Spot bleeding between periods

Contents

What causes bleeding between periods?

Other causes

Some other causes of bleeding between periods include:

  • taking the emergency contraceptive pill
  • injury to the vagina – for example, from having penetrative sex
  • recently having an abortion – seek medical advice if you’re bleeding heavily
  • sexually transmitted infections (STIs) such as chlamydia – it’s a good idea to get tested if you’ve recently had unprotected sex with a new partner
  • recently having a miscarriage
  • reproductive hormones not working normally – this is common in women approaching the menopause or in women with polycystic ovary syndrome (PCOS)
  • stress
  • vaginal dryness
  • harmless changes to the neck of the womb (cervix) – this may be called cervical ectropion or cervical erosion
  • cervical cancer – if you’re aged 25 to 64, you should be having regular cervical screening tests to detect any changes to your cervix; even if you’re up-to-date with screening tests, you should see a GP about irregular bleeding, particularly bleeding after sex, to eliminate the possibility of cervical cancer
  • womb (uterus or uterine) cancer – this is more common in post-menopausal women and most cases of endometrial cancer are diagnosed in women over the age of 50; see a GP if you’re over 40 and have bleeding between periods to eliminate the possibility of uterine cancer
  • vaginal cancer or vulval cancer
  • cervical or endometrial polyps – non-cancerous (benign) growths in the womb or the lining of the cervix
  • fibroids

Abnormal Vaginal Bleeding & Birth Control

Abnormal vaginal bleeding & birth control at a glance:

  • Vaginal bleeding that is considered abnormal occurs when a woman is not expecting her menstrual period, when the flow is lighter or heavier than normal, or when spotting occurs between periods.
  • Sometimes birth control pills, patches, injections, rings and implants can cause spotting between periods or abnormal vaginal bleeding.
  • In other situations, these hormone-based birth control methods are used to treat abnormal vaginal bleeding that result from other medical conditions.
  • Women who experience abnormal vaginal bleeding should consult their physician, as it can signal a serious underlying disorder.

When birth control causes abnormal vaginal bleeding

Birth control pills, patches, implants, injections and rings that contain hormones can cause abnormal vaginal bleeding as a side effect. This can occur:

  • During the first few months when a woman begins using hormone-based birth control.
  • When changing the type of birth control pill or the dose of estrogen.
  • When a woman does not take her birth control pill correctly, missing doses or not taking them at the same time each day.
  • After using birth control for a long time, which can affect the lining of the uterus and cause bleeding.
  • During the first few days of using an intrauterine device (IUD), one either with or without the synthetic hormone progestin; some women continue to experience spotting between periods with an IUD.
  • When using the Depo-Provera birth control injection.
  • When using a birth control implant.

It is important to check with a health care provider to determine the cause of abnormal vaginal bleeding. It may be due to one of the birth control issues above, which should be monitored.

Using birth control to treat abnormal vaginal bleeding

Abnormal vaginal bleeding may be caused by more serious factors, such as polycystic ovary syndrome, endometriosis, pelvic organ infections or certain cancers. Birth control pills, patches, implants, injections or rings that contain a combination of the hormones estrogen and a synthetic form of progesterone may be used to treat the abnormal vaginal bleeding caused by these conditions. These low doses of hormones regulate the menstrual cycle, reducing or eliminating the abnormal bleeding.

Can I use birth control pills if I have abnormal vaginal bleeding?

Check with your doctor first. Report any bleeding that occurs while taking birth control pills then follow your health care provider’s advice. In many instances, it is normal to continue with your current method of birth control.

When to see a doctor

It is important to see a physician for medical advice if abnormal vaginal bleeding increases or becomes severe. Other signs that medical attention is needed include:

  • Pain in the lower abdomen
  • Unusually heavy bleeding
  • Fever
  • Increase in the frequency or severity of symptoms

Get Treatment

Spotting Between Periods: Should You Worry?

If you’ve started taking the birth control pill or gotten a progesterone implant, it’s not unusual to experience irregular bleeding. If spotting doesn’t taper off, talk to your doctor. “You’re probably going to want to change birth control pills, because nobody wants to deal with that all the time,” Dr. Gottesfeld says.

Skipping a pill or two may also bring on spotting. “If you’re on birth control pills and you missed a pill, that can also make you have bleeding between your cycles, and I wouldn’t be so worried,” says Anne C. Ford, MD, associate professor of obstetrics and gynecology at the Duke University School of Medicine in Durham, North Carolina.

Spotting in the Early Years

Spotting between periods can mean different things at early versus later stages of your reproductive cycle.

When you first start having your period, it may be quite irregular for months or even years. This is because your brain, ovaries, and uterus are still working on getting in sync hormonally. Unless your bleeding is excessively heavy or prolonged, it’s usually not a problem, according to Dr. Ford.

Once you become sexually active, spotting after intercourse raises a red flag. This is especially true if you’re having unprotected sex or have just started having sex with a new partner.

Bleeding can signal a sexually transmitted infection (STI), such as chlamydia or gonorrhea, that should be treated promptly, Ford says. “Often, the cervix can be very friable or just bleed very easily from the infection,” she explains.

Another condition that can lead to bleeding after intercourse is cervical entropion, in which the fragile glandular cells lining the cervical opening grow on the surface of the uterus.

Much more rarely, post-sex spotting can be a sign of cervical cancer. Your doctor can take a Pap smear, a sample of cells from your cervix (the opening of the uterus at the top of the vagina) to test for STIs and abnormal precancerous or cancerous cells.

