- What Causes Two Periods in One Month?
- So how is it even possible to get two periods in one month?
- 1. You forgot to take your birth control.
- 2. You’re pregnant.
- 3. You have uterine polyps or fibroids.
- 4. You have an infection down there.
- 5. Your thyroid isn’t working properly.
- 6. You have PCOS.
- 7. You have precancerous or cancerous cells.
- 8. You’re seriously stressed out.
- 9. You’ve been traveling recently.
- 10. You’re in the early stages of menopause.
- 11. You’ve gained a lot of weight.
- 12. You have endometriosis
- Abnormal Menstruation (Periods)
- Making Sense of Menopause Bleeding
- Do you need treatment for multiple periods?
- Download Clue to track your period and menstrual cycle.
- Top things to know:
- What is the difference between the period, spotting, and bleeding?
- How does spotting differ from light period bleeding?
- What is the source of spotting?
- Common causes of spotting
- Why You Have Two Periods in One Month, According to an Ob-Gyn
- Abnormal Uterine Bleeding (AUB)
- Is it OK to Get My Period Twice in One Month?
What Causes Two Periods in One Month?
Your treatment will depend on the underlying cause of your frequent bleeding. If you naturally have shorter cycles or if you’ve recently started menstruating, you won’t need treatment. If anemia is a concern, your doctor may recommend iron supplements.
One possible treatment for periods that occur too frequently is hormonal birth control. This type of birth control can help regulate your periods and help resolve anemia issues caused by heavy bleeding.
Here are treatments for other possible causes of frequent bleeding.
If you have hypothyroidism, it means you have an underactive thyroid gland. Your body can’t make enough of the thyroid hormone. Your doctor will prescribe a thyroid hormone replacement therapy that you can take by mouth.
If you have hyperthyroidism, it means you have an overactive thyroid gland. Your body makes too much thyroid hormone. Several treatments are available for this condition. Your doctor will suggest the one they think is best for you.
If you’re beginning menopause, your doctor may prescribe hormone therapy and estrogen replacement therapy. These treatments can help regulate your periods until they slowly disappear as menopause progresses.
Fibroids and cysts
Your doctor may recommend a few different treatment options if you have uterine fibroids or cysts. These can include:
- Intrauterine device (IUD). An IUD is a form of birth control and can help relieve heavy periods. However, it won’t shrink fibroids.
- MRI-guided ultrasound surgery. This procedure is performed while you’re inside an MRI scanner. It’s considered noninvasive, and doctors can use it to remove the fibroid or cyst. This procedure is only done in specialized clinics.
- Uterine artery embolization. This is a minimally invasive procedure that blocks the blood supply to the uterus. That causes the fibroids to decay and shrink.
- Myomectomy. There are different types of myomectomy, which is a surgical procedure to remove fibroids. In a hysteroscopic myomectomy, the fibroid is removed through the cervix. No incisions are needed. In a laparoscopic myomectomy, small incisions are made in your abdomen to remove fibroids. An abdominal myomectomy is an open abdominal surgical procedure.
- Hysterectomy. A hysterectomy is a surgical procedure to remove the uterus.
- Gonadotropin-releasing hormone agonists. These are medications that can help treat fibroids. They block estrogen and progesterone and put you into a temporary postmenopausal state. This stops the fibroids from growing and can make them shrink. Your doctor may use this treatment to help prepare you for surgery.
Lifestyle changes can greatly impact your stress level, which can in turn affect your menstrual cycle. To help relieve stress, try exercising frequently, practicing meditation, or engaging in talk therapy.
If you’re feeling stressed because you’re overcommitted, ask for help. Finding the time to relax is important to your health, so don’t feel bad about saying no to additional projects or responsibilities.
Extreme weight loss or gain
Talk to your doctor about the possible reasons why you have had such a dramatic change in weight. They’ll work with you to help you manage your weight.
Reaction to birth control
Hormonal birth control introduces hormones into your body. This can affect your menstrual cycle. You may need to try a few different types of birth control to find one that works for you. It also takes a few months for your body to adjust to a new method of birth control.
Talk to your doctor about what you should expect when starting a new birth control method.
It’s bad enough dealing with your period once a month—the cramps, the mood swings, the ruined underwear… But twice?
As it turns out, getting your period twice in one month isn’t all that abnormal. But if you’re part of that (pretty unlucky) group, know this: “Irregular bleeding can have different implications depending on age, medical history, and family history,” says Alyssa Dweck, M.D., an ob-gyn and author of The Complete A to Z for Your V. “So it’s important to seek ob-gyn guidance if you have persistent, recurrent, or worrisome bleeding habits.”
So how is it even possible to get two periods in one month?
“The average cycle should occur every 21 to 35 days and last anywhere from two to seven days,” explains Lakeisha Richardson, M.D., an ob-gyn based in Greenville, Mississippi. So if you’re on the shorter end of that spectrum, that math could easily translate into getting your period twice in one month. And about 40 to 60 percent of women will have some irregular periods throughout their lives, she says.
