.

Health Conditions Associated with Post-Period Bleeding

In addition to the common causes of bleeding after your period, there are other reasons why you might have spotting but no period or spotting before period. 

Endometriosis

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (endometrium) is located outside the uterus. Many women with endometriosis have no symptoms, but it occasionally causes spotting a few days before or after your period. The most common symptom of endometriosis is long-term pelvic pain, especially just before and during the menstrual period or during sexual intercourse. 

Pelvic Inflammatory Disease (PID)

PID is usually due to a bacterial infection that spreads from the vagina or the cervix to the reproductive organs higher up. As the infection progresses, pain in the lower abdomen becomes increasingly severe, often with a low-grade fever and nausea or vomiting. It also causes irregular vaginal bleeding and unusual vaginal discharge that can give off a foul odor.

Cervical Lesions

Cervical erosions or lesions can cause abnormal bleeding or excessive menstrual bleeding, especially if you are post-menopausal. In rare cases, spotting may be a symptom of cancers or precancerous lesions related to the reproductive system. These are the cancerous lesions most likely to cause spotting:

• Endometrial cancer
• Cervical cancer

Medications and Contraceptives: How They Can Influence Bleeding

Birth Control Pills and Spotting

Starting on a new hormonal birth control, such as the pill or mini-pill, can change the amount and timing of bleeding since it affects your menstrual cycle. Suppose spotting continues beyond the first 3-4 cycles of oral contraceptive use. In that case, a woman should have her prescription adjusted to a pill containing a higher estrogen: progesterone ratio by either increasing the estrogen dose or decreasing the relative progestin dose.

Impact of Hormonal IUDs on Bleeding

Breakthrough bleeding or breakthrough spotting as the term is commonly used for women who are on hormonal contraceptives such as combined oral contraceptives, intrauterine devices (IUD), vaginal rings, injectable contraceptives, or implants. For the first 3 to 6 months, your period may become irregular, and the number of bleeding days may increase when you have a hormonal or non-hormonal IUD. You may also have frequent spotting or light bleeding when you first start using a hormonal or non-hormonal IUD.

Post-Coital Bleeding and Other Medications

Postcoital bleeding (PCB) is bleeding that occurs immediately after sexual intercourse. It’s not related to a woman’s menstrual cycle; the act of sex itself triggers it explicitly. In contrast, AUB occurs between menstrual periods. It is unpredictable and unrelated to intercourse. 

Several medications, including blood thinners like aspirin, hormonal agents, and neuroleptic drugs, can cause AUB. Herbal supplements such as ginseng, ginkgo, and soy protein can cause spotting. Treatments such as estrogen replacement therapy can also lead to bleeding between periods.

When to Be Concerned About Bleeding After Your Period

Signs That Warrant Medical Attention

It is essential to pay attention to your body. Tracking when spotting is happening and sharing other symptoms with your doctor is critical. Several signs indicate that bleeding after your period requires immediate medical attention. These include:

• Heavy bleeding 
• Prolonged bleeding 
• Pain and cramping 
• Reoccurring post-coital bleeding
• Symptoms such as weakness, fatigue, shortness of breath, or chest pain
• Any unusual vaginal discharge, fever, or changes in bowel habits

What Heavy or Prolonged Bleeding Could Indicate

Heavy menstrual bleeding is quite common; about one-third of women seek treatment for it, as it can be disruptive. It is usually characterized as bleeding that lasts more than 7 days or needing to wear more than one pad at a time and needing to change them every 2 hours or less to control menstrual flow.

It may indicate an underlying health problem that needs treatment since it can lead to iron deficiency anemia. Severe anemia can cause shortness of breath and increase the risk of heart problems. Some of the causes of heavy menstrual bleeding include the following:

• Fibroids and polyps
• Adenomyosis
• Irregular ovulation 
• Bleeding disorders 
• Medications such as blood thinners 
• The copper IUD
• Cancer
• PID
• Endometriosis
• Ectopic pregnancy
• Miscarriage

Diagnostic Tests and Procedures for Post-Period Bleeding

During your visit, your clinician may perform a pelvic exam, obtain cultures, or order blood tests or imaging to examine your condition more closely. They may also change your medication.

Treatment options differ based on the cause of spotting, so it’s essential to consult a healthcare provider if you have concerns about bleeding or spotting between your periods.

Blood Tests and Hormone Panels

The initial investigations for post-period bleeding often include:

• Pregnancy Test (β-hCG): This is crucial in all patients to rule out pregnancy.  
• Full Blood Count (FBC): To assess for anemia and identify other blood disorders.
• Coagulation Profile: This is used to evaluate for bleeding disorders. It is particularly relevant if there is a history of excessive bleeding or bruising.
• Serum TSH level: To assess thyroid function as thyroid disorders can affect menstrual regularity and bleeding patterns.

Ultrasound and Pelvic Exams

A pelvic exam checks the health of the reproductive organs; it involves a doctor or nurse inserting one or two lubricated, gloved fingers of one hand into the vagina and pressing on the lower abdomen with the other hand. This procedure examines the uterus and ovaries’ size, shape, and position.

Doctors commonly use a transvaginal ultrasound to visualize the uterus and ovaries, helping to identify structural abnormalities (e.g., fibroids, polyps, endometrial hyperplasia), pregnancy (if the β-hCG is equivocal or positive), and other pelvic pathology. These are crucial clinical investigations.

Other Diagnostic Options

Depending on the results of the initial investigations and the patient’s clinical presentation, further diagnostic procedures may be considered:

• Hysteroscopy: A minimally invasive procedure involving inserting a thin, lighted scope into the uterus to visualize the uterine lining and identify polyps, fibroids, or other abnormalities. This procedure is usually reserved for cases where ultrasound findings are inconclusive or suggestive of pathology.
• Sexually Transmitted Infection (STI) screening: This should be considered based on the patient’s sexual history and risk factors.
• Cervical Cancer Screening (e.g., Pap Smear): This should be performed if the patient’s cervical cancer screening is not up-to-date.
• Drug Interactions: Explore potential drug interactions that could affect bleeding patterns.

Treatment Options and Self-Care Tips

Post-period bleeding is a symptom with many causes. Therefore, a single management strategy or treatment option is unlikely to meet all patients’ needs. However, self-care tips for individuals include maintaining good hygiene and keeping a detailed record of your menstrual cycle and any instances of vaginal bleeding.

Medical Treatments for Underlying Conditions

The main goals in post-period bleeding are addressing and correcting the underlying primary cause. It may include medications to regulate hormones, surgery to remove fibroids or polyps, antibiotics for infections, or specialized cancer therapies.

Lifestyle Changes and Natural Remedies

Lifestyle changes can alleviate mild post-period bleeding. Maintaining a healthy weight, eating a balanced diet, and getting enough sleep are beneficial. One natural remedy to consider is Mira Fertility Tea, a specially formulated tea blend designed to support a healthy menstrual cycle and promote overall well-being.

Managing Stress and Hormone Balance

Stress can disrupt your hormones and contribute to irregular bleeding. Stress reduction techniques like meditation or yoga may also help, as stress can affect hormone levels and menstrual cycles. For example, Mira Fertility Meditations are guided meditations that can help you manage stress and promote relaxation.

Frequently Asked Questions