Almost all women experience spotting between periods from time to time. Often, it is normal and no reason for concern but in some cases, it can be an indicator of another problem. In this article, we’ll talk about what causes spotting before your period or in between periods and when you should seek help. Please note that this article will focus only on spotting experienced by non-pregnant, reproductive-age women.
What Is Spotting?
Spotting is any light bleeding from the vagina that is not attributed to a woman’s regular menstrual cycle. During ovulation and menstruation, there is a build-up and then shedding of the inner lining of the uterus (endometrium). Bleeding that occurs outside a menstrual period or after menopause is considered abnormal uterine bleeding or “vaginal spotting.” There are many causes of vaginal spotting which will be discussed in detail below.
What Is the Difference Between Your Period, Spotting, and Bleeding?
The word “bleeding” refers to both spotting and your period. Spotting tends to be lighter—more “spotty,” while your period is heavier. Technically, any time you bleed and it is not attributable to your period, it falls under the definition of spotting.
The bleeding that takes place during your period happens approximately every 28 days (although women’s cycles can vary significantly). You can generally tell that bleeding is menstrual based on the following criteria:
- Regular and predictable: Some women can set their calendar to their cycle, but even if yours fluctuates here and there, there is likely some sort of visible pattern and you know approximately when to expect your period and how long it will last.
- Other symptoms: Often, your period is preceded or accompanied by a range of different symptoms such as headaches, breast tenderness, and cramping.
- The color of the blood: Menstrual blood is usually bright red (although it may have a brownish tinge at the beginning or end of the period) and can contain clots.
This is in contrast to spotting, which frequently has the following characteristics:
- Irregular and unpredictable: While some women experience spotting on a regular basis or at the same time each month, it can also be highly unpredictable.
- Injuries or other symptoms: An injury or trauma to the vagina or cervix can cause spotting.
- The color of the blood: You may see brown spotting or blood that is a different color, texture or intensity from your usual menstrual bleeding.
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Causes of Spotting
Vaginal spotting is a common complaint in non-pregnant, reproductive-age women. There are several reasons you might be experiencing vaginal spotting and based on your symptoms, you may be able to tell what the cause is. Below we will delve into some of the most common causes of spotting before and after your period.
Changes in hormone levels
A common cause of spotting before or between periods is changes in hormone levels. Women’s cycles are ruled by hormones and any sudden fluctuations in those hormone levels can cause unexpected bleeding or spotting.
Among the reasons for hormonal changes—many of which are entirely benign—is the use of hormonal birth control. If you have recently started a new birth control pill or other hormonal birth control (such as certain types of IUDs, injections, the patch, etc.) it may take a few months for your body to adjust. The changing levels of hormones can cause spotting for a week or a few days. Failing to take your pill at the same time every day may also lead to spotting.
Many women report spotting during ovulation, which is attributable to the changes in estrogen levels at that time of the month. Just before ovulation (which is when the ovary releases an egg each month), levels of estrogen rise. Once the egg is released, estrogen decreases as progesterone increases. It is this shift in balance between the two hormones that can cause ovulation spotting. For some women who are trying to conceive, this can be a useful sign to help them know when ovulation is occurring.
A uterine fibroid is a non-cancerous growth in or on the uterus. Fibroids are very common and 20-80% of all women will experience fibroids by age 50, with the majority of cases presenting in women in their 40’s and early 50’s. While some women never experience symptoms, fibroids can cause spotting between periods. Fibroids can also cause longer and heavier periods.
Other symptoms of fibroids include a feeling of fullness in the pelvis, frequent urination, pain during sex, and lower back pain. A doctor can usually confirm the presence of a fibroid during a physical exam or with an ultrasound.
Infections and vaginal bleeding
Spotting can be caused by an infection in the reproductive organs. If this is the cause of your spotting between periods, it will likely be accompanied by a fever, pelvic pain which gets worse during sex, and foul-smelling vaginal discharge. This type of infection is caused when bacteria makes its way up the vagina and into the uterus or fallopian tubes. This usually occurs during menstruation, but it can also happen at other times during the month. If you suspect that you have any sort of infection, you should consult with a doctor for treatment.
The following types of infections can also cause spotting:
- Cervicitis: Cervicitis is an inflammation of the cervix, often, but not always, caused by a sexually transmitted disease (STD). Symptoms include bleeding between periods, bleeding/spotting after sex, increased vaginal discharge, and painful urination, although some women experience no symptoms at all.