If you don’t just have a cycle that’s on the shorter end of the spectrum, your “period” might actually be bleeding linked to a medical condition or missed birth control. And even though most of the reasons are totally benign, seeing your doctor can help identify the cause.
Here’s what might be going on if you’re getting two periods in one month—and what to do to get your cycle back on track.
1. You forgot to take your birth control.
Duh, right? “Missing birth control pills or forgetting your Depo-Provera shot will always cause irregular bleeding,” says Dr. Richardson. “Anytime you fail to take a birth control method correctly, you will bleed because you have an abrupt withdrawal of hormones.” This kind of bleeding, though, is not an emergency. “
What to do about it
If you resume your birth control by following the instructions, the bleeding will subside, she says. Just make sure to use a backup method of birth control to prevent pregnancy until your next period.
2. You’re pregnant.
I know: Pregnancy means missed periods. But “believe it or not, some women will bleed irregularly if they are pregnant,” says Dr. Dweck. Spotting during pregnancy is very common, especially in the first trimester, and can occur for a number of reasons, including after heavy exercise or sex, or due to polyps (benign lesions that can grow inside the uterus or cervix and bleed spontaneously), says Dr. Richardson. (Later on in pregnancy, spotting can occur after heavy exercise or sex or due to polyps, which are benign lesions that can grow inside the uterus or cervix and bleed spontaneously, Dr. Richardson adds.)
Much more rarely, ectopic pregnancies (e.g. when a fertilized egg implants outside of the uterus) can also cause irregular bleeding very early on in pregnancy, says Christine Masterson, M.D., chief of the women and children’s service line at Summit Medical Group in New Jersey.
Obviously, a bun in the oven can be ruled out with a simple pregnancy test. Keep in mind that false negatives are relatively common if you haven’t yet missed your period. If you experienced earlier-than-expected bleeding after your normal period, take the test again about a week after you’d usually expect to get your period.
Since ectopic pregnancies also result in a positive pregnancy test and can become an emergency if left untreated, see your doctor for an ultrasound to confirm whether the embryo has implanted in your uterus. If it is an ectopic pregnancy, you’ll receive meds and potentially other treatments to prevent life-threatening complications.
3. You have uterine polyps or fibroids.
Uterine issues like polyps or fibroids—benign lesions or tumors that can grow in the uterus—are very common and may be related to hormonal issues. “Uterine polyps can cause bleeding in between periods,” says Dr. Dweck, especially if they are touched, like during sex, and “fibroids can cause pain, back pain, abdominal bloating, anemia, pain with intercourse, and spontaneous bleeding because they’re not associated with the menstrual cycle,” explains Dr. Richardson.
What to do about it
Head to your ob-gyn for an ultrasound, a uterine biopsy, or a hysteroscopy (a scope that looks into the uterus). Hormonal medications such as progestins (sometimes in the form of an IUD) and gonadotropin-releasing hormone agonists may lessen symptoms of polyps and shrink uterine fibroids.
Sometimes, surgery or other medical procedures might be necessary to remove the growths. “Removal of the growths is usually curative and ensures that there are no other causes of irregular bleeding,” says Dr. Richardson.
4. You have an infection down there.
Vaginal and cervical infections are incredibly annoying for a number of reasons, not least of all that they can cause bleeding outside of your period. “Inflammation or infection of the cervix with bacteria such as bacterial vaginosis or trichomoniasis can cause irregular bleeding,” says Dr. Richardson.
Many STDs often don’t cause any other symptoms, although you may experience foul-smelling or gray, white or green discharge; itching or burning in your genital area; or burning during urination.
Check in with your doctor ASAP; these infections can be quickly and effectively treated, usually with antibiotics. “Research has shown that sexually transmitted disease such as trichomoniasis increases your risk of contracting HIV and other STDs,” she says.
Here’s how to tell if it’s a yeast infection—or something else:
5. Your thyroid isn’t working properly.
An underactive or overactive thyroid gland can cause your period to come twice in one month. “The thyroid gland is regulated by hormones produced and regulated in the same area of the brain—the pituitary and hypothalamus—as the hormones that control menstruation and ovulation,” explains Dweck. “When one is off, the other might be affected.”
If you have hyperthyroidism (where your thyroid produces too much of the thyroxine hormone), you may also lose weight unexpectedly, feel nervous or anxious, have a rapid heartbeat, or have trouble sleeping. Hypothyroidism (too little thyroxine hormone) can cause weight gain, constipation, fatigue, and increased sensitivity to cold, among other symptoms.
This is diagnosed with a blood test and typically treated with medication. Hypothyroidism drugs restore your levels to a normal level so symptoms should disappear and you start feeling better soon. Hyperthyroidism medications can clear up symptoms within a few weeks by keeping your thyroid from overproducing hormones. Most of the time this treatment permanently fixes the issue, although sometimes you may need surgery.