Mid-cycle bleeding could also mean that you’re pregnant and could be miscarrying, although spotting during pregnancy doesn’t always mean the pregnancy will be lost. Ectopic pregnancy, in which a fertilized egg grows outside of the uterus (usually within the fallopian tubes), can also cause bleeding, according to the American Congress of Obstetricians and Gynecologists (ACOG).

Spotting may also be due to vaginal trauma. “The vagina and the cervix are very vascular , so they bleed very easily,” says Lisa Dabney, MD, an ob/gyn in the division of urogynecology at Mount Sinai West in New York City. “A scratch in the vagina will always bleed more than a scratch in your regular skin would.”

Bleeding Between Periods in the Middle Years

Once you reach your thirties, the chance that spotting could indicate endometrial cancer, a type of cancer of the uterus, increases. Obesity also boosts your risk of endometrial cancer, even if you’re a younger woman. “We’re seeing more and more endometrial pathology like that because of the obesity epidemic. We have to worry about that in very obese women, even if they’re younger,” Ford says.

Spotting between periods “definitely becomes more worrisome after the age of 35, because it could be an early sign of endometrial cancer,” Dr. Dabney says. “Hormonal changes, fibroids, and polyps are far more common than endometrial cancer. It’s probably one of those things, but unless you have it evaluated, you don’t know if you’re that one in 1,000 people who has the cancer.”

Fibroids, benign growths that can form in your uterus, are more likely to cause irregular bleeding if they grow into the uterine lining. Polyps, another type of benign growth, can also grow in the uterus or on the cervix and may cause bleeding. Both fibroids and polyps can be removed surgically.

Endometrial hyperplasia, in which the lining of the uterus grows too thick, can also cause abnormal bleeding. While this condition is benign, it can be a precursor to cancer in some cases, according to ACOG.

If your doctor suspects you may have endometrial cancer, he or she will take a sample of tissue from the endometrium so that the cells can be examined under a microscope. Other tests, such as an ultrasound, may be used to determine if bleeding is related to polyps or fibroids.

The long march toward menopause — which officially occurs when a woman has not menstruated for a full year — begins for most women during their fourth decade. As your ovaries begin winding down egg production, your period is likely to become irregular. You may skip a cycle here or there, have your periods unusually close together, or experience heavy bleeding.

“As people’s ovaries start to age, you can see mid-cycle spotting,” Ford says. “That’s very normal and it comes from fluctuating hormone levels.” It can be hard to tell what’s normal and what’s not during this tricky time of life, according to Ford. “If your normal period was three to five days and now you’re bleeding seven to 10 days and it’s heavy, then it’s probably not a normal period.”

Taking hormones to cope with menopausal symptoms like hot flashes can also contribute to irregular bleeding.

After menopause, any vaginal bleeding is cause for concern. “If somebody’s having spotting when they’re postmenopausal, that’s definitely abnormal and needs to be looked into,” Gottesfeld says.

Abnormal Pain and Menstrual Bleeding
Spotting Between Periods

This is when bleeding happens between menstrual periods. Sometimes, this can be normal, but in other cases it can be a sign of a problem.

The majority of women will at some point experience bleeding in the middle of the menstrual cycle. This is called intermenstrual bleeding, or spotting. As with other variations from normal bleeding, sometimes spotting is not something you need to worry about, and other times it can be a sign of a problem.

Why am I bleeding in the middle of my cycle?

Spotting mid-cycle can happen for many reasons and is experienced by most women at some point. The most common reason for spotting is due to hormonal birth control. If you have just started a form of hormonal birth control (e.g., the birth control pill, injection, patch, vaginal ring, implant or IUD), spotting is very common in the first few months. If it doesn’t taper off after 3 months, see your doctor. Taking your birth control pill at the same time every day can help prevent mid-cycle bleeding – even a few hours difference can cause spotting, especially for the progesterone-only pill.

Other reasons you might be spotting include:

Ovulation

Some women experience mild spotting during ovulation. This is likely due to hormonal changes related to ovulation. Estrogen causes the endometrium to thicken, and peaks at ovulation. Progesterone rises at that time to maintain the endometrium. If insufficient progesterone is present at the time the estrogen begins to drop, spotting may result. This spotting usually lasts from 1-3 days and is mid-cycle and is not cause for concern.

If your egg was fertilized, it will usually implant in the endometrium about five to seven days later. This may result in light brown or pink spotting as some of the vessels are disturbed when the fertilized egg attaches to the endometrium.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilize egg implants in the fallopian tube or elsewhere in your abdomen. This can cause heavy bleeding and pain in your abdomen. An ectopic pregnancy can cause serious complications and must be treated either with medication or surgery.

Infection

An infection of your reproductive organs, such as chlamydia or gonorrhea can cause inflammation and bleeding mid-cycle. If you have had unprotected sex with a new partner, or have abnormal discharge or fever, it’s a good idea to get tested.

Cancer or precancerous conditions

Cancers or precancerous diseases of the cervix or uterus can cause bleeding between periods. Women between age 25 and 70 should have a Pap smear every three years to screen for cervical cancer. Uterine cancer is more common in post-menopausal women, but if you are experiencing bleeding between periods, see your doctor to rule this out.

How long does breakthrough bleeding last?

