A comprehensive guide to understanding why you spot in between periods.
Spotting before periods is a frustrating bodily function that women may or may not understand. For all those times you had to throw out a new pair of underwear, for all those times you panicked in your white jeans, and for all those times you thought there was something wrong with your reproductive system, we’re setting the record straight. We have dived into the top 29 reasons why you would spot before your period. But first, we need to define spotting and understand how it affects you and your body.
What is spotting between periods?
A normal menstrual cycle occurs every 28 days, followed by menstrual bleeding that usually lasts for about 4-7 days. It doesn’t have to be exactly 28 days interval but can range from 21 to 35 days. Young girls may experience their periods somewhere from 21 to 45 days or more apart. Women in their 40s will frequently have less frequent menstrual cycle. Some women experience menstrual cycles for longer times, some women experience less.
Spotting is the vaginal bleeding after your menstrual period and before your next period. It can be a pink or brown spot on your underwear or toilet paper while wiping. Spotting can also be noticed as a blood spot or two, or more, and can even potentially resemble a menstrual period. Spotting can occur for many reasons, ranging from normal to abnormal. Sometimes too, it is difficult to ascertain the real cause. If you think you may be experiencing spotting check to ensure that the bleeding is coming from the vagina and is not from your rectum or the urine. To check that the bleeding is coming from your vagina, cervix or uterus, insert a tampon into the vagina. If you are still not sure, a careful medical examination by your health care provider is most frequently the best way to discover the source of the bleeding. The medical exam can be done even while you are bleeding.
Diagnosis of abnormal uterine bleeding
To discover why you are spotting, your medical personnel may conduct a number of tests which includes the following:
- General examination
- Examination of your medical history
- Examination of your menstrual history
- Physical examination
- Carrying out Pap test and blood tests
- Vaginal ultrasound
- Endometrial biopsy.
The Difference Between Spotting and Bleeding
Spotting is any light vaginal bleeding which you experience in between your monthly period. You are experiencing spotting when you notice a few drops of blood every now and then on your underwear. The quantity is not usually enough to fill a pant liner. Bleeding on the other hand, is a heavier form of blood flow. When you are bleeding, you will need a pant liner or pad to prevent the blood from soaking your clothes.
*Using the traffic light colors, we have determined if the cause is low, medium, or high risk. Use this measure as a reference, but consult your doctor when making health decisions.
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Low-risk reasons for spotting before period
1. It’s your first period. EVER.
For many girls, your first few years of menstruating are very new and confusing marked by painful feelings like cramps, tampons and pads, and irregular menstrual cycles. Not only do girls experience these off-schedule menstrual periods, many girls experience spotting. This is normal and is usually just a hormonal misstep that makes our uterine lining shed at the wrong time of the month. Essentially, this means our bodies are trying to understand this new “feature” and work out all the nuances of our reproductive system and “becoming a woman.”
2. You have done something new with contraceptives.
Millions of women in the US use some form of birth control. Spotting is a common and normal side effect if you are starting, stopping, or switching birth control medications. Estrogen helps keep the lining of the uterus in place. Changing or messing with the estrogen levels in your body as a result of varying your birth control use could lead to spotting in between periods. This type of spotting does not last for longer than 1-3 months as your body tries to adapt to the new estrogen levels.
Spotting is usually a side effect of using hormonal contraceptives which may include a combination of oral contraceptive pill, injections of long-acting artificial progesterone, a rod containing slow-release progesterone usually inserted in the upper arm, or intrauterine system devices that releases progesterone implanted into the womb. Treatments that involve progesterone alone frequently result in spotting. Spotting here usually occurs as a result of the drop in hormone levels.
When you start taking hormonal contraceptives, it is common to experience spotting around two weeks after your last period. Your periods will normally get back to the standard routine within six months. The spotting caused by hormonal contraception should usually stop after a month or two of starting but may reappear when ceasing it.
Spotting can also occur with birth controls such as an intrauterine device (IUD). An IUD is a device that is inserted into the uterus and left to prevent pregnancy. The hormones in the IUD are slowly released, which controls the menstrual cycle and reproduction abilities. However, in the first three to six months, it is very common to spot from an IUD, even if the doctor has used a hormonal or copper IUD. Intrauterine device (IUD) acts as a foreign body in your womb can prompt spotting or heavy bleeding. The spotting should subside over time though and is a completely normal side effect.