6. You have PCOS.
Polycystic ovarian syndrome is a hormone imbalance that affects between 8 and 20 percent of women, according to the National Institutes of Health. “It’s a result of less frequent ovulation or the lack of ovulation, leading to an imbalance of estrogen, progesterone, and testosterone,” Dr. Dweck explains. “One of many symptoms includes irregular bleeding.”
While PCOS causes irregular periods, many women actually experience less frequent or skipped periods. Other commonly associated symptoms include acne, difficulty maintaining weight, hair growth in places typical to men (like the upper lip or chin), and fertility issues, she says.
If you think there’s a chance you have PCOS, schedule an appointment with your doc to be evaluated with a pelvic exam, ultrasound and blood test. If PCOS is causing irregular bleeding, you’ll likely get put on birth control pills or progesterone therapy to regulate your cycles. And since PCOS symptoms are often linked to weight gain, your practitioner may suggest lifestyle changes to help you lose weight.
7. You have precancerous or cancerous cells.
When found in either the uterus and cervix, precancerous and cancerous cells can cause irregular bleeding. “Suffice it to say, a tumor growing on the cervix or uterus can bleed erratically,” says Dr. Dweck. One study even found that irregular periods are more likely to lead to ovarian cancer, so early detection is key.
These are diagnosed with an ultrasound and uterine biopsy, and a pap smear and cervix biopsies, respectively, so if you’ve ruled out other causes, get to an ob-gyn STAT.
8. You’re seriously stressed out.
High levels of stress can cause either more frequent periods or completely missed ones, says Dr. Masterson, because the hormones that trigger your ovaries to ovulate every month originate in the brain (you know, the same place where stress starts).
Basically, when you’re swamped at work or worrying a lot (especially if it’s causing you to get less sleep), those hormones can misfire and affect your cycle in negative ways.
If you know you’ve been mentally stretched to the limit lately, consider doing some yoga or meditation exercises, or talking to someone who can help manage your stress. You’ll be surprised how much it can help your mind and body, says Dr. Masterson.
9. You’ve been traveling recently.
If you get back from vacation and find an earlier-than-expected period welcoming you home, you might be able to blame said vacation on your irregular bleeding. Depending on how far from home you went, excessive traveling can disrupt your period.
“Interfering with your circadian rhythms, like changing time zones or working night shifts, can cause changes in the hormones that trigger your cycle,” says Dr. Masterson.
As long as the travel was a one-time thing, this should resolve on its own. If you work the night shift regularly, though, irregular periods might be your new normal. Aim to clock at least six hours a night, and make the most of the sleep you do get by blocking out noise and light and avoiding using screens (like your phone) right before you nod off.
Since you’re already feeling the effects of late nights—and shift work can do harm to your health over time, increasing the risk of anxiety, depression, GI problems and even heart disease—you may want to consider talking to your boss about whether it’s possible to rework your schedule.
10. You’re in the early stages of menopause.
Perimenopause, which can start as early as your mid-thirties, can cause irregular periods, including ones that are more frequent and heavier than usual, says Dr. Masterson. Other symptoms to watch out for include hot flashes, night sweats, vaginal dryness, and sleep problems.
There’s not much you can do here (you’ve got to let nature run its course), but there are ways to ease the overall effects of perimenopause, like medications or other therapies, if your OB has confirmed that’s what’s happening. Hormone replacement therapy, which involves taking a pill to bump up your estrogen levels, can help ease the symptoms of perimenopause and reduce bone loss linked to menopause.
11. You’ve gained a lot of weight.
Rapid weight gain or loss and excessive amounts of exercise can also affect the hormones that stimulate ovulation, changing the typical pattern of your cycle.
“Usually if you are doing extreme exercise or have gotten underweight, your body turns off the ovulatory process—it thinks it’s in a famine situation, and that’s not a great time to have a baby,” Masterson explains. “But if you’ve become extremely overweight, you might see irregular bleeding happening more or less frequently than normal.”
If you think your weight might be to blame for your irregular periods, check in with your doc—it’s possible that there are external factors, like a medical condition or new medication, contributing to your weight gain that would be worth looking into.
12. You have endometriosis
Endometriosis is a condition where some of your uterine lining becomes trapped outside of your uterus. That means there’s more tissue to shed every month, causing more frequent and heavier periods. Your periods may also be quite painful, and you may have other symptoms like nausea, fatigue, pain during sex, and pain with bowel movements.
Check in with your doc, who may run a few tests, such as ultrasound, pelvic exam, and possibly and MRI or biopsy. If endometriosis is to blame for your irregular periods, you might get a prescription for birth control or another hormonal therapy that can help reduce the pain and slow the growth of endometrial tissue.
Ashley Mateo Ashley Mateo is a writer, editor, and UESCA-certified running coach who has contributed to Runner’s World, Bicycling, Women’s Health, Health, Shape, Self, and more. Colleen de Bellefonds Colleen de Bellefonds is an American freelance journalist living in Paris, France, with her husband and dog, Mochi.
