Here's Why You Might Be Spotting Between Your Period

Spotting between periods is pretty common, and it's usually not anything to worry about. Learn more about the many possible reasons behind spotting—and when it might be the sign of something serious.

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Photo: Karolina Grabowska / Pexels

Spotting is generally defined as vaginal bleeding that happens at any time other than during your period. These episodes are often shorter and lighter than your regular period flow but, depending on the cause of the bleeding, might also also come with cramps.1

While bleeding between periods can be inconvenient, it isn't typically a cause for concern and is usually treatable. Sometimes, though, spotting can be a sign of a serious condition.

Causes of Spotting Between Periods

Spotting happens for a variety of reasons. It can be a common sign of several conditions or lifestyle changes or—more rarely—a clue that something's wrong.

Hormonal Birth Control

Using hormonal birth control like the pill, implant, injection, or intrauterine device (IUD) is a common cause of spotting. With IUDs and the pill, spotting will typically get better in three to six months after starting. Spotting with implants and injections may or may not decrease with continued use.2

This side effect is generally not harmful. But if it's particularly bothersome, check with a healthcare provider for treatment options, including changing birth control methods, taking ibuprofen, or adding short-term estrogen treatment.3

Certain Medical Conditions

Some underlying health conditions that disrupt hormone levels may cause spotting. This includes hypothyroidism, when the thyroid gland produces too few hormones, and polycystic ovary syndrome, a hormone imbalance that affects ovulation.4,5 Once diagnosed, these conditions can be treated with medication to help regulate hormones, cutting down on the spotting episodes.

Pregnancy

Your period stops when you're pregnant, but it's actually fairly common to experience some spotting, particularly in the early stages of pregnancy. Data suggest that about one in four pregnant women experiences spotting during the first trimester.6

The process of the fertilized egg implanting into the uterine lining is what can first cause spotting. The spotting can happen one to two weeks after fertilization. Early spotting might also occur because more blood vessels are developing in the cervix, making it more susceptible to bleeding.7

While bleeding later in pregnancy can be cause for concern, bleeding early in pregnancy often isn't. Still, it's important to contact your healthcare provider if you notice bleeding at any point in your pregnancy.7

Medications

Several types of medication can prompt spotting, including:8,9

  • Hormone therapy
  • Tamoxifen, a medication for early-stage breast cancer
  • Blood thinners
  • Certain antidepressant and antipsychotic drugs
  • One-time-use emergency contraception pills, like Plan B

Always check with a healthcare provider before stopping any prescribed medications on your own.

Uterine Fibroids or Polyps

Two different types of growths on the uterus—known as uterine fibroids and uterine (endometrial) polyps—can cause spotting and, sometimes, cramping.10,11 These masses are typically small, non-cancerous, and otherwise not very bothersome. Both are more likely to develop as you age and can be treated with medications or, in severe cases, surgery.8,12

Sexually Transmitted Infection

Certain sexually transmitted infections (STIs), such as chlamydia and gonorrhea, can cause abnormal vaginal bleeding. If these STIs are to blame for your spotting, you'd likely also notice unusual vaginal discharge and sometimes a burning sensation while you're urinating.13,14 STIs can be diagnosed through testing with a healthcare provider who can then recommend treatment options to clear up the infection.

Ovulation

For some, spotting can happen during ovulation. This is the point in your menstrual cycle when the ovaries release an egg. This type of spotting lasts for a day or two and is sometimes accompanied by cramping.15

Sex

It's not uncommon to notice spotting after sex. Up to 9% of women are believed to experience it. This can be attributed to a number of factors, such as:16

  • A thin or dry vaginal wall
  • Endometriosis
  • Non-cancerous polyps
  • Inflammation, such as from an infection

Injury or Trauma

Any type of injury to your vaginal area can prompt spotting. While sexual trauma is a possible cause, know that routine activities like getting a pap smear or having rough sexual intercourse can lead to bleeding, too.12,17 Keep an eye on the spotting and contact a healthcare provider if it doesn't stop or is accompanied by pain.

Perimenopause

The years leading up to your last menstrual period are known as perimenopause. It usually starts when someone is in their mid- to late 40s.18

During this time, hormone levels can fluctuate more than normal. This prompts period changes, potentially including spotting. But unlike flow changes and skipped periods, spotting is not considered a normal part of perimenopause and should be brought up to a provider as it can be a sign of a medical condition.19

Other signs and symptoms of perimenopause include vaginal dryness, sleeping problems, and hot flashes—all of which can be treated with options like medication, hormone therapy, and lifestyle changes.18

Stress

Physical and emotional stress can take a toll on your body—and your menstrual cycle. Experts think elevated stress levels can disrupt your cycle's hormone regulation, causing spotting.20 Spotting between periods can also happen with lifestyle changes, such as dieting or a new exercise routine.12

Miscarriage or Ectopic Pregnancy

If it's possible that you may be pregnant, heavier spotting along with cramps could potentially signal a miscarriage or an ectopic pregnancy, which is when a fertilized egg implants outside of the uterus.21,22

Other signs of a miscarriage include abdominal pain and fluid or tissue coming from the vagina.23 Other signs of an ectopic pregnancy include low back pain and mild pain in the abdomen or pelvis.22

Both can be emergencies, so if you are experiencing any of these symptoms, you will want to call a healthcare provider right away to get appropriate medical attention.

