You've been tracking your periods and can heave a sigh of relief because you still have a long way to go before your next cycle. But, suddenly, you feel that familiar wetness, and sure enough, you find random spotting in your underwear.
Aside from the inconvenience of dealing with breakthrough bleeding, unexpected spotting can also be stressful. You're just not sure about what's happening in your body! In this article, we will describe all the reasons why you could be spotting between your periods.
But first, let us go back to the basics and understand why we bleed during our monthly cycles in the first place!
As you know, the bleeding you experience during your monthly periods comes from the inner lining of the uterus, which sheds if you do not get pregnant during that month. In every cycle, an egg is released from a mature follicle in your ovary through ovulation.
If that egg meets a male sperm, it gets fertilized to form an embryo that implants itself into the uterine lining. The embryo eventually grows into a baby. But, if fertilization does not occur, then without implantation, the uterine lining begins to shed, which is let out as blood through the vagina.
Menstrual bleeding occurs approximately every month in non-pregnant women. Most women experience:
- A regular schedule, even though the time between periods may vary.
- A predictable bleeding pattern begins with light spotting, gets heavier for a day or two, and then gets gradually lighter, ending with spotting. The blood is usually bright red, with clots or strings of coagulated blood, although it may be brown at the start and the end of the cycle.
- Bleeding usually lasts 5-7 days.
- Premenstrual symptoms just before the period occur due to hormonal changes. This includes breast tenderness and headaches.
- Mild to intense cramping as the muscles of the uterus contract to push out its inner lining.
- Menstrual blood is usually red: The color can help differentiate a period from spotting- although the blood may be brown at the beginning or end of the period. Some women see large clots or strings of blood during their monthly period, which is less common with spotting.
On the other hand, spotting is light vaginal bleeding that occurs before or after your regular period. Since it only involves small amounts of blood, you may only notice it when it stains your underwear or on tissue paper after you've used the restroom. Some women experience a day or two of light spotting every month and are not alarmed by it. However, if you have just noticed that you have frequently been spotting, it is advisable to look into it. Depending on the cause behind spotting, it may also be accompanied by other symptoms, like abdominal pain or vaginal pain in case of injury or infections.
Causes of Spotting
Now that we know the differences between regular menstrual bleeding and spotting, let's dive into the causes of spotting before your period.
As discussed earlier, ovulation occurs when a mature follicle releases an egg. Some women experience cramping around ovulation, while others observe spotting. Studies have shown that almost 5% of menstruating women experience mild bleeding or spotting. If you notice light pink or red spotting for 1-2 days around 12-14 days before your next cycle, it could be ovulatory bleeding. You can also keep an eye out for other symptoms of ovulation like
- Changes in your cervical mucus, which becomes more liquid and transparent, like egg whites
- A difference in the position or firmness of your cervix
- Changes in your basal body temperature
- Increased sex drive Breast tenderness
- Intensified sense of smell, taste, or vision
2. Implantation bleeding
Research shows that 15 to 25% of pregnant women experience bleeding in early pregnancy. Spotting usually occurs during this period when a fertilized egg attaches to the inner uterine lining during implantation. It usually happens a few days before your next period begins. You may notice light pink to dark brown discharge, which is shorter, with a lighter flow than your usual period. You may also experience other symptoms of implantation, like
- Headache and body ache
- Mood swings
- Light cramping Breast tenderness
While implantation bleeding isn't dangerous for a growing fetus, you should seek medical aid if you experience heavy bleeding while pregnant.
How do you make out the difference between ovulation bleeding, implantation bleeding, and period blood?
The most common sign that you may be approaching menopause is irregular or missed periods. Still, some women may also experience spotting as their cycles get lighter or heavier than usual.
Certain cancers that affect the female genital organs like uterine, cervical, ovarian, or vaginal cancer can cause abnormal bleeding, spotting, and vaginal discharge. While spotting is not always a sign of cancer, repeated spotting after menopause should be checked out.
Some people may experience spotting after sustaining injuries to the vaginal area. The most common causes are after a procedure like a pelvic exam or inserting a condom. In other cases, rough sex or sexual assault can irritate and damage the delicate tissues of the vagina.
