Hi, thanks for the query. I understand your concern. It is important to first understand the cause of bleeding. It may be due to uterine tumors like fibroids [non cancerous], cervical polyps, cervical erosions and cancer of cervix and uterus in older patients. Other reasons are hormonal dysfunction like thyroid or female sexual hormones. To understand the cause a detailed history and physical examination is needed. If you have undergone this, discuss all these issues with your gynecologist. Some conditions like fibroid need an ultrasonography for diagnosis. Endometrial cancer may need a biopsy. It would be of immense help if you could inform me about your age, number of children if any and any other medical disease. For similar women in my clinic, I do a pelvic examination, sonography and a D and C [to collect endometrial tissue, it also helps to tell if there is female hormonal dysfunction] if the above two do not reveal any abnormality So it is recommended that you have at least a vaginal examination, thyroid test as well as sonography done before beginning contraceptive pills. Thanks for using HCM. Feel free to ask any more questions that you may have. Dr Madhuri Bagde Consultant Obstetrician and Gynecologist