If you use hormonal contraceptives like a depot injection or rod, you may experience spotting between your first two or three periods after the installation.
When you are on contraceptive, you may as well experience spotting if you skip one of your oral contraceptives.
Hormone replacement therapy used for treatment of menopausal symptoms can also cause spotting.
3. You just took the morning after pill.
Emergency contraception, AKA the morning after pill, can cause light spotting. Although it is not a side effect, the hormones in the medication (either progestin alone or progestin combined with estrogen) can cause women to bleed at off menstrual cycle times. This type of spotting is completely normal. However, it is important to note that this does not indicate you have your period, and therefore does not signify you are not pregnant.
4. You have implantation spotting.
Some spotting is normal very early in pregnancy. If you are spotting, but your period isn’t due for another few weeks, it could be because of implantation spotting. Implantation spotting, or implantation bleeding, is when a fertilized egg attaches itself on the inside wall of your uterus. When the embryo implants in the uterus, tiny blood vessels can erupt and cause the expectant mother to spot, usually a pink or brown type of discharge. Implantation spotting usually occurs before your next period and five to ten days after conception. Approximately 1/3 of women who reported having experienced implantation spotting claimed that this type of spotting was different than menstrual spotting. Reasons included the different color in the spotting (blood is darker than period blood), texture (more discharge like), and pain associated with spotting (cramps at the same time). The risk level is low, but If you have had an ultrasound that confirms you are pregnant, you need to get in touch with your doctor right away. Spotting can be a sign of an ectopic pregnancy where the fertilized embryo develops outside the uterus. Ectopic pregnancy when left unattended to can be life-threatening for the woman.
5. You are experiencing ovulation spotting.
Ovulation spotting is very regular for certain women and is nothing to be worried about. Women can notice spotting a day or two into ovulating. When you ovulate, it is common to experience light spotting, usually pale pink in color. There are several potential reasons for ovulation spotting. For example, it can be caused by the surfacing of ovarian follicles. When a follicle matures and bursts, it can cause mild pain and some light bleeding. An increase in your estrogen levels during ovulation can result in light spotting or bleeding. It is also important to note that ovulation time is when you are most fertile. Be sure not to mistake this type of spotting with menstrual spotting!
6. You are perimenopausal.
When you approach menopause, you may start to experience pink or brown spotting and even light bleeding before your period. During this transitional stage, your periods may be more irregular, sometimes heavier, and you may have occasional spotting about a week before your period. Ovulation occurs in the middle of your cycle, followed by menstruation approximately 2 weeks later. When you are in perimenopause, your hormone levels may become irregular and not follow this usual pattern. Once you enter menopause, all menstrual bleeding stops. However, if you are bleeding into this stage, it is important to consult your doctor and seek immediate attention. Hormonal replacement can be a common cause of vaginal bleeding in menopause, but spotting could also be a sign of cancer or other serious conditions that require medical attention.
7. You have vaginal dryness.
Vaginal dryness, or vaginal atrophy, is a common cause of spotting. It occurs when vaginal tissue is no longer moist and elastic, and becomes irritated due to a change in estrogen. When the production levels of estrogen are disrupted, it can cause the vagina to feel itchy, dry and irritated. Women who are in menopause tend to experience vaginal dryness more often than women who are not. This is because their ovaries are producing less estrogen, which leads to a thinner vaginal tissue layer and a reduction in the number of lubricating glands. However, women not in menopause can experience vaginal dryness. For women who are experiencing vaginal dryness and are definitely not near perimenopause, there are many factors that can create this condition. Childbirth and its aftermath, friction during sexual intercourse, hormone treatments, contraceptives, medications such as antidepressants, and reactions to substances such as alcohol can trigger vaginal dryness. If you are still menstruating, vaginal dryness is usually nothing to worry about. If you are spotting during menopause from vaginal dryness, consult a doctor immediately.