Normally, breakthrough bleeding can last about 8 to 12 weeks. But by the 12th week, it completely stops. During this time, you are advised to continue taking your birth control pills. The only time you may need to stop taking the pills or you may need to take different pills is when the breakthrough bleeding persists beyond the 12 weeks.

But do not change your contraception method without consulting your doctor first.

How to stop breakthrough bleeding?

About 40% of women experience breakthrough bleeding when they start using oral contraceptives. This bleeding usually subsides by the 12th week after use of the birth control pills.

Generally, there is nothing you can do to stop the bleeding. But you can seek supportive counseling if you feel you really need it, but you should continue to take your pills.

After 12 weeks of oral contraceptive use, your doctor may prescribe you supplemental estrogen or ibuprofen, which you may need to take every day for about a week or two. If the bleeding does not subside despite taking medication or supplemental estrogen, consult your doctor immediately.

Chances are that you may need to take a different birth control pill to increase your levels of estrogen and progestin. Or there could be an underlying health problem that is causing you to experience persistent breakthrough bleeding.

Does bleeding decrease the efficacy of the pill?

Bleeding does not decrease the efficacy of the pill. In fact, certain birth control pills are known to cause breakthrough bleeding especially the ones that only contain the hormone progestin. Women are usually advised to take birth control pills that contain both progestin and estrogen to prevent breakthrough bleeding or to decrease it.

It should also be understood that taking birth control pills continuously over a long period of time can also cause breakthrough bleeding. This is why doctors recommend women to take a break from taking contraceptive pills to avoid health complications.

Pills can cause blood clotting. And blood clotting can cause a number of serious health problems such as heart attack, stroke, DVT, and pulmonary embolism.

When should I worry about breakthrough bleeding and see my healthcare provider?

It is normal to worry when you start experiencing some breakthrough bleeding when you are on contraception. But it is normal to experience spotting especially when you are on the pill as this is a sign that your body is adjusting to new hormones.

But aside from spotting and other mild symptoms, there are symptoms that may be cause for concern because they could be a sign of something more severe. When you experience the following symptoms together with the breakthrough bleeding, visit your doctor immediately.

  • Chest pain
  • Sudden shortness of breath
  • Severe abdominal pain
  • Heavy bleeding
  • Eyesight problems
  • Severe pain in the legs

In closing

Breakthrough bleeding is normal and it should not be a reason to worry or panic. For instance, if you are taking birth control pills for the first time, you may experience some spotting.

Breakthrough bleeding may also occur if you start using a different type of contraception other than the one you had previously used. Cervix irritation can also cause breakthrough bleeding, but in such a case, the bleeding stops after a couple of weeks and you won’t even need medication.

Cancer of the ovaries, uterus, vagina or cervix may also cause breakthrough bleeding. Diseases and health conditions such as endometriosis, subchorionic hematoma, diabetes and hyperthyroidism may also cause spotting.

If you have fibroids or an STI you may experience breakthrough bleeding. Women who smoke a lot and women who have already reached menopause may also experience breakthrough bleeding.

In a few words, breakthrough bleeding is normal in some circumstances, but not all. If the bleeding does not subside within the time it is supposed to or if you start to experience heavy bleeding, you need to see your doctor.

Oral contraceptives and breakthrough bleeding: What patients need to know

Practice recommendations

  • Lack of adherence is a common cause of breakthrough bleeding. Focus counseling on ensuring that patients understand and can follow pill-taking instructions before switching pills or method (A).
  • If breakthrough bleeding extends beyond 4 cycles and a woman wish to continue using oral contraceptives, consider switching to a pill with a higher ethinyl estradiol (EE):progestin ratio, either by increasing the EE dose or decreasing the relative progestin dose (C).
  • Breakthrough bleeding may be due to progestin type; switching from an estrane to a gonane may reduce it (C).
  • Women who have breakthrough bleeding after having well-controlled menstrual cycles on oral contraceptives should be assessed for for causes not related to their birth control pills, such as pregnancy, cervicitis, smoking, or interactions with medications (A).

In 1982, more than 20% of women surveyed in a nationally representative sample had discontinued oral contraceptives (OCs) on their own or at the recommendation of their physician due to bleeding or spotting.1 Sadly, the percentage today has not decreased much.

Understandable concern, embarrassment, and annoyance lead these women to abandon OCs.1,2 What they often don’t know, though, is that breakthrough bleeding generally is greatest in the first 3 to 4 months after starting OCs,3 and it steadily declines and stabilizes by the end of the fourth cycle.4 Timely counsel could enable many of these women to cope with the bleeding and stick with an effective contraceptive method. Additional incentives are noncontraceptive benefits of OCs: improved menstrual regularity and decreased menstrual blood loss, dysmenorrhea, and risk of ovarian and endometrial cancer.

Women who discontinue OCs on their own switch to less effective methods of birth control or use no method.1,2 Consequences may be unexpected pregnancies and increased abortion rates.5 With patients who are using OCs, it would be appropriate to ask periodically whether they are satisfied with OC use.

In this review we discuss the mechanisms and management of breakthrough bleeding in women taking OCs, and provide tips for counseling that may help decrease the risk of discontinuation due to menstrual abnormalities in the initial months of use.

Breakthrough bleeding in this review refers to either unplanned spotting or bleeding, regardless of requirement for protection—unless defined otherwise by a specific study under discussion.