Abnormal Menstruation (Periods)
What is abnormal menstruation?
Most women have menstrual periods that last four to seven days. A woman’s period usually occurs every 28 days, but normal menstrual cycles can range from 21 days to 35 days.
Examples of menstrual problems include:
- Periods that occur less than 21 days or more than 35 days apart
- Missing three or more periods in a row
- Menstrual flow that is much heavier or lighter than usual
- Periods that last longer than seven days
- Periods that are accompanied by pain, cramping, nausea or vomiting
- Bleeding or spotting that happens between periods, after menopause or following sex
Examples of abnormal menstruation include the following:
- Amenorrhea is a condition in which a woman’s periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless a woman is pregnant, breastfeeding, or going through menopause (which generally occurs for women between ages 45 and 55). Young women who haven’t started menstruating by age 15 or 16 or within three years after their breasts begin to develop are also considered to have amenorrhea.
- Oligomenorrhea refers to periods that occur infrequently.
- Dysmenorrhea refers to painful periods and severe menstrual cramps. Some discomfort during the cycle is normal for most women.
- Abnormal uterine bleeding may apply to a variety of menstrual irregularities, including: a heavier menstrual flow; a period that lasts longer than seven days; or bleeding or spotting between periods, after sex, or after menopause.
What causes abnormal menstruation (periods)?
There are many causes of abnormal periods, ranging from stress to more serious underlying medical conditions:
- Stress and lifestyle factors. Gaining or losing a significant amount of weight, dieting, changes in exercise routines, travel, illness, or other disruptions in a woman’s daily routine can have an impact on her menstrual cycle.
- Birth control pills. Most birth control pills contain a combination of the hormones estrogen and progestin (some contain progestin alone). The pills prevent pregnancy by keeping the ovaries from releasing eggs. Going on or off birth control pills can affect menstruation. Some women have irregular or missed periods for up to six months after discontinuing birth control pills. This is an important consideration when you are planning on conception and becoming pregnant. Women who take birth control pills that contain progestin only may have bleeding between periods.
- Uterine polyps or fibroids. Uterine polyps are small benign (noncancerous) growths in the lining of the uterus. Uterine fibroids are tumors that attach to the wall of the uterus. There may be one or several fibroids that range from as small as an apple seed to the size of a grapefruit. These tumors are usually benign, but they may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort.
- Endometriosis. The endometrial tissue that lines the uterus breaks down every month and is discharged with the menstrual flow. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself to the ovaries or fallopian tubes; it sometimes grows on the intestines or other organs in the lower digestive tract and in the area between your rectum and uterus. Endometriosis may cause abnormal bleeding, cramps or pain before and during periods, and painful intercourse.
- Pelvic inflammatory disease. Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. Bacteria may enter the vagina via sexual contact and then spread to the uterus and upper genital tract. Bacteria might also enter the reproductive tract via gynecologic procedures or through childbirth, miscarriage, or abortion. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor, irregular periods, pain in the pelvic and lower abdominal areas, fever, nausea, vomiting, or diarrhea.
- Polycystic ovary syndrome. In polycystic ovary syndrome (PCOS), the ovaries make large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts) may form in the ovaries. These can often been seen on an ultrasound. The hormonal changes can prevent eggs from maturing, and so ovulation may not take place consistently. Sometimes a woman with polycystic ovary syndrome will have irregular periods or stop menstruating completely. In addition, the condition is associated with obesity, infertility and hirsutism (excessive hair growth and acne). This condition may be caused by a hormonal imbalance, although the exact cause is unknown. Treatment of PCOS depends on whether a woman desires pregnancy. If pregnancy is not a goal, then weight loss, oral contraceptive pills, and the medication Metformin® (an insulin sensitizer used in diabetes) can regulate a woman’s cycles. If pregnancy is desired, ovulation-stimulating medications can be tried.
- Premature ovarian insufficiency. This condition occurs in women under age 40 whose ovaries do not function normally. The menstrual cycle stops, similar to menopause. This can occur in patients who are being treated for cancer with chemotherapy and radiation, or if you have a family history of premature ovarian insufficiency or certain chromosomal abnormalities. If this condition occurs, see your physician.
Other causes of abnormal menstruation include:
- Uterine cancer or cervical cancer
- Medications, such as steroids or anticoagulant drugs (blood thinners)
- Medical conditions, such as bleeding disorders, an under- or overactive thyroid gland, or pituitary disorders that affect hormonal balance
- Complications associated with pregnancy, including miscarriage or an ectopic pregnancy (the fertilized egg is implanted outside the uterus; for example, within the fallopian tube)
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Making Sense of Menopause Bleeding
During the transitional phase of perimenopause — the period before you’ve officially reached menopause — it is not abnormal to experience changes in menstrual bleeding that can be uncomfortable and sometimes even alarming.