8. You are stressed.
Stress can cause about almost anything in your body. It can create many imbalances in your body and spotting is no exception. Emotional stress (depression, anxiety, worry, insomnia) and physical stress (weight loss or gain, illness, poor diet, over exercising) can affect your period cycle. This is because extreme stress can cause your body to release more amounts of the hormone cortisol, which then causes your body to release less estrogen and progesterone. This hormonal imbalance can mess up your period cycle, and can make them irregular or late, and cause spotting in between. While exercising is a good reliever of stress, over-exercising can also cause an absence of menstruation (amenorrhea) and cause you to spot.
9. You have a decline in estrogen.
One out of ten women experience light spotting during ovulation in their menstrual cycle because of a brief decline in their estrogen levels that happens when an egg is released from an ovary. This type of spotting usually occurs about ten to fourteen days before your next period. Spotting can also occur due to reduction of the level of estrogen which usually precedes ovulation. This type of spotting occurs due to alteration of the amount of estrogen that is stimulating the endometrium. The decline in estrogen causes women to experience brown vaginal discharge, or spotting. They can also experience cramping and slight pain.
10. You’re experiencing delayed ovulation.
If you are a woman who ovulates later in your cycle, it may lead to mittelschmerz. Mittelschmerz is one-sided, lower abdominal pain that is associated with ovulation in the middle of your menstrual cycle, usually about fourteen days before your next period. The pain lasts from a few minutes to hours, but can continue on-and-off for a few days. It usually is on the side of the ovary that is releasing an egg. Aside from mild pain, mittelschmerz can cause mild vaginal bleeding, or spotting. Delayed ovulation can also mean you have a small cyst on the surface of your ovary, which leads to the egg breaking through, causing vaginal spotting.
11. You have a delayed or partial period.
During a normal period, the blood coming from the vagina consists of old blood, endometrial lining, and dead tissue. When you have a delayed or partial period, your monthly flushing does not complete and leaves a small amount of lining behind. This lining is left in the uterus for up to a month. When this remaining tissue finally expels, it leaves behind a brownish or pinkish color, or spotting. Again, while you may be alarmed and confused, this type of spotting is normal.
12. You have inserted an object into your vagina or experienced a vaginal injury.
If you have just inserted something into your vagina (tampon, penis, etc), you could cause spotting. If you just had sex and your vagina isn’t lubricated enough, the friction can cause you to spot. You can also spot from having sex with a partner that has a large or thick penis, or if you have a small vaginal opening. Cervical bleeding can occur if you have deep penetration during sex. Post coital bleeding can also occur early in pregnancy when the blood vessels in the cervix gets engorged with blood and irritated. Inserting a tampon when you are too dry or too forcefully can also cause spotting.
13. You have a urethral prolapse.
The urethra is a tube that connects your bladder to the outside of your body which carries urine from the bladder to the urethral opening. Urethral prolapse occurs when the inner lining of your urethra protrudes through the opening of the urethra. Because of this, the opening of your urethra can resemble a pink donut or ball and seem larger and more swollen than normal. This can cause irritation in the vagina, causing small amounts of blood, or spotting, to occur. This is easily treatable with treatments such as estrogen cream, sitz baths, and antibiotics.
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Medium-risk reasons for spotting before period
14. You are impregnated.
If you are newly pregnant, chances are you will experience spotting. In the first few months of your pregnancy, it is normal to experience spotting due to all the new hormonal changes. If you are unsure if you are pregnant, take a pregnancy test or consult your gynecologist right away. A doctor can help guide you in the right direction for your pregnancy and confirm the spotting is normal and not caused by an ectopic pregnancy, which if not treated, can be life threatening.
15. You have a slow thyroid or low thyroid levels.
Hormonal imbalances are one of the primary reasons for vaginal spotting before your period. One of the reasons a woman might be producing too much estrogen is due to a thyroid issue. A slow thyroid (hypothyroidism) can create changes and imbalances in your metabolism, sense of body temperature, and period, but is rarely life threatening. Low thyroid hormones can cause other scarier symptoms such as constant fatigue, irregular body temperature, significant weight gain, hair loss, and neck pain. A doctor should address these symptoms as soon as possible. But rest assured, they are normal and usually treatable with medicine.
16. You just had a baby or a pregnancy loss.
Light spotting to heavy bleeding can occur for the first few weeks after childbirth, pregnancy loss or an induced abortion. This happens because your uterus has not contracted to the pre-pregnancy size or because there is still remaining fetal tissue in your uterus. While this spotting can be normal, it should be checked with your doctor.