4 factors contribute to breakthrough bleeding

Breakthrough bleeding may be due to any the following factors: 1) physiologic effects of OCs on the endometrium, 2) OC-related parameters, including dose, formulation, and regimen, 3) patient behavior, including compliance, using concomitant medications, and smoking, and 4) benign or malignant pathology.

OCs and the endometrium: Estrogen-progestin balance significant

Progestin and estrogen in combination OCs have profound effects on the endometrium, which, though not contributing to contraception, do lead to a predictable pattern of bleeding or such problems as breakthrough bleeding or lack of withdrawal bleed.

Normally, estrogen causes the endometrium to proliferate. Progesterone stabilizes the growing uterine lining. Since the introduction of OCs in 1960, the trend in formulation has been to use the least amount of hormone necessary to inhibit ovulation. Given that the progestin is primarily responsible for the contraceptive efficacy of OCs, the risk of pregnancy is not altered with decreases in the estrogen component. However, significantly lowering the estrogen in OCs may account for breakthrough bleeding. Unplanned bleeding, though, is not dependent solely on the estrogen component as variations in the progestin can contribute to breakthrough bleeding.7

Most OC users in the US take low-dose formulations, so designated because the estrogen component is <50 μg. This level of estrogen in combination with a progestin provides excellent contraceptive efficacy, but may be insufficient to sustain endometrial integrity in some women.8 Studies that have compared OCs containing 20 μg ethinyl estradiol (EE) with those containing 30 μg or 35 μg EE have not been very useful for judging breakthrough bleeding rates because the products often also vary in the phasing and type of progestin. Some studies show more breakthrough bleeding with 20 μg EE pills,9-11 but others show equal or improved cycle control with the lower EE dose.

How is irregular bleeding defined?

For the purpose of performing studies, unplanned bleeding is classified by the World Health Organization into 2 categories: 1) breakthrough bleeding, which requires sanitary protection, and 2) spotting, which does not require sanitary protection.6 Despite this formal classification, trials have varied in their terminology and method of recording menstrual irregularities, making comparisons between studies difficult. In addition, there is wide variation among women in tolerance to bleeding abnormalities, perceptions of heavy vs light bleeding, as well as the need for protection.3

Nevertheless, menstrual abnormalities are consistently cited as a common reason for discontinuing OCs. A prospective US study of 1657 women performed in the 1990s reported that 37% of OC users had stopped taking OCs by 6 months after starting a new prescription because of side effects.2 Irregular bleeding was the most common cause; cited by 12% of women, followed by nausea, weight gain, and mood changes, which ranged from 5% to 7%.

What Causes Spotting Before Periods?

There are several reasons you might experience spotting before your period. Many of these causes can be effectively treated or dealt with.

1. Birth control

Hormonal birth control pills, patches, injections, rings, and implants can all cause spotting between periods.

Spotting can happen spontaneously, or when you:

  • first start using a hormone-based birth control method
  • skip doses or don’t take your birth control pills correctly
  • change the type or dose of your birth control
  • use birth control for a long period of time

Sometimes, birth control is used to treat abnormal bleeding between periods. Talk to your doctor if your symptoms don’t improve or worsen.

2. Ovulation

About 3 percent of women experience spotting related to ovulation. Ovulation spotting is light bleeding that occurs around the time in your menstrual cycle when your ovary releases an egg. For many women, this can be anywhere between 11 days and 21 days after the first day of your last period.

Ovulation spotting may be light pink or red in color, and will last for about 1 to 2 days in the middle of your cycle. Other signs and symptoms of ovulation may include:

  • an increase in cervical mucus
  • cervical mucus that has the consistency and look of egg whites
  • a change in the position or firmness of the cervix
  • a decrease in basal body temperature before ovulation followed by a sharp increase after ovulation
  • increased sex drive
  • pain or a dull ache on one side of the abdomen
  • breast tenderness
  • bloating
  • an intensified sense of smell, taste, or vision

Paying close attention to these symptoms may help you narrow down your window to conceive.

3. Implantation bleeding

Implantation spotting may occur when a fertilized egg attaches to the inner lining of your uterus. But everyone doesn’t experience implantation bleeding when they become pregnant.

If it does occur, implantation spotting happens a few days before your next period should occur. Implantation bleeding is usually light pink to dark brown in color, much lighter in flow than a typical period, and doesn’t last as long as a typical period.

You may also experience the following with implantation:

  • headaches
  • nausea
  • mood swings
  • light cramping
  • breast tenderness
  • an ache in your lower back
  • fatigue

Implantation bleeding isn’t something to worry about and doesn’t pose any danger to an unborn baby. However, if you do experience heavy bleeding and know that you’re pregnant, you should seek medical attention.

4. Pregnancy

Spotting during pregnancy is not uncommon. About 15 to 25 percent of women will experience spotting during their first trimester. The bleeding is often light, and the color may be pink, red, or brown.

Usually, spotting isn’t a cause for concern, but you should let your doctor know if you have this symptom. If you experience heavy bleeding or pelvic pain, contact your doctor right away. This could be a sign of miscarriage or an ectopic (tubal) pregnancy.

5. Perimenopause

As you transition to menopause, you may have months where you don’t ovulate. This transitional time is called perimenopause.

During perimenopause, your periods become more irregular, and you may experience some spotting. You might also skip your periods altogether or have menstrual bleeding that’s lighter or heavier than usual.