8 Hygiene Rules for a Healthy Vagina
These menstrual cycle fluctuations are usually due to declining hormone levels that occur in all women as they get older. As a result, some women skip periods for a month or more, others may experience a heavier or a lighter flow, and others may have a longer or shorter amount of time between periods. In fact, only 10 percent of women will stop having their periods for good without experiencing some irregularity in their cycles first. While perimenopausal bleeding due to changing hormone levels is normal, it’s still important to rule out more serious causes, and also to know what can help you manage the situation most effectively.
Menopausal Bleeding: When to See Your Doctor
According to JoAnn Manson, MD, MPH, PhD, an endocrinologist and professor of Women’s Health at Harvard Medical School, you should see your doctor “if you notice lengthening of the cycle itself — the time between your periods. If it lengthens from four weeks between periods to five or six weeks, then that’s quite normal as you go through the transition. However, if you start to have bleeding every two weeks or in the middle of your cycle, you may want to discuss that with your doctor, because that’s less common. And if you have heavier bleeding, or bleeding that is lasting much longer than your typical menstrual period, you should go see your doctor as well.”
Your doctor should then be able to tell you if you’re experiencing normal changes associated with perimenopause, or if it’s something that’s not related, like a benign growth called a fibroid, a polyp in your uterus, or possibly even something more serious like cancer. Bleeding could also be caused by certain medications, thyroid problems, other chronic medical conditions, infection, or a potentially precancerous condition called endometrial hyperplasia.
If there is any question, your doctor will order tests to determine the cause of the irregular bleeding. Depending on your symptoms, these might include an ultrasound, a sonohysterography , a hysteroscopy , D&C , or an endometrial biopsy.
Ways to Manage Menopausal Bleeding
Once it’s determined that your ongoing bleeding is related to perimenopause and not to a more serious condition, there are a number of options that you and doctor can consider to help stabilize the situation. These include:
Low-dose birth control pills: Oral contraceptives can be used to regulate your cycle, and they have the added benefit of controlling other perimenopausal symptoms like hot flashes and night sweats. “But,” Dr. Manson cautions, “it has to be a low-dose oral contraceptive, and can’t be taken by a woman who has multiple risk factors for cardiovascular disease — like hypertension or diabetes — or who smokes.”
Progestogen: A version of progesterone, the hormone that causes the uterine lining to slough off each month, progestogen may be helpful for women who experience intermittent bleeding and who are not ovulating. Normally, progestogen is prescribed for 10 or 14 days, Manson says. “Then it will be withdrawn, which will eliminate the excess cells lining the uterus. While that may increase bleeding, it will make it more regular.”
Monitoring your symptoms: Keeping track of your perimenopausal bleeding with your doctor can help determine when — or if — it’s best to start treatment. Many women can cope with perimenopausal bleeding without hormone intervention. It’s helpful to keep your doctor in the loop, however, because you may need to take iron supplements if anemia becomes a problem as a result of increased bleeding.
How to Recognize the Signs of Perimenopause
Enhance your overall health: This is always a good idea and will help to make the transition through perimenopause and menopause easier. Many doctors advise that as you enter perimenopause, it is a good time to make a special effort to live a more healthy life by:
- Quitting smoking
- Decreasing the amount of alcohol you drink
- Getting to a healthy weight and staying there
- Taking a multivitamin supplement
- Making sure your calcium levels are adequate
Do you need treatment for multiple periods?
The occasional double period is usually nothing to stress about. However, you should see your doctor if you experience any of the following:
- 2 periods in a month for two to three consecutive months
- Heavy menses
- Lower abdominal pain, especially if it doesn’t get better within one to two days
- Bleeding or spotting between menses that you may often mistake as 2 periods in a month
- Pain during sex
- Large blood clots during menses (the size of a quarter or bigger)
- Severe menstrual cramps
The treatment for two periods in one month depends on the cause of the bleeding. Women who have a short menstrual cycle naturally or who are in the early stages of puberty don’t require treatment.
Your doctor may suggest hormonal birth control as a possible treatment for multiple periods in a month, as it can help regulate menses and resolve anemia that occurs due to heavy bleeding. If you’re already taking hormonal birth control and it’s causing you to have a period twice in one month, then be sure to talk to your physician about using a different method of birth control.
For hypothyroidism, your doctor may prescribe an oral thyroid hormone replacement therapy. For hyperthyroidism, several treatment options are available and your doctor will suggest the one that is best for your condition.
During perimenopause, your physician may suggest menopausal therapy to regulate your menses until they disappear when you enter menopause.
If you have uterine fibroids, your doctor may recommend different therapies, including an intrauterine device, uterine artery embolization, or surgery.
You may make certain lifestyle changes to reduce your stress levels, as stress certainly impacts your menstrual cycle. Possible changes include exercising regularly, practicing meditation, reducing your intake of caffeine, and listening to soothing music.
