Bleeding between periods
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
On this page
- Overview
- What counts as intermenstrual bleeding?
- When to see your GP first
- Common causes
- TCM patterns
- Acupuncture
- Chinese herbal medicine
- Self-help
- Urgent red flags
- Frequently asked questions
1. Overview
Intermenstrual bleeding — spotting or bleeding that occurs outside of the normal menstrual period — is a symptom that should always be investigated medically before attributing it to a hormonal pattern. In traditional Chinese medicine, once serious causes have been excluded, intermenstrual bleeding has clear pattern diagnoses and responds well to treatment with acupuncture and Chinese herbal medicine. I am Dr (TCM) Attilio D’Alberto, a women’s health specialist with over 25 years of clinical experience.
2. What counts as intermenstrual bleeding?
Intermenstrual bleeding is any vaginal bleeding that occurs between regular menstrual periods. Forms include:
- Mid-cycle spotting — light pink or brown spotting around ovulation (day 14 in a 28-day cycle)
- Premenstrual spotting — brown or pink spotting in the days before the period
- Post-coital bleeding — bleeding after intercourse
- Continuous spotting — persistent spotting throughout the cycle
- Postmenopausal bleeding — any bleeding after 12 months without periods (always urgent to investigate)
- Breakthrough bleeding — on hormonal contraception or HRT
3. When to see your GP first
New or unexplained bleeding between periods should always be assessed by your GP to rule out:
- Cervical pathology (cervical ectropion, polyps, dysplasia, cancer)
- Endometrial pathology (polyps, hyperplasia, cancer)
- STIs — particularly chlamydia, which is a common cause of post-coital bleeding
- Pelvic inflammatory disease
- Pregnancy-related bleeding (including ectopic pregnancy)
- Endometrial cancer in women over 40 (postmenopausal bleeding is urgent)
Standard investigation typically includes: cervical screening if due, sexual health screening, transvaginal ultrasound, possibly hysteroscopy, and hormone profiling. TCM treatment is appropriate once these causes have been excluded or treated.
4. Common causes
Hormonal causes
- Mid-cycle ovulation spotting — light pink or brown spotting at day 14 reflects the small oestrogen drop accompanying the LH surge; usually benign
- Luteal phase defect — insufficient progesterone in the second half of the cycle leads to premenstrual spotting (see luteal phase defect)
- Anovulatory cycles — without ovulation, the uterine lining can build up irregularly and shed unpredictably; common in PCOS and perimenopause
- Perimenopause — fluctuating oestrogen and progesterone produce irregular bleeding patterns
- Hormonal contraception — breakthrough bleeding, particularly in the first 3 months, with the implant or progesterone-only pill
- Thyroid disease — both hypo- and hyperthyroidism affect the cycle
- Hyperprolactinaemia — raised prolactin disrupts ovulation
Structural causes
- Endometrial polyps — very common cause of irregular bleeding and post-coital bleeding
- Uterine fibroids — particularly submucosal fibroids
- Cervical polyps
- Cervical ectropion — benign change at the cervical opening; common cause of post-coital bleeding
- Endometriosis and adenomyosis
- Intrauterine adhesions — particularly after surgery
Other causes
- Pregnancy — implantation bleeding, threatened miscarriage, ectopic pregnancy, chemical pregnancy
- Sexually transmitted infections — particularly chlamydia, gonorrhoea
- Pelvic inflammatory disease
- Bleeding disorders
- Anticoagulants and other medications
- Severe stress and significant weight change
- Cervical or endometrial cancer (less common but always rule out)
5. TCM patterns
Kidney yin deficiency with empty heat
Mid-cycle spotting (around ovulation), with night sweats, dry mouth, hot palms, lower back ache. The Kidney yin is insufficient to anchor the rising yang energy at ovulation, leading to vessel instability. Common in stressed women and around perimenopause.
Kidney yang deficiency with luteal phase spotting
Brown or pink spotting in the days before the period, with cold lower body, low libido, watery vaginal discharge, fatigue. Insufficient yang to support the corpus luteum and maintain the lining. Often associated with luteal phase defect and recurrent early miscarriage.
Spleen qi deficiency (sinking)
Pale, watery, prolonged spotting, fatigue, breathlessness, heaviness, easy bruising. The Spleen qi is too weak to hold the blood in the vessels.
