Bleeding is a fact of life for most women, as a normal part of the menstrual cycle and not immediate reason to panic.
But bleeding can also be a sign that something’s wrong.
Dr Rebekah Hoffman, chair of the Royal Australian College of General Practitioners for NSW and ACT, says it’s very common for women to delay seeking help for abnormal or heavy bleeding.
“It’s expected that women bleed frequently,” she suggests as a reason for this complacency.
“It’s not talked about how much bleeding is normal, and people can presume that their levels of bleeding are really normal when in fact they’re double protecting, they’re actually flooding (bleeding out),” she says.
About half of Australians, for example, do not seek medical help for heavy periods despite these having a debilitating effect on their lives. Meanwhile, menstrual stigma – a sense of shame and lack of education around periods – is common.
From abnormal to heavy bleeding, vaginal or rectal bleeding, we spoke to the experts about when this might be a cause for concern.
Menstruation or between cycles
“There are lots of things that can cause bleeding in between cycles, and some of them are very benign, but some of them are concerning,” says Professor Louise Hull, an obstetrician gynaecologist and head of the endometriosis group at the University of Adelaide’s Robinson Research Institute.
This could be anything from a polyp to an abnormal pap smear or hormonal changes, she says.
“If it’s persistent or ongoing outside of the menstrual cycle, it’s worth going and seeing someone. Many things are easily treated or investigated,” she says.
Heavy or abnormal uterine bleeding is fairly common and might, for example, be a sign of endometriosis, which affects about one in seven women.
Research from the Australian Longitudinal Study on Women’s Health, published last year, found the prevalence of heavy menstrual bleeding increased from 17.6 per cent at age 22 years to 32.1 per cent at 48 years.
Abnormal vaginal bleeding is also a common symptom of uterine cancers, rates of which are rising faster than any other type of women’s cancer in Australia, with the sharpest increase among women aged 25 to 40.
Perimenopause or menopause
Menstrual disturbance or irregularities are common during perimenopause or menopause due to changing hormone levels.
“Lots of women find their bleeding gets heavier, and the frequency of their periods gets closer together before they stop,” Hoffman says.
“Often, people will bleed more in the 12 to 18 months before they stop bleeding … it can be like being a teenager again, where it’s really hard to manage. And that can be really distressing.”
While this can be normal, Hoffman says heavy or abnormal bleeding should always be checked by a medical professional.
Hormone replacement therapy (HRT) can also cause abnormal bleeding.
“Sometimes it’s a bit of adjusting to the medication,” says Hull, but left untreated it can lead to something more malignant.
Pregnancy and early postpartum
Any bleeding during pregnancy is considered abnormal, says Hull, and a sign to seek medical attention.
“Particularly in early pregnancy, we want to make sure the little one’s fine, the hormones are OK, and the pregnancy’s well supported. Sometimes it [bleeding] can be associated with a miscarriage or an ectopic pregnancy,” she says.
“About half the time, people will get some bleeding, and usually, it’s as the placenta grows, it can grow into a little blood vessel, and you get a bit of bleeding, and it settles down, but you’d always want to get that checked out.”
In early postpartum, Hull says some bleeding is expected two to four weeks after giving birth and this should progressively lighten.
However, Hoffman says that if bleeding continues, or gets heavier and is accompanied by other discharge, odour or fever, you should seek medical attention.
Bleeding during or after sex
Bleeding during or after penetrative sex can be caused by friction or dryness.
“Especially if you’re using any toys or anything like condoms or things that you’ve not used before, you might cause some inflammation or some irritation,” Hoffman says.
But post-coital bleeding can also be a sign of cervical cancer, so she urges anyone experiencing it to consult a healthcare professional and ensure they’re up-to-date with their cervical cancer screening.
Other times, it can be a matter of a benign polyp or soft cells sitting close to the surface of the cervix, says Hull, which can be a simple fix.
Bleeding from your rectum
“Any bleeding is abnormal coming from the rectum and needs an examination,” Hoffman says.
“That might be a hemorrhoid that’s bleeding, a fissure or a little tear, some people eat beetroot and then after their stools look like there’s blood. And that’s a very benign cause, but essentially, you need to have a chat to your GP.”
Bleeding from the rectum is a common symptom of bowel cancer – which Hoffman points out is becoming more common among younger Australians.
“It’s important to know your family history of bowel cancer, and what age they were diagnosed because that would change what our recommendations were for testing,” says Hoffman, who urges everyone to have conversations with family about rectal bleeding and what it means.
Endometriosis around the bowel can also cause bleeding in this area, Hull adds.
What to do if you notice bleeding
If you’re experiencing any unexpected bleeding, the best thing to do is seek medical advice, whether or not it’s accompanied by pain or changes in blood colour.
“It’s a matter of any change in your symptoms, whether you’ve seen it once, whether you’ve seen it twice, whether you’ve had it before,” Hoffman says.
Finally, she urges people to remain up to date with screenings – which for bowel cancer now starts at age 45, and for cervical cancer, starts at 25.
Advice here is general in nature. Always talk to a healthcare professional if you are concerned about any of the symptoms below, and call 000 if you are experiencing heavy bleeding or severe pain.
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