While having a period every two weeks may be somewhat normal for women with a short menstrual cycle, it can be surprising for women who tend to have a cycle that’s more regular in length.
In many cases there’s no reason to worry about having your period twice a month, but sometimes it can indicate an underlying medical problem.
Since there are many different reasons that you could have two periods in one month, the best course of action is to mention it to your doctor. They can help figure out the reason behind the double periods and together you can decide on an action plan.
Download Clue to track your period and menstrual cycle.
Updated on June 20, 2019.
Top things to know:
In Clue, spotting is any bleeding outside your menstrual period
Light bleeding at the beginning or end of your period is not spotting
Any unexplained spotting should be addressed with your healthcare provider
Spotting can be a side effect of your hormonal contraceptive
What is the difference between the period, spotting, and bleeding?
The lines between menstrual bleeding (i.e. your period), spotting, and non-menstrual bleeding can get kind of confusing.
Menstrual bleeding is bleeding that is associated with the shedding of the endometrium at the end of the menstrual cycle.
Spotting has different definitions, depending on who you ask.
Researchers and healthcare providers often describe spotting as bleeding that doesn’t require sanitary protection (e.g. you don’t need to use a pad or tampon) (1).
However, this is kind of an arbitrary definition. Even if bleeding isn’t heavy, some people may just choose to use protection anyway.
In theory, spotting can happen at any time during your cycle, so around the period or between periods. Below we talk more about spotting vs. the period.
Bleeding that doesn’t seem to be associated with the period, such as bleeding during the middle of your cycle, that requires sanitary protection is called non-menstrual bleeding. Sometimes people describe this bleeding as heavy spotting.
In the rest of this article, we’re going to refer to all non-menstrual bleeding as “spotting” for convenience.
How does spotting differ from light period bleeding?
Sometimes people describe light bleeding that occurs at the beginning or end of their period as spotting.
It can be hard to differentiate spotting from menstrual bleeding by just looking at the amount. Generally, if you have light bleeding that occurs within 2 days of your period, you should consider that part of your period, not spotting (2). However, if it’s very, very light – like you only see a little on your toilet paper – that probably could be considered spotting.
For example, if you have light bleeding on Sunday, no bleeding on Monday, and bleed enough to require a tampon on Tuesday, you should consider Sunday the start of your period.
In Clue, there are four categories for bleeding: light, medium, heavy, and spotting. The first 3 categories – light, medium, and heavy – are for bleeding associated with your period. Any other bleeding should be categorized as “spotting” in Clue. That way, so Clue will be able to give you more accurate predictions and insights about your body and cycles.
What is the source of spotting?
Spotting can come from your upper reproductive tract (like your uterus) or your lower reproductive tract (like your cervix or vagina). Spotting is different from your period, which is the cyclical shedding of your uterine lining, your endometrium. Heavier spotting is most often from the uterus, while lighter spotting can come from the upper or lower tract (3).
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Common causes of spotting
1. Hormonal contraception
Spotting is a common side effect of hormonal contraception, especially during the first few months of starting a new method (4).
If you’re taking combined oral contraceptives (the most common type of birth control pill), you may have spotting that goes away after a couple of months (4). If spotting between withdrawal bleeding continues, your pill may not be the best fit for you, and you may want to try another brand with a different chemical formulation (4). Spotting might also happen if you forget to take your pills and the levels of the pill’s hormones drop in your body.
Spotting is common and often unpredictable with the hormonal IUD, the contraceptive implant, the contraceptive shot (injection, and the mini-pill (a progestin-only pill) (5).
Spotting is also a common symptom of early pregnancy. About 1 in 4 people experience spotting, usually gestational weeks 5 and 8 (or about 1 to 4 weeks after someone expects their period) (6). Spotting is usually nothing to worry about—research has shown that people with spotting aren’t more likely to have a miscarriage than people who don’t have spotting (6). However, heavy spotting or bleeding may be more of a concern. If you’re pregnant and bleeding, call your healthcare provider to check in, just so they know what’s going on.
While many sources call spotting in early pregnancy “implantation bleeding,” there isn’t strong evidence that it’s associated with an embryo’s implantation in the uterus. It may actually be related to hormonal changes, as the production of progesterone switches from the ovary to the forming placenta (6).
Spotting can be a symptom of an ectopic pregnancy (7). This is a pregnancy that is growing somewhere other than the uterus, usually the fallopian tube. Ectopic pregnancy bleeding may be coupled with other symptoms including abdominal pain on one side, shoulder pain, and/or dizziness. If you experience symptoms of spotting and suspect you may have an ectopic pregnancy, seek immediate medical help.
3. Physical conditions and infections
Spotting can also be caused by infections and physical changes in the reproductive tract, or hormonal imbalances. Physical conditions that can cause spotting episodes include fibroids (abnormal growth of muscle tissue on your uterus), uterine or cervical polyps(abnormal growths on your cervix or the inside of your uterus) and endometriosis (8).