Endometrial, Cervical, or Ovarian Cancer

In rare cases, spotting can be a symptom of certain cancers, such as endometrial (uterine), cervical, or ovarian cancer. With a gynecological cancer, you'd likely also notice other severe symptoms, such as pain, that may get worse over time.24 If you're past the menopause phase or have a family history of these cancers, this risk might be higher, so it's best to see a healthcare provider about it.25

When to See a Healthcare Provider

While the occasional spotting doesn't usually signal a serious issue, it's a good idea to check with a healthcare provider if you notice any vaginal bleeding that's unusual for you.

Consider keeping track of your symptoms to help your healthcare provider form a diagnosis. Jot down:12

  • Details about your typical menstrual cycle, such as the length and consistency of the flow
  • The number of times you've noticed spotting
  • Any additional symptoms, such as cramps

Seek medical care as soon as possible if the spotting is:26

  • Severe, persisting, or getting worse
  • Linked to other symptoms, such as dizziness, fever, fatigue, or abdominal pain
  • Happening after menopause

Summary

Spotting typically isn't a cause for alarm—especially if you recently started taking hormonal birth control—but there is a chance that it could be the sign of something more serious, like a sexually transmitted infection, thyroid condition, or (in rare cases) cancer.

It's worth checking with a healthcare provider if your spotting is unusual or bothersome because there are treatment options or birth control alternatives available. In the meantime, try tracking your spotting days and symptoms.

Sources:

  1. Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):383-390.
  2. Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65(4):1-66. doi: 10.15585/mmwr.rr6504a1.
  3. Centers for Disease Control and Prevention. Management of women with bleeding irregularities while using contraception.
  4. Thakur M, Maharjan M, Tuladhar H, et al. Thyroid Dysfunction in Patients with Abnormal Uterine Bleeding in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2020;58(225):333–337. doi:10.31729/jnma.5033.
  5. Harris HR, Titus LJ, Cramer DW, Terry KL. Long and irregular menstrual cycles, polycystic ovary syndrome, and ovarian cancer risk in a population-based case-control study. Int J Cancer. 2017;140(2):285-291. doi:10.1002/ijc.30441.
  6. Hendriks E, MacNaughton H, MacKenzie MC. First trimester bleeding: Evaluation and management. Am Fam Physician. 2019;99(3):166-174.
  7. American College of Obstetricians and Gynecologists. Bleeding during pregnancy.
  8. Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women. Am Fam Physician. 2019;99(7):435-443. PMID: 30932448.
  9. MedlinePlus. Emergency contraception.
  10. Office on Women's Health. Uterine fibroids.
  11. Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019;7:2050312119848247. doi:10.1177/2050312119848247.
  12. MedlinePlus. Vaginal or uterine bleeding.
  13. Centers for Disease Control and Prevention. Gonorrhea - CDC basic fact sheet.
  14. Centers for Disease Control and Prevention. Chlamydia - CDC basic fact sheet.
  15. Dasharathy SS, Mumford SL, Pollack AZ, et al. Menstrual bleeding patterns among regularly menstruating women. Am J Epidemiol. 2012;175(6):536-545. doi:10.1093/aje/kwr356.
  16. Tarney CM, Han J. Postcoital Bleeding: A Review on Etiology, Diagnosis, and Management. Obstet Gynecol Int. 2014;2014:192087. doi: 10.1155/2014/192087.
  17. MedlinePlus. Pap Smear.
  18. Office on Women's Health. Menopause basics.
  19. American College of Obstetricians and Gynecologists. Perimenopausal bleeding and bleeding after menopause.
  20. Rafique N, Al-Sheikh MH. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Med J. 2018;39(1):67-73. doi:10.15537/smj.2018.1.21438.
  21. American College of Obstetricians and Gynecologists. Early pregnancy loss.
  22. American College of Obstetricians and Gynecologists. Ectopic pregnancy.
  23. MedlinePlus. Miscarriage.
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  25. American College of Obstetricians and Gynecologists. Perimenopausal bleeding and bleeding after menopause.
  26. Office on Women's Health. Period problems.
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