Women's Health: Abnormal Bleeding, Persistent Pain and When to Get Help

Emergency signs: act now

In the US, call 911 (or your local emergency number elsewhere) if you have:

• Pelvic or belly pain that is severe, getting worse, or hurts when you move or touch the area. [1]
• Pelvic pain with fainting, dizziness, pain in the tip of the shoulder, difficulty breathing, sudden confusion, or heavy vaginal bleeding. [1]
• Bleeding in pregnancy with severe belly pain, shoulder pain, nausea with faintness, or heavy bleeding that soaks a pad soon after you put it on. [2]
• Sudden, sharp, intense belly pain with dizziness, fainting or looking very pale if you could be pregnant, which can signal a ruptured ectopic pregnancy. [3]
• Confusion, drowsiness or difficulty speaking with a suspected urinary infection. [4]

If you are thinking about harming yourself or your baby, call or text 988 (US Suicide & Crisis Lifeline, free, 24/7). Postnatal depression and PMDD can include thoughts of suicide or self-harm. [5][6]

This page uses NHS (UK) pages for warning signs because they were readable and recent. They name UK numbers; we have replaced them with US equivalents. Use your own local emergency number outside the US.

Same-day or prompt care

Book an appointment

• Bleeding after menopause (12 months without a period): get it checked, even if it is light or happened once. [8] It is not usually serious but can be a sign of cancer. [8]
• Heavy periods: needing to change protection every 1 to 2 hours, clots larger than about 2.5 cm, periods over 7 days, or bleeding that limits daily life. [9] Also tiredness or breathlessness, which can reflect iron deficiency anemia. [10]
• Bleeding between periods or after sex. [9]
• Periods that become more painful, heavier or irregular, pain with sex, urinating or bowel movements, a swollen belly, loss of appetite or unexplained weight loss. [7]
• Persistent pelvic pain or bloating that comes and goes or does not go away. [1]
• Recurrent UTIs: 2 in 6 months or 3 in 12 months. [4]
• Vaginal dryness lasting a few weeks, with unusual discharge, or with bleeding after sex. [11]
• A lump or bulge in or around the vagina. [12]
• Menopause symptoms affecting daily life, a fast heartbeat, or bleeding that gets heavier rather than lighter. [13]
• PMS not helped by lifestyle changes. [6]

See the topic pages: period pain, heavy and irregular periods, urinary tract infections, perimenopause and menopause, pelvic floor and pelvic pain.

Hormone-sensitive conditions and supplements

If you have or have had a hormone-sensitive cancer (such as breast, uterine or ovarian), talk to your clinician before using herbs. NCCIH says it is uncertain whether black cohosh is safe in these cases and that chasteberry may not be safe. [14][15] The NHS notes some herbal remedies may cause serious side effects with other medicines. [16] Pregnancy: black cohosh, red clover and chasteberry may be unsafe in pregnancy and breastfeeding. [14][17][15]

Never stop prescribed medicine to try a supplement. Read:

• Medication interactions


• Pregnancy and breastfeeding safety


• Existing conditions and natural remedies


• Talking with a health professional


• Black cohosh, soy, red clover and hormone claims

What to bring to an appointment

A symptom diary helps: the NHS suggests recording PMS symptoms for at least 2 cycles, and tracking periods with a diary or app. [6][18] The NHS advises bringing any medicines you take when you go for emergency care; a list of your supplements is also useful. [1]