Pelvic inflammatory disease (PID), which happens when certain pelvic infections (like STIs) go untreated, can also be another culprit for unscheduled spotting. Other symptoms of PID can include pain in the lower abdomen, unusual vaginal discharge, and fever (9). If you suspect you have spotting and other associated symptoms of PID or of physical pelvic conditions, it’s important to discuss this with your healthcare provider as soon as possible.
Urinary tract infections (UTIs) can cause bleeding from the urethra (where you pee from, between your clitoris and vagina). Pain while urinating, paired with a small amount of blood on the toilet paper, might be signs of a UTI (10).
Consistently spotting after penetrative vaginal intercourse is not considered normal. Bleeding after sex (postcoital spotting) is often caused by an issue with the cervix or polyps (11). Some people may experience spotting after their first intercourse experience, which is normal. If you’re noticing spotting after sex, talk to your healthcare provider.
4. Ovulation and/or hormonal issues
Spotting can also occur around the time of ovulation . It’s unclear why some people experience ovulation bleeding while others don’t—some research suggests it happens in people who have higher levels of some hormones (12).
Spotting a few days before the period starts, in the late luteal phase, might suggest low progesterone (especially if your luteal phase is unusually short) (13), but more research is needed.
today to track spotting and discover your personal patterns.
Article was originally published on October 5, 2017
Why You Have Two Periods in One Month, According to an Ob-Gyn
Your period doesn’t get weird slang names—“on the rag,” “shark week,” and “code red,” to name a few—for nothing. To be frank, those two to seven days every month are annoying at best and agonizing at worst.
So getting two periods in one month seems entirely cruel. What is my body doing?! you shout to no one in particular. The silver lining of it all? Menstruation gives you a clue into what’s going on with your health—and this is one problem that may be about way more than just picking up an extra box of tampons this month.
First things first, we have to ask: Are you pregnant? “If you’re sexually active, this is one of the initial things I think about. Some women do get irregular bleeding when pregnant,” says Mount Kisco, New York-based ob-gyn Alyssa Dweck, MD, author of The Complete A to Z for Your V. And if you were trying for a baby, rest assured that the irregular bleeding can be totally normal and not indicative that there’s something wrong. Take a pregnancy test and, if positive, call your ob-gyn; they’ll let you know when they want you to come in for an appointment.
RELATED: 8 Reasons You’re Spotting Between Periods
Now that that’s out of the way, you should also know that, well, nothing may be going on. “Just because you have two periods that happen to land within the same calendar month doesn’t mean there’s a problem,” says Dr. Dweck. That’s because a normal menstrual cycle is between 24 and 38 days, according to the American College of Obstetricians and Gynecologists (ACOG). If your period came at the very beginning of this month and then showed up again at the end, this falls within a typical window.
Consider your age too: Is it possible you’re going through perimenopause, a time when periods are known to do some pretty wacky things? This is the decade or so before you go through the transition to menopause; consider it a possible cause if you’re over 40 years old. “Perimenopause is a time when your hormones can be all over the place, ovulation can be sporadic, and you can get your period twice in a month,” says Dr. Dweck.
The issue is if you’re bleeding sooner than that or in between periods. At that point, a too-soon period may indicate a hormonal imbalance with estrogen, progesterone, or testosterone, which are all involved in ovulation. “This can cause irregular ovulation. Essentially, your uterus isn’t sure when or how much to bleed,” says Dr. Dweck. As one example, the hormonal disorder polycystic ovary syndrome (PCOS) can cause irregular bleeding.
Then there’s your thyroid, the gland that regulates your metabolism. One that’s over- (hyper-) or under- (hypo-) active can change up the frequency of your flow, Dr. Dweck says.
RELATED: 10 Things That Mess With Your Period
As you can see, figuring out why you’re suffering through two periods in one month isn’t so cut and dry. Other “structural” problems, like uterine fibroids or polyps may also bring on an additional bleed, and you can have breakthrough bleeding from an IUD or hormonal birth control pills, the ACOG notes.
All that’s to say, be in touch with your ob-gyn, but don’t panic. “You can have a weird period episode, especially since stress, diet changes, travel, or exercise can cause irregularities, but if it’s happening over and over, you should be seen by your doctor,” says Dr. Dweck.
Along with a physical exam, he or she may run additional testing—blood work, ultrasound, etc.—depending on what’s suspected. After that, the underlying cause will inform treatment, whether it’s thyroid medication, a new birth control, or a plan for managing PCOS. Your body can do some weird stuff sometimes, but luckily your ob-gyn can help you crack this menstruation mystery.
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Abnormal Uterine Bleeding (AUB)
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What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding (AUB) is the name doctors use to describe when something isn’t quite right with a girl’s periods. Doctors also sometimes call AUB “dysfunctional uterine bleeding” (DUB). Like lots of medical names, it can sound worse than it is. Most of the time, AUB isn’t something to worry about.
