At some point in life, most people will experience bleeding outside of their period (spotting). But why am I spotting between periods? When should I see a doctor if I’m bleeding throughout my cycle? There are a few reasons why bodies may spot during the menstrual cycle, and it doesn’t always warrant a trip to the doctor.
Here are a few reasons spotting between periods may occur, and when to get it checked out:
Breakthrough bleeding (spotting outside of the menstrual week) commonly occurs with those on oral contraceptive pills. Spotting throughout the cycle is especially common during the first few months of taking a new birth control pill. This spotting can occur while your body acclimates to the new level of hormones that keep the endometrial lining stabilized, and thus, in the interim, spotting may occur.
Breakthrough bleeding can also happen when you miss a birth control pill or take one late. This delay in consuming the hormones is enough for some bodies to destabilize the endometrial lining and trigger some to shed off, resulting in light spotting¹.
Talk to your health provider if… you regularly experience spotting between periods on birth control after the three-month adjustment phase. If your spotting is heavy enough to require a pad or a tampon, it’s a good time to consult with your health provider as well. Doctors can help determine why these symptoms are occurring and try a new plan to avoid the side effect of breakthrough bleeding.
Ovulation & Hormonal Imbalances
When reproductive hormones rise and fall, the endometrial lining can be affected. This is why some people experience spotting around the time of ovulation mid-cycle. The change in hormones needed to trigger the ovaries to release an egg can also cause light cramping and bleeding. Similarly, general hormonal imbalances may cause breakthrough bleeding in the cycle, such as PCOS, thyroid disorders, etc. Low progesterone specifically is linked to spotting toward the second half/end of the menstrual cycle².
Talk to your health provider if… you aren’t sure what’s causing your spotting. A simple blood work panel can show if it’s just an imbalance of hormones causing the spotting. There may be solutions to correct the hormonal imbalance and explore other causative factors. It may also be helpful to track your ovulation cycle.
Unexplained bleeding between periods could be a sign of an underlying reproductive condition such as endometriosis, fibroids, cysts, or polyps. These conditions involve variations of physical growths/barriers in the reproductive tract that may cause bleeding, both when unprovoked and provoked (such as bleeding after penetrative sex).
Identifying underlying conditions is essential to both minimizing uncomfortable symptoms and as a precaution as some conditions such as polyps can potentially be cancerous (though most are benign).
Talk to your health provider if… you’re regularly experiencing bleeding between periods or bleeding after sex. These could indicate an underlying condition. A doctor can utilize diagnostic imaging and tools to further assess and treat what is going on.
Vaginal infections such as Bacterial Vaginosis or Trichomoniasis, as well as Sexually Transmitted Infections (STI) such as Chlamydia, Gonorrhea, and Syphilis, can be the culprits of mid-cycle spotting as they cause inflammation³. Infections of these sorts don’t always cause other symptoms and can exist quietly, so ruling them out as a cause of spotting between periods can be important.
Talk to your health provider if… you have a new sexual partner or there’s a change in vaginal discharge/bleeding. Infection testing can be done via a cervical exam with a swab of the inside of the vagina. These results can help rule out infection as a cause of breakthrough cycle bleeding.
If you are sexually active it’s important to be aware that spotting can also be a sign of early pregnancy too. If you have not had breakthrough bleeding before and have been sexually active, consider ruling out pregnancy.
Stress, Lifestyle Changes
There are also times where bodies spot for no apparent reason, with no underlying cause, such as stress. When our bodies are under large amounts of stress or changes (sleep patterns, eating habits) we may experience spotting between periods. Some may be able to pin stress and lifestyle changes as direct correlations to their breakthrough bleeding.
Why Am I Spotting Between Periods? Seek Answers.
Spotting can be frustrating to deal with, and while it may seem manageable, it’s not something that should be left untreated. If you experience regular spotting between periods every month, speak with your health provider. It can help to track your period so you can show your them exactly when spotting is occurring. Forty-six percent of visits to doctors to discuss spotting between periods are resolved with just verbal communication and don’t require further testing of internal exams⁴. If you're experiencing irregular periods, this blog post can help.
If an internal exam is necessary, remember that you are always in control, check out this article for tips on preparing for a cervical exam.
In summary, if you have the odd bout of spotting outside of your period throughout the year it’s likely nothing to stress about. If you regularly experience breakthrough bleeding in your cycle, it’s worth discussing with your doctor why this is happening to rule out underlying causes and get your cycle regular and you feeling your best.
- Schrager, S. (2002, May 15). Abnormal uterine bleeding associated with hormonal contraception. Retrieved March 18, 2021, from https://www.aafp.org/afp/2002/0515/p2073.html
- Crawford, N., Pritchard, D., Herring, A., & Steiner, A. (2016, January 25). Prospective evaluation of the impact of intermenstrual bleeding on natural fertility. Retrieved March 18, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853238/
- Chlamydia, gonorrhea, and syphilis. (n.d.). Retrieved March 18, 2021, from https://www.acog.org/womens-health/faqs/chlamydia-gonorrhea-and-syphilis
- De Vries, C., Wieringa-de Waard, M., Vervoort, C., Ankum, W., & Bindels, P. (2008, April 15). Abnormal vaginal bleeding in women of reproductive age: A descriptive study of initial management in general practice. Retrieved March 18, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2358883/