6. Trauma

Trauma to the vagina or cervix can sometimes cause irregular spotting. This can be due to:

  • sexual assault
  • rough sex
  • an object, such as a tampon
  • a procedure, like a pelvic exam
  • If you’ve experienced sexual assault or were forced into any sexual activity, you should seek care from a trained healthcare provider. Organizations like the Rape, Abuse & Incest National Network (RAINN) offer support for survivors of rape or sexual assault. You can call RAINN’s 24/7 national sexual assault hotline at 800-656-4673 for anonymous, confidential help.

7. Uterine or cervical polyps

Polyps are small abnormal tissue growths that can occur in a number of places, including the cervix and uterus. Most polyps are benign, or noncancerous.

Cervical polyps typically don’t cause any symptoms, but may cause:

  • light bleeding after sex
  • light bleeding between periods
  • unusual discharge

Your doctor can easily see cervical polyps during a routine pelvic exam. Generally, no treatment is needed unless they’re causing bothersome symptoms. If they do need to be removed, removal is generally easy and not painful.

Uterine polyps can only be seen on imaging tests like ultrasounds. They’re most often benign, but a small percentage can become cancerous. These polyps most commonly occur in people who have finished menopause.

Symptoms may include:

  • irregular menstrual bleeding
  • very heavy periods
  • vaginal bleeding after menopause
  • infertility

Some people may only experience light spotting, while others experience no symptoms at all.

8. Sexually transmitted infection

Sexually transmitted infections (STIs), such as chlamydia or gonorrhea, can cause spotting between periods or after sex. Other symptoms of STIs include:

  • painful or burning urination
  • white, yellow, or green discharge from the vagina
  • itching of the vagina or anus
  • pelvic pain

Contact your doctor if you suspect an STI. Many STIs can be treated with minimal complications when caught early.

9. Pelvic inflammatory disease

Abnormal bleeding between periods is a common symptom of pelvic inflammatory disease (PID). You can develop PID if bacteria spreads from your vagina to your uterus, fallopian tubes, or ovaries.

Other symptoms include:

  • painful sex or urination
  • pain in the lower or upper abdomen
  • fever
  • increased or foul-smelling vaginal discharge

If you experience any signs of an infection or PID, see your doctor. Many infections can be successfully treated with the right therapies.

10. Fibroids

Uterine fibroids are growths on the uterus. In addition to spotting between periods, they can cause symptoms, such as:

  • heavy or longer periods
  • pelvic pain
  • low back pain
  • painful intercourse
  • urinary problems

Some women with uterine fibroids don’t experience any symptoms. Fibroids are also typically benign and may shrink on their own.

11. Endometriosis

Endometriosis happens when tissue that normally lines the inside of your uterus grows outside of the uterus. This condition can cause bleeding or spotting between periods, as well as other symptoms.

About 1 out of every 10 women in the United States is believed to have endometriosis, but many cases go undiagnosed.

Other signs and symptoms of endometriosis include:

  • pelvic pain and cramping
  • painful periods
  • heavy periods
  • painful intercourse
  • infertility
  • painful urination or bowel movements
  • diarrhea, constipation, bloating, or nausea
  • fatigue

12. Polycystic ovary syndrome (PCOS)

Irregular bleeding between periods is sometimes a sign of polycystic ovary syndrome (PCOS). This condition happens when a woman’s ovaries or adrenal glands produce too much “male” hormones.

Some women with PCOS don’t have their periods at all or have very few periods.

Other symptoms of PCOS include:

  • irregular menstrual periods
  • pelvic pain
  • weight gain
  • excessive hair growth
  • infertility
  • acne

13. Stress

Stress can cause all kinds of changes in your body, including fluctuations in your menstrual cycle. Some women may experience vaginal spotting due to high levels of physical or emotional stress.

14. Medications

Certain medicines, such as blood thinners, thyroid medications, and hormonal drugs, can cause vaginal bleeding between your periods.

Your doctor may be able to take you off these drugs or recommend alternatives.

15. Thyroid problems

Sometimes, an underactive thyroid can cause you to spot after your period ends. Other signs of an underactive thyroid (hypothyroidism) include:

  • fatigue
  • weight gain
  • constipation
  • dry skin
  • sensitivity to cold
  • hoarseness
  • thinning hair
  • muscle aches or weakness
  • joint pain or stiffness
  • high cholesterol levels
  • puffy face
  • depression
  • slowed heart rate

Treatment for an underactive thyroid usually involves taking an oral hormone pill.

16. Cancer

Certain cancers can cause abnormal bleeding, spotting, or other forms of vaginal discharge. These may include:

  • endometrial or uterine cancer
  • cervical cancer
  • ovarian cancer
  • vaginal cancer

Most of the time, spotting isn’t a sign of cancer. But you should get checked out by your doctor, especially if you’ve already been through menopause.

17. Other causes

Certain medical conditions, such as diabetes, liver disease, kidney disease, and bleeding disorders, may cause spotting between your periods.

Talk to your doctor if you have these issues and experience spotting.

WHY AM I SPOTTING BEFORE, AFTER, AND IN BETWEEN MY PERIOD?

  • Menstruation
  • November 10th, 2018
  • by Blood + Milk Team

You know when you’re on your period. The blood is flowing, your mood is swinging, and your cramping uterus just confirms what you already know to be true. When you’re spotting, things might not be so clear. Seeing a few red dots in your underwear could mean so many different things: pregnancy, ovulation, stress, a looming visit from Aunt Flo. Regardless of how well you know your body and your menstrual cycle, unexpected bleeding of any kind can be anxiety inducing. Don’t panic—we’ve got the lowdown on spotting before, after, and in-between your periods.

