It’s safe to say that everyone who has a period experiences some type of spotting from time to time. Spotting describes light bleeding outside of a regular menstrual period. As opposed to a period, which generally has a heavier flow and may continue for several days, spotting is much lighter and most often persists for no more than a day or two. Blood is most often pink, brown or light red, and it may not require the use of a pad or tampon. Spotting can happen for many reasons, and while it is often harmless, understanding its causes is essential to knowing when it may require attention.
The role of hormones in spotting
One common reason for spotting is hormonal changes in the body. Hormones play a significant role in regulating the menstrual cycle, and when their levels fluctuate, spotting may occur. There are a variety of ways that hormone changes occur.
- Hormonal medication. One obvious example is the effect that birth control has on hormonal signaling. Most women experience light bleeding between periods during the first several months after beginning or coming off of birth control pills, patches, injectable contraception, the implant or IUDs as their body gets accustomed to the new hormonal signaling.
- Stress-related spotting. Stress is another potential cause for spotting. When a woman experiences high levels of stress, her body secretes the stress hormone cortisol, which can interfere with the signaling between reproductive hormones. This may temporarily pause ovulation or may partly signal the uterine lining to shed, leading to spotting.
- Physical demands. Rapid weight changes and extreme physical exercise have a similar influence as mental stress.
Ovulation spotting
Spotting may happen mid-cycle when an egg is released from the ovary – ovulation. Ovulation spotting is usually light, lasts less than 24 hours and is often associated with mild cramping or increased cervical mucus. The exact reason for ovulation spotting is not totally understood, but it is generally a harmless occurrence.
Vaginal injury or infection
Local infection or injury can be a cause of spotting. For example, spotting may occur after a pap-smear examination or after sexual intercourse. Both of these can irritate the vagina and cervix, but spotting should resolve within 24 hours. Sexually transmitted infections (STIs) like gonorrhea and chlamydia can cause local inflammation and irritation of the cervix, making it sensitive and prone to light bleeding.
Implantation spotting
In some individuals, light spotting may be a first sign of pregnancy. This type of spotting occurs when a fertilized egg (an egg that has merged with a sperm) sticks to the uterus and implants itself. This type of spotting is called implantation bleeding, and it happens because the implanted egg disrupts a small blood supply. Implantation bleeding is normally very light and tends to be close to the time a person might expect their period, which can sometimes cause confusion. However, it is usually much lighter and shorter than a period and does not have any period-associated symptoms.
Underlying medical problems
When spotting is due to an underlying medical problem, it’s often referred to as “abnormal uterine bleeding.” The most common causes of abnormal uterine bleeding are due to hormonal imbalances. Hormonal imbalances (which basically means that your hormones aren’t sending the right signals at the right time) are especially common in teenagers whose reproductive systems are still developing and in those approaching menopause, when hormone levels naturally decline. Other medical conditions that disrupt the menstrual cycle and cause abnormal bleeding include thyroid disorders, polycystic ovary syndrome and bleeding disorders. Finally, structural abnormalities of the uterus, like fibroids, can also cause abnormal bleeding.
When to seek help
While spotting often doesn't require treatment, there are signs that it may suggest something else is going on. If spotting becomes more frequent or heavy, lasts longer than a day or two or is accompanied by other symptoms like pain, fatigue or abnormal vaginal discharge, consider discussing with your doctor. You can expect the doctor to get a detailed history of your menstrual patterns, ask about medication use (especially birth control), address stressors or other lifestyle changes and perform a physical exam. Depending on possible causes, the doctor may order blood tests or imaging to look at your ovaries and uterus.
Treatment of spotting
The specific treatment for spotting depends on the underlying cause. If hormonal changes are responsible, birth control pills or other hormonal therapies might be prescribed by your physician to regulate your cycle and prevent irregular bleeding. For people with medical conditions such as PCOS, medications to manage insulin resistance or induce ovulation may be recommended. Infections that cause spotting are usually treated with antibiotics or other medications.
When spotting is related to external causes (like stress or diet and exercise patterns), changes can take a little more time. The management of stress through relaxation, counseling or physical activity may help in restoring hormonal balance. Good weight and a proper diet also help in maintaining regular menstrual cycles.
Conclusion
Light bleeding outside of a regular period window is generally harmless. Tracking your period can help determine if there are patterns to your spotting and if there are any factors that can be addressed to reduce spotting. When spotting is frequent, heavy, or accompanied by other symptoms, it’s worth discussing with your doctor.