Intermenstrual and post-coital bleeding

Intermenstrual and post-coital bleeding are very common presenting complaints among women of reproductive age. The majority of cases of unscheduled bleeding in premenopausal women result from benign conditions such as endometrial polyps, infection or from oral contraceptive use. Cervical and endometrial cancers however are associated with abnormal bleeding and therefore it is essential that women with these symptoms are evaluated carefully. The single most important stage in the assessment of women with unscheduled bleeding is a vaginal speculum examination; the presence of bleeding should not delay this essential investigation. Women with risk factors for endometrial malignancy or symptoms suggestive of gynaecological pathology may warrant ultrasound examination and/or endometrial biopsy. This review discusses three common causes of intermenstrual and postcoital bleeding and outlines some of the important considerations in the assessment and management of these patients.