The Difference Between Spotting and Your Period

Generally, periods come every 21 to 35 days. Some women have shorter periods that last up to 2 days, while others menstruate for up to 7 days. Still others can bleed for even longer but this is a sign of a heavy period (or menorrhagia) and, although common, is not normal and can indicate that there are underlying reproductive issues.

The first day of your period is considered “day 1” of your monthly cycle and is often accompanied by period pains: headaches, cramps, cravings, and the like. Though it may seem like you’re bleeding out, the amount of blood women release is usually between 4 and 7 tablespoons. The color of period blood can range but is typically red or, if your uterus is shedding off old tissue, brown.

On the other hand, spotting can occur at any time during your monthly cycle and is most likely going to be just a few drops of blood throughout the day. Spotting blood is usually either light pink or dark brown. Though cramps and periods seem to be best buds, you probably won’t feel any pain if you’re spotting—unless you are experiencing implantation spotting but we’ll get to that.

Now that you’re clear on the differences between spotting and having your period, let’s move on to the really important stuff: why you’re spotting at different times throughout your menstrual cycle.

You’re Stressed

When our society glorifies busy-ness and often views a packed schedule as a status symbol, who isn’t stressed these days? No one, that’s who. Whether it’s stress from a chaotic career, family issues, or just general pressure to be amazing at everything (you really are enough, lady), increased levels of cortisol can take a toll on your menstrual cycle. While missed or irregular periods are common symptoms of being so stressed that you can’t even, so is spotting.

If you can correlate your spotting to times when your stress levels are through the roof, you may have identified the cause. Your best bet is to do what you can to tone down on the stress — take a bubble bath, do some yoga, or just start saying no to things you don’t want to do (or don’t really have time for). Managing your stress in a healthy way should help your spotting subside and your menstrual cycle go back to normal.

You are Ovulating

When you finish up your period, your brain signals to your ovaries that it’s time to make an egg. When your ovaries release that egg into your fallopian tube, you’re officially ovulating. This usually happens around day 14 of your cycle but, of course, this can vary if you have a shorter or longer cycle. That 12 to 24-hour window that your egg is waiting for sperm to find and fertilize it can cause bleeding. Though only about 1 to 2 percent of women have ovulation spotting, those who do may find that their pink or light brown spotting is mixed in with some “egg white” looking discharge, which is a sign of ovulation and fertility.

Your Eggo is Preggo

So, you know how your ovaries release an egg during ovulation? Well, if that egg isn’t fertilized, it dissolves into the inner lining of your uterus, which is sloughed off during your period. But if it is fertilized, it travels back up into your uterus, sperm in tow, and implants to start growing a baby. While your egg gets cozy in your uterus, you may experience what is known as implantation bleeding. This is one of the earliest signs of pregnancy but is not one that all women experience. If you do get implantation spotting, it can last anywhere from a couple of hours to a couple days and you just might feel a little bit of cramping in your lower abdomen.

Your Period Just Stopped

You just put the unused tampons from your purse back into the little black box on your counter (yay!) but – bam! – spots of blood in your favorite panties. WTH, right? Well, lady, hate to break it to you but this is one of the most common spotting times. The reason behind after-period spotting is usually that your uterus didn’t finish flushing out its unused inner lining. Unless your period starts again soon after it ends, you don’t have anything to worry about.

You Just Started, Stopped, or Switched Birth Control

Though men can’t seem to handle the side effects as well as women can, birth control is still such a great invention. Especially for those of us who don’t want children (yet or ever), dealing with the side effects is well worth it if it means preventing pregnancy. One of those side effects is spotting.

If you just got an IUD, spotting is a normal symptom that can last several months. Thankfully, many IUD users eventually have lighter periods or no periods at all. Similarly, starting, stopping, or missing a dose of an oral contraceptive can cause pink or brown spotting. This is due to your estrogen, which keeps the lining of your uterus in place. Doing anything that alters your estrogen levels can cause spotting.

You Took a Morning After Pill

That night of fun ended with you popping a Plan B on your way home the next morning. You thought all was good in your uterus but now you’re spotting. Don’t mistake this as a sign of pregnancy or your period. The hormones present in emergency contraceptive—estrogen and progesterone—can cause light spotting. It should go away pretty quickly so put on a pantyliner and go celebrate not being pregnant with a mimosa (or 3).

You Have Uterine Fibroids

Uterine fibroids are a type of benign tumor that grow in and around the wall of the uterus. Though doctors haven’t identified a specific cause of fibroids, they do say that African American women and overweight women are more at risk for developing them. Spotting is one of the main side effects, along with infertility, painful sex, lower back pain, and a chronically bloated feeling. In other words, don’t assume you have uterine fibroids just because you’re spotting. There are a lot of other causes that are far more likely.

You’re Sick

So this is a little tricky. Being sick with the cold or flu isn’t likely to cause spotting but not feeling well when you’re spotting could be a sign of another health problem—anything from an STI, like chlamydia, to a miscarriage to cervical cancer.

Don’t jump right to this conclusion, though. It’s another factor you can consider but isn’t necessarily a primary cause of spotting. Rule out stress, birth control, and pregnancy before you start Googling symptoms and diagnosing yourself. Actually, don’t even attempt to diagnose yourself. Go to your doctor if you think something is wrong—you know your body better than anyone.