- Chlamydia: Chlamydia is a common sexually transmitted infection caused by a bacteria. It is easily treated once diagnosed, but because people are often asymptomatic or have only mild symptoms it can be missed. Symptoms include spotting between periods and/or after sex, abdominal pain, painful urination, and pain during sex.
- Gonorrhea: Gonorrhea is another sexually transmitted infection caused by bacteria. Spotting caused by Gonorrhea would likely occur after sexual intercourse. Other symptoms include painful urination, pain during sex, increased vaginal discharge, and abdominal or pelvic pain.
- Pelvic inflammatory disease (PID): PID is an infection of the female reproductive organs, usually caused by a sexually transmitted disease. Similar to other infections, there may not be any noticeable symptoms, and it is often diagnosed when either chronic pelvic pain develops or when a woman is having issues with infertility. When there are symptoms, they include spotting in between periods, spotting after sex, fever, painful urination, abdominal pain, and heavy vaginal discharge.
- Vaginitis: A change in the balance of vaginal bacteria or an infection can cause inflammation of the vagina known as vaginitis. It is characterized by light spotting, change in color, odor or amount of vaginal discharge, and pain during sex and urination.
- Implantation bleeding: Some women experience very light spotting when a fertilized egg attaches to the lining of their uterus. You may think that you are spotting when your period is due, but then no period arrives. This could actually be implantation bleeding, one of the earliest signs of pregnancy.
There are four key signals to differentiate between implantation bleeding and your period:
- Color: Implantation bleeding tends to range from light pink to dark brown, as compared to the bright red of a period.
- Clotting: There are no clots with implantation bleeding, while menstrual blood may contain clots in a variety of sizes.
- Time: Implantation bleeding can last anywhere from a few hours to three days, unlike a period which typically lasts from 3-7 days.
- Amount: Implantation bleeding is a very small amount that does not require a tampon or pad. It can be intermittent or a constant flow, but it will be very light and not easily mistaken for the flow of a menstrual cycle.
Blunt trauma to the vagina can cause spotting or more intense bleeding, whether from an accidental injury, sexual intercourse, or sexual assault. If you have been sexually assaulted, please seek help and support immediately.
Uterine or cervical polyps
Both uterine and cervical polyps can cause spotting before periods. Cervical polyps are growths on the cervix that are usually benign (but should be checked to be sure) and produce symptoms such as spotting, increased vaginal discharge, heavier periods, and bleeding after sex. Uterine polyps are similar, but grow in the uterus and are more common in women who are 40-50 years old than in younger women. Symptoms include irregular periods, heavy periods, spotting between periods, spotting after menopause, and infertility.
Endometriosis is a condition where the lining of the uterus grows outside of the uterus, instead of on the inside. It is very painful, particularly during the menstrual period, and it can cause spotting between periods.
What You Can Do to Prevent or Stop Spotting
Prevention or treatment of spotting is dependent on the cause. In some cases, it is a matter of waiting it out, such as when starting a new hormonal birth control. It can take your body a few months to adjust, and then the spotting will stop. During that time, you may experience spotting for a week or two each month.
Other treatments may include the prescription of additional hormones to regulate the cycle, the removal of polyps or fibroids, or (in severe cases) surgery. If spotting is the result of an infection, then treatment of that infection should clear it up.
When to Seek Help About Spotting Before Your Period
In the majority of cases, spotting is not a sign of anything serious and is more of a nuisance than a medical emergency. However, you should certainly seek medical attention if you suspect that you may have an infection, sexually transmitted disease, or if you have been injured or sexually assaulted.
It is important for all women to keep track of their cycles so that a change in their pattern is easily noticed and can be checked out. If you generally see spotting two days before your period and suddenly experience spotting for two weeks before your period, that warrants a conversation with a doctor.
While this article has focused on women who are not pregnant, if you do experience spotting and there is a chance you may be pregnant, you should seek immediate medical care. Vaginal spotting is often normal during early pregnancy, but spotting during pregnancy can be a sign of an early miscarriage or an abnormal pregnancy such as an ectopic pregnancy.
If you experience any heavy bleeding, to the point that you soak through two pads or tampons in one hour for two hours in a row, call your healthcare provider or go to the emergency room. Bleeding this heavy can be serious or even life-threatening.
How K Health Can Help
Spotting can be concerning when you’re not sure what’s causing it. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.