17. You are taking certain drugs, such as anticoagulants.
Anticoagulants (or “blood thinners”) are drugs that help prevent your blood from clotting or prevent existing clots from growing. These drugs help keep clots from forming in your heart, veins, or arteries. These drugs should only be taken if advised by your doctor. While anticoagulants help with clotting, one side effect is spotting before your period or bleeding more than normal on your period.
Also medications like phenothiazides, which are antipsychotic tranquilizers and tricyclic antidepressants which affect serotonin uptake can as well result to spotting. Spotting is also common in women who are taking corticosteroids (anti-inflammatory) medications. Taking blood thinning medications like Heparin, Warfarin or Aspirin also result to spotting.
18. You have cervical erosion (cervical ectropion).
Cervical erosion is when the cells from inside your cervical canal, or glandular cells, are present on the outer surface of your cervix. This is easily found if you get a cervical screening test, also known as a smear test, the area appears red, because glandular cells are red. You can be born with cervical erosion or develop it through hormonal changes. For many women, there are no problems associated with cervical erosion. However, for some, it can cause spotting as glandular cells bleed more easily and can create more mucus than squamous epithelial cells.
19. You have an impending miscarriage, had a miscarriage, or had an abortion.
Women who miscarry commonly spot before a miscarriage. A miscarriage is the loss of the pregnancy before a woman has been pregnant for 20 weeks. Women who miscarry commonly spot beforehand. In the unfortunate case of an impending miscarriage, you might experience distinct symptoms like abdominal cramping, back pain, lower abdominal pain and spotting. While, these symptoms can be common in pregnancy in the first place, in many cases, spotting and cramping can be the first indication of a miscarriage.
If the vaginal bleeding becomes heavier and includes clots or when the blood color is altered, it is no longer considered spotting and most likely represents a miscarriage. It is usually possible between 5 to 6 weeks of pregnancy. If you’re concerned about a potential miscarriage, you should visit your primary care physician or OB/GYN. He or she might recommend an ultrasound of the uterus or blood tests to follow changes in pregnancy hormones. Unfortunately, a miscarriage in process cannot be stopped. Treatment may involve watching the symptoms until they pass. Sometimes, it is necessary to take medication or have a surgery to remove any remaining pregnancy contents from the uterus. Women with a negative blood type (like "A negative"), need an injection of a drug called Rh(D) immune globulin (RhoGam) to help prevent problems in future pregnancies.
Abortions can be performed two ways: surgically or using medication. A surgical abortion is also known as an aspiration abortion, dilation and curettage (D&C), or dilation and evacuation (D&E). After a surgical abortion, vaginal bleeding is common, but typically lasts less than a week or so. The bleeding is usually lighter than a menstrual period, though some blood clots can be passed as well. When women take medication to end a pregnancy, known as a medication abortion, this also causes spotting followed by heavier vaginal bleeding and clots. After the pregnancy passes, the bleeding lightens and tapers off over 1-2 weeks. As with miscarriages, women who experience an abortion may need an ultrasound of the uterus and blood tests to follow changes in pregnancy hormones. Women with a negative blood type, need an injection of RhoGam to help prevent problems in future pregnancies as well. If you are concerned about post-abortion symptoms, it is best to get checked at the clinic where you had the abortion or by your doctor.
Following a pregnancy loss or termination, it is common and normal for women to experience a variety of emotions. Seeking support by talking with loved one or with a healthcare provider about these feelings can be helpful.
20. You have Polycystic Ovary Syndrome (PCOS).
Polycystic Ovary Syndrome (PCOS) is a hormonal imbalance that interferes with normal ovulation and can cause abnormal bleeding, or spotting between periods. It can also cause annoying things like unwanted hair and acne. It is very common in teen girls and young women. One out of every 10 woman has PCOS. If you have PCOS, your ovaries are not getting the right hormonal signals from your pituitary gland. Without these signals, you can’t ovulate every month, which affects your menstrual cycle. This causes your period to be irregular, and spotting in between. Ask your healthcare provider if you are experiencing symptoms such as irregular periods, extra hair on your face and other parts of your body, acne, weight gain, and patches of dark skin on the back of your neck and other areas. The most common treatment for PCOS is birth control or other types of hormonal therapy.