You Recently Got Your First Period

Reaching your menarche may be the start of a decades-long menstrual cycle but rarely are the first few years of bleeding consistent. In addition to irregular periods making it hard to know when you’re safe to rock your white shorts, spotting is a common occurrence for girls who are just getting acquainted with tampons, cramps, and an undeniable craving for chocolate.

Should you worry?

Don’t worry until it’s time to worry. Basically, if you can link your spotting to stress, birth control, the morning-after pill, or your first period, you’re in the clear. If you think you have an STI, cervical cancer, are pregnant, or have uterine fibroids, it could be time to schedule an appointment with your doctor.

Overall, spotting is normal and nothing to freak out about. It’s not something you can (or need to) try and stop. Just let your uterus do its thing. On that note, if you are spotting for more than a week at a time, have any pain or discomfort during spotting, or just have a feeling that something isn’t right – trust your gut instinct and head to your gynecologist.

One final point on spotting: don’t use a tampon (even a low-absorbency one) to control spotting. This can greatly increase your risks of getting Toxic Shock Syndrome. Though using organic tampons eliminate the fear of having toxins in your vagina, spotting doesn’t produce nearly enough moisture to make using a tampon safe. Stick with a pantyliner and you’ll be just fine.

This article has been medically reviewed by Dr. Janet Brito.

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**We love reading your comments, but unfortunately are unable to post or respond to comments or questions that outline specific medical issues and seek medical advice. For any medical concerns, we always advise consulting a medical professional. If you’d like to learn more about your period, we’d recommend checking out other Blood and Milk articles.**

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In an ideal world, women would bleed out of their vaginas on a totally predictable schedule. (Well, okay, not really, but you know what we mean—in a more ideal world.) In reality, though, spotting and breakthrough bleeding is extremely common. There are plenty of things that can cause you to bleed off-cycle, and many of them are nothing worth freaking out about. For instance, spotting is often related to early pregnancy or the birth control pill, and it’s typically harmless as Jacques Moritz, M.D., an ob/gyn at NewYork-Presbyterian and Weill Cornell Medicine, tells SELF. Sometimes, though, breakthrough bleeding may be a sign of a medical issue that requires evaluation and treatment.

That’s why we’re going to make the blanket recommendation that if you are seeing bleeding between periods and aren’t sure why—especially if it’s new or accompanied by pain or other symptoms—you should get in touch with your primary care physician or ob/gyn so they can help you figure out what’s going on. In any case, here are some of most common reasons people experience spotting and breakthrough bleeding.

1. You recently started a new birth control pill.

Spotting during the first three months after going on a new birth control pill is par for the course, Dr. Moritz says. “It may take three months for your body to get used to the medicine and the lining of your uterus to adjust to it.”

Spotting can also occur when you switch from a brand name to a generic, Dr. Moritz says. Gynecologists suspect that generics may not perfectly match brand-name formulations, and that the slight difference may be enough to cause breakthrough bleeding. The FDA says all generic drugs work the same as their brand-name counterparts, but allows for a slight, natural variability. (But it won’t change the main function of the drug.) If after three months on a new pill you’re still spotting, or you suddenly start spotting on your current pill, ask your ob/gyn about switching medications.

2. You’re taking a very low-dose birth control pill.

Many of the newer generations of lower hormone birth pills have either very little estrogen or no estrogen at all, relying mostly on progestin to regulate your cycle. While many people like these formulations because they experience fewer side effects, the super-low dosage makes breakthrough bleeding more likely, even when you’ve been using the same pill for a while. “The pill is making the lining of the uterus so thin that the little blood vessels are fragile and just break because they don’t have enough hormones for support,” Dr. Moritz explains. If the spotting bothers you, ask your ob/gyn about switching to a higher dose pill.

3. You have an IUD.

Similarly to the pill, a hormonal IUD can cause breakthrough bleeding at first—for up to three to six months after insertion. When it comes to the copper IUD, irregular bleeding (and heavier, more painful periods) is relatively common and can go on for quite a while. As SELF previously reported, this is because the device can irritate and inflame the uterus. Although doctors generally recommend giving your body six months or so to adjust, talk to your ob/gyn if you’re miserable.

4. You have an STI.

While gonorrhea and chlamydia are usually asymptomatic—one of the reasons regular STI screening is so important—they can both cause vaginal bleeding (along with other symptoms), especially if the infection is left untreated and allowed to spread throughout the reproductive system. Endometritis (inflammation of the endometrium) and cervicitis (inflammation of the cervix) can occur, as well as pelvic inflammatory disease (PID), which can cause complications like permanent damage to the fallopian tubes and fertility issues. (Although gonorrhea and chlamydia are the most common infections associated with PID, according to the Mayo Clinic, other types of bacteria can cause it too.)

5. You’re about to become pregnant.

Implantation bleeding is one of the earliest signs of pregnancy, occurring in up to 25 percent of women, according to the American College of Obstetricians and Gynecologists (ACOG). One to two weeks after fertilization, when the fertilized egg implants in the uterine lining, a very small amount of blood may flow from the uterus and out the vagina. “It’s just a little spot, not a lot,” Dr. Moritz says. You may experience cramps as well.