Blood heat
Bright red spotting, with thirst, irritability, red tongue, fast pulse. Heat in the blood drives it outside the vessels.
Blood stasis
Dark or clotted spotting, fixed sharp pain, history of fibroids, endometriosis or adenomyosis. Stasis prevents clean shedding and produces leakage at other points in the cycle.
Liver qi stagnation with heat
Stress-driven spotting, irritability, breast tenderness, headache, sometimes accompanied by red eyes or bitter taste in the mouth.
6. Acupuncture
Acupuncture regulates the menstrual cycle by stabilising the hypothalamic-pituitary-ovarian axis, supporting progesterone in the luteal phase, regulating blood flow to the uterus and addressing the underlying TCM pattern. Treatment is timed to the cycle phase — nourishing yin in the follicular phase, supporting yang in the luteal phase. Most patients see meaningful change within 3 cycles of consistent weekly treatment.
7. Chinese herbal medicine
Formulas used:
- Zhi Bai Di Huang Wan — for Kidney yin deficiency with empty heat
- You Gui Wan — for Kidney yang deficiency with luteal phase spotting
- Gui Pi Tang — for Spleen qi deficiency unable to hold the blood
- Xiao Yao San or Jia Wei Xiao Yao San — for Liver qi stagnation
- Gui Zhi Fu Ling Wan — for blood stasis
I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, individually tailored and adjusted phase-by-phase through the cycle.
8. Self-help
- Track your cycle carefully — note when bleeding occurs in relation to ovulation and the period
- Ensure adequate iron intake; check ferritin if bleeding is significant
- Manage stress — chronic stress disrupts the hormonal axis
- Sleep 7–9 hours per night
- Reduce alcohol — impairs hormonal regulation
- Address underlying conditions (PCOS, thyroid, perimenopause)
- If on hormonal contraception, breakthrough bleeding usually settles within 3 months; persistent spotting warrants discussion with your GP
9. Urgent red flags
Seek urgent assessment for:
- Any bleeding after the menopause (12 months without periods)
- Heavy bleeding with dizziness, faintness or signs of anaemia
- Bleeding with severe pelvic pain
- Bleeding in pregnancy or where pregnancy is possible
- Bleeding with fever, vaginal discharge or pelvic tenderness (possible infection)
- Persistent post-coital bleeding
- Bleeding lasting more than 7 days regularly
10. Frequently asked questions
What causes bleeding between periods?
Common causes include hormonal imbalance (luteal phase defect, anovulatory cycles, perimenopause), structural issues (endometrial polyps, fibroids, cervical ectropion), infection (chlamydia), pregnancy-related causes, hormonal contraception, thyroid disease, and rarely cervical or endometrial cancer. New or unexplained bleeding always warrants GP assessment.
Is mid-cycle spotting normal?
Light brown or pink spotting at ovulation (around day 14 of a 28-day cycle) is common and usually benign — it reflects the small drop in oestrogen accompanying the LH surge. Heavier or persistent mid-cycle bleeding warrants investigation.
What is luteal phase spotting?
Brown or pink spotting in the days before the period, often associated with insufficient progesterone (luteal phase defect). In TCM terms, it usually reflects Kidney yang deficiency. Responds well to acupuncture, Chinese herbal medicine and B6 supplementation.
Can stress cause bleeding between periods?
Yes — chronic stress disrupts the hypothalamic-pituitary-ovarian axis, can suppress ovulation and lower progesterone. Both anovulatory cycles and luteal phase defect can result, both of which produce intermenstrual bleeding.
Should I see a doctor for spotting between periods?
Yes — new or unexplained intermenstrual bleeding should always be assessed by your GP to exclude serious causes (cervical pathology, endometrial polyps or hyperplasia, cancer, STIs). TCM treatment is appropriate once these have been excluded.
Can acupuncture help with bleeding between periods?
Yes — once serious causes are excluded. Acupuncture regulates the cycle by stabilising the HPO axis, supporting progesterone in the luteal phase and addressing the underlying TCM pattern. Most patients see meaningful change within 3 cycles.
To discuss intermenstrual bleeding, contact me or book a consultation at my Wokingham, Berkshire clinic.