21. You have inflammation or infection in your cervix (cervicitis).
Cervicitis is the inflammation or irritation in your cervix. The symptoms are very similar to vaginitis, such as vaginal discharge, itching, pain with intercourse, and spotting. If the urine tube, or ureter, gets infected, you can feel pain and burning when you pee, which also can be a sign of cervicitis. Cervicitis can be caused by non-infections such as trauma, frequent douching, or exposure to chemical irritants. Cervicitis can be also by infections, such as certain sexually transmitted diseases (STDs). A doctor can diagnose and treat cervicitis in just a few days. The most common reason for cervicitis are sexually transmitted diseases, so the best prevention method is using a condom and being protected during intercourse.
22. You have a Sexually Transmitted Disease (STD).
As just mentioned, cervicitis can cause spotting and be caused by sexually transmitted diseases. Most common types that cause spotting are chlamydia and gonorrhea. Chlamydia, if not treated, can cause serious health issues such as pelvic inflammatory disease, and infertility. Because chlamydia does not often cause symptoms, it is important to get tested every year. However, certain symptoms include unusual vaginal discharge burning while urinating, spotting between periods, pain in your stomach, back pain, nausea, and pain during sex. Gonorrhea is another common STD that, if untreated, can lead to infertility and can spread to parts of the body such as the blood, joints, heart, or even the brain. Symptoms include yellow or vaginal discharge that may smell bad, a burning sensation while urinating, pain during sex, and spotting between periods. Gonorrhea can also be in other parts of your body, such as the throat and anus. Trichomoniasis and genital herpes can also cause cervicitis. To prevent any types of STDs, go get regularly tested at your doctor or local clinic.
23. You have an ovarian cyst.
Spotting between periods can also be caused by ovarian cysts. Ovarian cysts are small sacs that develop in your ovaries and are filled with fluid. You may not know you have ovarian cysts until one ruptures. If one ruptures, you can experience lower pelvic pain, spotting, and severe discomfort. It is important to go immediately to the doctor if you are in extreme pain. Normally, doctors will wait and see if the cysts resolve themselves. If they don’t, they can be surgically removed.
24. You have Uterine Fibroids.
Uterine Fibroids (also known as leiomyomas or myomas) are noncancerous growths of the uterus that can occur during your childbearing years. They can range in size from tiny growths that are almost undetectable to the human eye, to large, bulky growths that can alter and enlarge your uterus. You can also have more than just one fibroid at a time. It is common for women to have fibroids at some point in their life, as they show no symptoms and can be so small it is undetectable. However, some women who experience uterine fibroids have symptoms such as heavy menstrual bleeding, spotting between periods, pelvic pressure or pain, frequent urination, and constipation. Although uterine fibroids are not usually dangerous, they can cause pain and discomfort and can lead to complications, such as anemia from heavy blood loss. Seek a doctor if you are experiencing pelvic pain that won’t go away, overly heavy, prolonged painful periods, or spotting between periods.
High-risk reasons for spotting before period
25. You have Polyps.
Uterine Polyps, or Endometrial Polyps, are noncancerous growths that are attached to the inner wall of the uterus that extend into the uterine cavity. Polyps may be associated with fibroids.
Polyps form when there is overgrowth of cells in the lining of the uterus. They are mainly found in women who are going through or have finished menopause, but it is possible for younger women to get polyps as well. Usually, these are noncancerous. However, some can be cancerous and turn into cancer. While polyps usually stay in the uterus, some can travel through the opening of the uterus (cervix) into the vagina. Symptoms for polyps include irregular menstrual bleeding, spotting before periods, vaginal bleeding after menopause, and infertility. Seek a doctor if you have any of these symptoms.
26. You have Adenomyosis.
Adenomyosis is a noncancerous growth that occurs when endometrial tissue exists within and grows into the muscular walls of your uterus. The endometrial tissue thickens, breaks down, and bleeds, like it should in a normal menstrual cycle. However, an enlarged uterus can be painful and cause you to spot between periods and have heavier periods. While the cause of Adenomyosis is unclear, it usually occurs after menopause. Some treatments can relieve pain, but the only cure is a hysterectomy.