6. You’re pregnant and having a subchorionic hematoma or hemorrhage.

This is essentially a blood clot that can occur when the outermost membrane surrounding the embryo (the chorion) separates a little from the uterine wall, allowing some blood to pool in that space between the two. Sometimes, that blood flows out of the vagina, but sometimes not. In any case, it’s painless and very common, Dr. Moritz says. Usually everything is fine, though depending on factors like the size of the hematoma, the mother’s age, and the age of the fetus, they can sometimes come with a slightly increased risk of miscarriage, Dr. Moritz says.

7. You had vaginal intercourse while pregnant.

During pregnancy, “the cervix gets very sensitive, so when the penis touches it, it can bleed a lot,” Dr. Moritz says. Additional blood vessels are developing there, according to ACOG, so bleeding a little after intercourse is no big deal. “It’s totally fine,” he reassures. It doesn’t mean anything has happened to the baby—a penis can’t actually get past the cervix and harm the fetus.

8. You’re having a miscarriage or ectopic pregnancy.

Though bleeding during pregnancy is common and usually harmless, especially in early pregnancy, there are a few worst case scenarios you should be aware of. Bleeding is the first sign of a miscarriage, Dr. Moritz says, which occurs in about 10 percent of known pregnancies, according to ACOG. Cramping may also occur.

Everything you need to know about breakthrough bleeding

The following factors can cause breakthrough bleeding in women who are not pregnant:

  • hormonal contraception
  • IUDs
  • infections
  • fibroids

Hormonal contraception

Share on PinterestBreakthrough bleeding may be caused by a variety of medical conditions.

Women who use hormonal birth control often experience breakthrough bleeding, particularly if they have recently switched contraceptive methods. Breakthrough bleeding may occur for several months, as the body adjusts to the new form of birth control.

Breakthrough bleeding is also common in women who use birth control pills to skip their periods.

Monthly packs usually contain 3 weeks of hormonal pills and an additional week of placebo pills. During this final week, a period will occur because the person is not receiving contraceptive hormones.

Other hormonal contraceptive pills, some containing ethinylestradiol and levonorgestrel, extend the amount of time between periods. For example, a person taking this medication may get a period every 3 months. This method of contraception is also likely to cause breakthrough bleeding.

There are also various birth control methods that may cause people to stop menstruating completely while the drug is active or device is inserted. These include the implant, depo-provera, and mirena. The current medical consensus is that long term or even continuous use of birth control pills is safe, as menstruation is not physiologically necessary.

Women taking hormonal contraceptives may be more likely to experience breakthrough bleeding if they:

  • miss a pill or take one at a different time
  • are ill, especially if they are vomiting or having diarrhea
  • starting any new medication

IUDs

IUDs are popular forms of birth control. No daily pill is required, and a device can be functional for several years.

Hormonal IUDs release a contraceptive medication called progestin, while copper IUDs prevent pregnancy without the use of hormones. Both types cause changes to the menstrual cycle, and any such disruption may lead to breakthrough bleeding.

This bleeding is especially common in the first 3 months after the IUD is inserted.

Infections

The following infections and conditions can cause breakthrough bleeding:

  • sexually transmitted infections (STIs), such as chlamydia or gonorrhea
  • vaginitis
  • pelvic inflammatory disease

An infection may cause additional symptoms. These can include:

  • cloudy urine
  • pelvic pain
  • unusual odor
  • abnormal vaginal discharge
  • burning in the pelvis
  • pain during intercourse
  • heavy periods

The issues above all require medical intervention.

Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus grows elsewhere in the pelvic area. This tissue may develop in the ovaries or fallopian tubes, or around the bladder or bowels.

Endometriosis causes a range of symptoms, including:

  • severe pain during menstruation
  • pelvic pain when not menstruating
  • pain during sex
  • nausea during a period
  • constipation or diarrhea during a period
  • bleeding or spotting between periods

This pain may be so severe that a person cannot engage in regular activities.

Endometriosis may also make becoming pregnant difficult.

Fibroids

Uterine fibroids are abnormal growths that form in or around the uterus. There are many causes, including genetics and hormones.

Some people with uterine fibroids have no symptoms. Others experience breakthrough bleeding. Additional symptoms include:

  • pelvic pressure and pain
  • heavy periods
  • frequent urination
  • constipation
  • a backache
  • leg pain
  • incomplete voiding

Fibroids may be very small or large enough to distort the uterus.

Breakthrough bleeding in pregnancy

As many as 30 percent of people who have been pregnant experienced breakthrough bleeding in the early stages.

This can indicate:

  • a sensitive cervix
  • implantation bleeding
  • subchorionic hematoma
  • a miscarriage or ectopic pregnancy

Any time vaginal bleeding occurs during pregnancy, consult a doctor.

Sensitive cervix

The cervix is located at the base of the uterus. During pregnancy, it softens and becomes more sensitive. Intercourse and vaginal exams may be more likely to cause irritation.

If bleeding from the cervix is not related to intercourse or an exam, it may be a sign of cervical insufficiency. This occurs when the cervix begins to open before the baby is fully developed, increasing the risk of premature delivery.

Implantation bleeding

This occurs when the fertilized egg first becomes implanted in the uterus.

Implantation bleeding typically occurs 6–12 days after conception and a few days before the first missed period.

This bleeding will often be so light that no tampon or pad is needed. Many people with implantation bleeding are not yet aware that they are pregnant.

Subchorionic hematoma

This occurs when the placenta separates from the original site of implantation. The bleeding that results may be light or heavy.

Subchorionic hematomas are often harmless, but a doctor should evaluate any bleeding during pregnancy.

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