6. Uterine or cervical polyps
Cervical polyps are small finger-like growths that arise from the inner lining of the uterus and cervix. Your doctor can see polyps during a routine examination, and you may not always need treatment if they aren't causing any symptoms. But, in some cases, they can cause irregular and heavy periods, light bleeding between periods, spotting after sex, and unusual discharge from your vagina.
7. Sexually transmitted infections
Sexually transmitted infections (STIs) like yeast infections, chlamydia, or gonorrhea, can cause spotting between periods or after sex. You may also experience other symptoms like a burning sensation when you pass urine, a white, yellow, or green discharge from your vagina, itching in the vaginal area, and pain in your lower pelvis. Most STIs can be treated with medication if they are caught early.
8. Pelvic inflammatory disease
When bacteria from a vaginal infection spread upwards and affect your uterus, fallopian tubes, or ovaries, you may experience abnormal bleeding and spotting. This is a symptom of pelvic inflammatory disease (PID). You may also have a fever, foul-smelling vaginal discharge, and pain while passing urine or having sex. If a PID is not treated by antibiotics, the bacteria may spread to your blood and this can be life-threatening.
Uterine fibroids are soft tissue growths in the uterus. They can affect fertility, making it harder for you to get pregnant or take a pregnancy to term. As a result, you may experience heavy or more extended periods, pelvic and lower back pain, and frequent spotting. Most fibroids are benign and may shrink on their own, while others need medication or surgery.
The inner lining of your uterus is rich in blood vessels, and hormones like estrogen and progesterone primarily influence its growth. In some cases, this endometrial tissue grows outside the uterus in your ovaries, abdomen, and intestines. This causes bleeding and spotting between periods, painful cramping, infertility, and discomfort during sex, while passing stool or urine. 1 in every 10 people with a uterus may have endometriosis. However, many cases are undiagnosed. You may need a combination of medication and surgery to treat endometriosis.
11. Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) occurs when a person's ovaries or adrenal glands produce high amounts of androgens or "male" hormones. They struggle with pregnancy because the condition causes irregular menstrual cycles with spotting between periods. They also tend to gain weight and have excessive hair growth with acne because of the hormonal imbalance. A combination of hormonal birth control, diet, and exercise is known to regulate the symptoms of PCOS.
Everyone experiences emotional, mental, and physical stress, but stress causes significant bodily changes for some people. This is because of the release of the stress hormone cortisol, which pushes the body to release lower levels of estrogen and progesterone. As a result, a hormonal imbalance causes irregular cycles and bleeding between periods.
Blood thinners, thyroid medicines, hormones, and birth control commonly cause spotting and bleeding between periods. Birth control medication contains estrogen and progesterone in pills, patches, injections, or implants. You may experience spotting if you skip doses, change the type or amount of your medication or use the same method for a long time. Talk with a doctor if your symptoms get worse, as they may be able to provide an alternative form of birth control that avoids vaginal bleeding.
14. Thyroid disease
If you have an underactive thyroid, your thyroid gland does not produce enough thyroid hormone to properly regulate your body's internal processes. This includes your periods. You may experience spotting after your period ends, but you may also notice sudden weight gain, dry skin, puffy face, hair fall, constipation, joint pain, and muscle stiffness. You may need to take thyroid hormones to treat the condition.
Spotting during pregnancy is common, affecting 15 to 25% of people during their first trimester. Bring it to your doctor's attention if you experience spotting. Get medical attention immediately if you have sudden heavy bleeding with pelvic pain, as that could indicate a miscarriage or an ectopic pregnancy.
When should you see a doctor for spotting between periods?
While spotting between periods may not be alarming, it may be a symptom of a more severe condition. If you do experience frequent spotting and it's accompanied by other symptoms like pain, heavy bleeding, fever, or itching, visit your doctor. They may conduct a pelvic exam, blood tests, or sonography to rule out some of the conditions we went through earlier.
How is spotting treated?
Your treatment will depend on the reasons behind your spotting. For example, you may need to take antibiotics for a pelvic infection or STI, but hormone medicines to correct an imbalance. Some conditions like endometriosis, fibroids, and cancer may even require surgery.
Spotting between periods can be due to many reasons, and while most do not require any interventions, others are more serious, and you may need your doctor to look into them. Understanding the reasons behind spotting and recognizing spotting patterns is often the first step to finding a solution. As they say, prevention is better than cure!