27. You have Pelvic Inflammatory Disease (PID).
Pelvic Inflammatory Disease (PID) is an infection in a woman’s reproductive organs. It is often caused by infections such as STDs, like chlamydia and gonorrhea, and use of IUDs and douches. You are more likely to get PID if you have an STD and do not get treated, have more than one sex partner, have had PID before, douche, or use an IUD. PID is a serious health concern that can affect the fertility in women. In fact, one out of eight women with PID have difficulties getting pregnant. There are no tests for PID, and it might be hard to detect as symptoms are mild. Symptoms include pain in lower abdomen, fever, unusual discharge and bad odor from your vagina, spotting between periods, bleeding during sex, and burning sensation when you urinate. See a doctor immediately if you have any of these symptoms. It is also important to get tested every year for STDs to be sure you have all the information you need to prevent this. PID is curable, if found early. However, treatments won’t undo any damage that has already happened to your reproductive system. The longer you wait for treatment, the more damage that can ultimately occur. Antibiotics are a cure for PID, but only if you finish your entire dosage. Detection is key. Leaving PID untreated can lead to formation of scar tissue inside and outside the fallopian tubes leading to tubal blockage, ectopic pregnancy, infertility, and long-term pelvic/abdominal pain.
28. You have an ectopic pregnancy.
Ectopic pregnancy, also known as eccyesis or tubal pregnancy, is a complication in pregnancy where the embryo forms and attaches outside the uterus. In a normal pregnancy, a fertilized egg attaches itself to the lining of the uterus. In an ectopic pregnancy, the fertilized egg occurs in one of the tubes that carry eggs from the ovaries to the uterus. An ectopic pregnancy cannot end normally. The fertilized egg has no chance for survival, and the growing tissues might destroy some reproductive parts. It can lead to extensive blood loss and can be life threatening for the mother. In the beginning, an ectopic pregnancy might not show any symptoms. If symptoms do occur, they are usually the same as any pregnancy, such as missed period, tenderness in the breasts, and nausea. However, spotting and light vaginal bleeding and pain in your pelvis and abdomen are the first signs of an ectopic pregnancy. See a doctor immediately if you are experiencing severe pain in your abdomen or pelvis, vaginal bleeding, extreme lightheadedness, fainting, and shoulder pain. Ectopic pregnancies can occur for a few reasons, including inflammation, infection, fertility issues, structural concerns in your body, contraceptives, and smoking.
29. You may have a malignant cancer.
Spotting can be a sign of malignant cancers, such as endometrial, ovarian, and cervical cancers. Endometrial cancer is the most common of the gynecological malignancies, and the most curable. It arises from the glandular tissue within the uterine lining. Unfortunately, most patients do not experience symptoms until the cancer has widely metastasized. Symptoms include fatigue, bloating, abdominal swelling, gastrointestinal issues such as gas, nausea, and indigestion, change in bowel movements, and vaginal spotting. Ovarian cancer is a growth of abnormal malignant cells that begin in the ovaries. Women with ovarian cancer report symptoms that are persistent and are abnormal for their bodies. Symptoms include bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, abnormal spotting, or urinary symptoms. Cervical cancer is detected through pap smears screenings and pelvic examinations. Vaginal spotting is the first type of symptom of the disease. Heavier vaginal bleeding, heavy vaginal discharge, and lower abdominal pain are other symptoms that occur. For all of these cancers, early detection is key. Routinely go in for frequent checks and talk to your healthcare provider if you experience any symptoms.
Vaginal spotting between periods has many potential causes. They can be normal and just a part of life, or they can be serious and even life-threatening. It is important to understand your symptoms and body and routinely go to the doctor. But before you do, take the quiz below to find out about your specific condition.
When to contact a health care provider
Spotting between your periods is common, but you should consult your doctor if it occurs more than once or twice in a row to determine the cause and ensure doesn’t constitute any health risk or take steps to stop it if the cause is a medical concern. Seek your doctor’s help if:
- You are pregnant
- If you cannot explain why you spot between periods
- The spotting occurs after menopause
- If it moves from just spotting to heavy menstrual-like bleeding.
- If in addition to the spotting, you feel pain, exhausted or feeling dizzy.