Abnormal uterine bleeding means that periods may be heavier or last longer than normal or not come at all. Bleeding between periods is also a sign of AUB. AUB isn’t usually a major problem, but it can lead some girls to develop anemia (fewer red blood cells than normal).
If a girl has AUB, it might mean her periods last longer or have more bleeding than normal. Or, it might mean the opposite — that her bleeding is light and her periods aren’t coming as often as they should.
Because AUB isn’t usually a problem, doctors often don’t do anything about it. But sometimes they take action if a medical condition is causing AUB. Doctors also might treat AUB if it is causing another problem. For example, doctors may worry that a girl could get
if she is bleeding more than she should.
What Causes Abnormal Uterine Bleeding?
Most of the time, AUB happens because of changes in the body’s hormone levels.
For teen girls, one of the most common causes of hormone changes is when the body doesn’t release an egg from one of the ovaries. This is called
The release of an egg is part of the menstrual cycle. If a girl’s body doesn’t release an egg, the hormone changes can lead to less frequent or heavy periods.
Anovulation is most likely to happen after a girl first starts getting her period. That’s because the signals from the brain to the ovaries aren’t fully developed yet. It can last for several years until a girl’s periods become regular.
Other things can lead a girl to develop AUB. Some illnesses (like thyroid disease or polycystic ovary syndrome) can mess with the body’s hormones. Problems like compulsive exercise, not eating healthy foods, or too much stress can cause hormone changes. Some severe cases of AUB are caused by bleeding disorders such as von Willebrand disease.
What Are the Signs & Symptoms of Abnormal Uterine Bleeding?
Every woman has a heavy period from time to time. How do you know if it’s abnormal uterine bleeding? Only a doctor can tell for sure, but there are some signs that bleeding might not be normal.
One thing that can alert you to problems is the 1-10-20 test:
- You use more than 1 sanitary pad or tampon per hour.
- Your period lasts more than 10 days.
- There have been fewer than 20 days between your periods.
If you notice any of these things, call your doctor. Bleeding in between periods or after sex also can be a sign of AUB.
If your period stops for more than 3 months, ask your doctor about that too. If you’re not bleeding, the lining of the uterus can keep building up. Eventually it will need to flow out.
How Is Abnormal Uterine Bleeding Diagnosed?
A doctor will want to rule out other health problems before deciding a girl has AUB. For example, doctors might find out that a girl with heavy periods has a bleeding disorder like von Willebrand disease.
To diagnose AUB, doctors will ask questions about periods and bleeding. Expect your doctor to ask the date your last period started.
A doctor also might ask questions that don’t seem connected to bleeding — like about recent weight changes or if you have ever had sex. Doctors ask these questions because conditions like polycystic ovary syndrome and some STDs can cause abnormal bleeding. If they’re not treated, they may lead to more serious health issues, like infertility (not being able to have a baby).
Girls who have had sex and miss a period need to see a doctor. Missed periods could be a sign of pregnancy as well as a sign of AUB. If you have heavy bleeding or bleeding between periods, it could be an infection or other problem. For example, an ectopic pregnancy (when a pregnancy implants someplace other than the uterus) can cause bleeding, and can be life-threatening.
A doctor might do a physical exam and maybe a pelvic exam. Sometimes doctors order blood tests or ultrasound exams. Blood tests also can show if a girl has anemia.
How Is Abnormal Uterine Bleeding Treated?
Doctors treat AUB based on what’s causing it.
If a girl has very heavy bleeding, her doctor might test for anemia and prescribe iron pills or other treatments. For very light or irregular bleeding that goes on for a long time, medical professionals often prescribe birth control pills. Birth control pills contain hormones that can help balance a girl’s menstrual cycle.
Most girls just need time for their bodies to adjust to their hormones. Eventually, their menstrual cycles get regular naturally. If you’re ever worried that your period might not be normal, talk to your doctor.
Reviewed by: Robyn R. Miller, MD Date reviewed: December 2018
Is it OK to Get My Period Twice in One Month?
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Is it bad if I get my period twice in one month? Why does this happen?
It’s often normal during the teen years to have irregular periods. When a girl’s period is irregular, it might come more than once a month or only come every few months. Some girls find they get their period more than once some months, then they might not have another for several months. This is the body’s natural way of adjusting to the changes that come with growing up.
Your cycle should settle down within a couple of years of getting your first period. If your periods are heavy, often come more than once a month, or if you’ve had sex, check in with your doctor or nurse practitioner or visit a local health clinic. Some clotting problems, hormone problems, and sexually transmitted infections (STDs) can cause girls to bleed more.
A checkup can help determine if you need any medication or treatment — such as iron supplements to prevent anemia or antibiotics for an infection. Best of all, getting checked out can put your mind at ease and give you a chance to learn more about your body.
*Names have been changed to protect user privacy.
Reviewed by: Julia Brown Lancaster, MSN, WHNP-BC Date reviewed: January 2015