Many women are embarrassed about vaginal discharge, but we really shouldn't be. Whilst nobody tends to talk about it, it's something all pre-menopausal women experience. But what if the colour, texture or smell of your discharge changes? We look at what's normal and what's not.
For women who haven't entered the menopause, vaginal discharge usually comes from the cervix and will change in appearance depending on what stage of her cycle a woman is at.
"The cervix - located at the neck of the womb - secretes mucus all the time," explains , consultant gynaecologist and medical director at the , London. "As the body prepares to ovulate, that mucus is quite stretchy and runny due to hormones released by the growing follicle. This mucus-like discharge helps sperm to travel through the uterus and into the tubes to fertilise the egg."
However, once ovulation has taken place, the texture of this discharge changes. "Once a woman ovulates, the mucus then changes to become thick and blobby. Because pregnancy may have taken place, the mucus changes into a thick 'plug' which seals the cervix and stops bacterial contamination during early pregnancy," explains Eskander.
Before your period
Many women experience a brownish tinge to their discharge 2-3 days before their period starts.
"Just before women have a period, they may get a brownish discharge. This is because the disintegration of the lining of the womb happens actually 2-3 days before you see it, meaning discharge may be tinged with a little blood," continues Eskander.
After the menopause
Once menopause has taken place, women are unlikely to experience vaginal discharge (unless they're using HRT).
It could also be a sign of atrophic vaginitis - which might seem odd, when this condition is caused by vaginal dryness, but it also makes you prone to vaginal infection which can lead to discharge and soreness.
In addition, any postmenopausal bleeding should also be cause for concern.
"Most of the time, postmenopausal bleeding is due to vaginal atrophy but cancer of the womb lining must be excluded by examination and transvaginal scan, sometimes with biopsy," explains Eskander.
What your discharge could mean
So, when it comes to discharge, what should women look out for?
A significant increase
If you experience any noticeable change to your vaginal discharge, it could be time to seek medical advice. For example, in the case of a significant increase.
"Even if your discharge remains normal in appearance, an increase that results in you having to wear pads or pantyliners could be a sign that something is wrong," explains Eskander.
One cause of a noticeable increase in discharge could be chlamydia infection.
"This infection can sometimes cause excessive white discharge, as a result of irritation of the cervix," he adds.
Frothy, white-grey discharge
A frothy, white-grey discharge might indicate a vaginal infection, such as bacterial vaginosis.
"Bacterial vaginosis is caused by bacteria commonly found in the gut," says Eskander. "We have lots of bacteria in the gut and naturally the area around the anus, the perineum and the vulva will contain bacteria that come from the colon. If these bacteria are transferred to the inside of the vagina, they may flourish and cause symptoms, including a frothy, white-grey discharge, often with an ammonia or fish-like smell."
Another common vaginal infection is candida infection, or thrush, caused by a fungus known as Candida albicans. This causes a lumpy, cottage cheese-like discharge. Many women experience thrush, particularly after taking antibiotics.
"The vagina normally contains a small amount of the fungus, but this is kept in check by other wonderful and non-harmful bacteria. Normally the vagina has a number of bacteria which make the vagina more acidic, to help prevent infection of the uterus," explains Eskander.
"If women take systemic wide-spectrum antibiotics, it kills all these useful bacteria, allowing fungus infection to flourish."
Another hard-to-ignore symptom of thrush is irritation.
"If there is significant vaginal irritation, even without discharge, it's likely to be thrush. Sometimes with this infection, discharge can appear normal at first, or just slightly thicker than usual - a bit like yoghurt."
"Thrush can be treated with pessaries or oral tablets, and if there is irritation then a cream can be applied," Eskander adds.
If you experience yellow discharge, this could be an indication of an infection in the cervix.
"If the discharge becomes yellow it almost certainly implies bacterial infection," agrees Eskander.
Infections in the cervix can be caused by a reaction to chemicals, such as those found in tampons. However, the discharge may also be a symptom of a sexually transmitted infection (STI), such as genital herpes or gonorrhoea.
As well as a sign that your period is about to arrive, or a potential problem with ovulation, brown discharge can be associated with a vaginal parasite known as Trichomonas vaginalis, another STI.
"This is a nasty little parasite which causes severe irritation," says Eskander. "If it does give a discharge it can cause a brown discharge because it makes the vagina very red and irritated from all this movement."
However, as might be expected, the main symptom of this condition is severe irritation.
Finally, brown discharge may also be caused by a polyp (a fleshy teardrop of tissue) on the cervix or inside the uterus.
"A brown discharge in the vagina or coming out of the vagina is usually associated with bleeding from somewhere. The source of the bleeding could be a polyp on the cervix or inside the uterus. It may also imply there is a problem with ovulation which can cause bleeding between periods," explains Eskander.
As many women experience brown discharge from time to time due to hormonal fluctuations or breakthrough bleeding between periods, with this particular discharge it's worth waiting to see whether the problem resolves itself before seeking medical help.
"On the whole, with this type of discharge, it's safe to wait for a week or two weeks if you don't have any other symptoms. However, if it's consistent after two weeks, or you think you could be at risk of an STI, it's important to consult your doctor," advises Eskander.
When to see a doctor
Although it's hardly the most appealing of symptoms, vaginal discharge can be a good indicator of the health of a woman's reproductive system. If you do experience any changes or are worried, it's important to seek medical advice.