Spotting After Period Ends? Possible Explanations

JANE FLANAGAN / YOUR BODY

If you experience spotting after your period ends, you may think your monthly period has come again (too soon!) Or you may wonder if your period even ended.

But there is a difference between your monthly period and other vaginal bleeding. If spotting or breakthrough bleeding occurs, there could be a number of possible explanations, including contraceptives, external or anatomical causes, common infections, and health conditions. 

Some of these are normal, and have no cause for concern and others require consulting a medical professional. 

Read on to learn more about what can cause bleeding and what it could mean for your health...

What Is Spotting?

In general, spotting is any kind of light bleeding that would not require the use of a period product and is not associated with your period. We’ll go through some of the different characteristics of menstrual bleeding versus spotting.

Here’s an overview to help you tell the difference:

period vs spotting blood

How Does Spotting Relate to Your Menstrual Cycle?

Spotting is any kind of light bleeding that would not require the use of a period product and is not associated with your period. There can be many causes of spotting between periods: Some totally safe and normal, and some that are concerning and may be a sign that something more serious is going on with your health. Spotting doesn’t usually follow a pattern.

While most spotting can be unpredictable, light bleeding that is caused by events in the menstrual cycle, like ovulation—which occurs when your ovary releases a follicle or oocyte (immature egg) each month—may occur regularly. 

How Do You Know If You're Spotting? 

Spotting blood can have a different hue than period blood. It might be variations of brown, and it can also have a different texture.

Finally, most spotting is light: A panty liner or leakproof underwear is usually sufficient to handle the bleeding caused by spotting. 

If you experience persistent spotting or heavy bleeding outside a period that requires more than a panty liner, you should consult a medical professional.

What Could Cause Spotting After Your Period?

The truth is there are many possible explanations for bleeding between periods. Some of these you’ll be able to rule out on your own (e.g., if you’re not on medication or know you're not pregnant). But others will require a doctor’s visit to test for and rule out. 

This list is not exhaustive, but these are the most common causes of bleeding between periods.

Birth Control Causes

  • Birth control pills: According to Medical News Today, irregular bleeding between periods can occur in the first six months of taking a new birth control pill, or switching between birth control pills. Doctors sometimes refer to this as breakthrough bleeding. Usually light red or reddish-brown, the blood tends to look similar to that at the start or end of a period.
  • Morning-after pill: According to the Mayo Clinic, the morning-after pill can cause bleeding between periods or heavier menstrual bleeding. Spotting or light bleeding can occur up to 1 month after taking emergency contraception to prevent pregnancy, although most people who take the morning-after pill do not experience bleeding between periods. 
  • Intrauterine device (IUD): Some women with an IUD for birth control may also experience non-period bleeding. According to the American College of Obstetricians and Gynecologists, "Breakthrough bleeding happens more often with low-dose and ultra-low-dose birth control pills, the implant, and hormonal IUDs."

Other Causes

  • Trauma or medical examination: If you’ve experienced rough sex or a pelvic exam including a speculum, you may also experience vaginal bleeding.
  • Medications: Certain medications may cause abnormal vaginal bleeding. Your pharmacist should advise you of any side effects of medication.
  • Stress: Increased stress may trigger many reactions, including breakthrough or abnormal uterine bleeding.

Common Infections

The following infections may cause abnormal vaginal bleeding between periods. It’s worth noting that most infections are treatable. However, it's important to see a doctor as infections can become more serious if symptoms are ignored.

  • Sexually transmitted infection (STI), including chlamydia, gonorrhea, and trichomoniasis
  • Pelvic inflammatory disease (PID), an ascending infection of the upper female reproductive system

Pregnancy-Related Causes

  • Implantation bleeding: After a sperm fertilizes an egg, the fertilized egg implants in the uterus. Sometimes, implantation may cause spotting known as implantation bleeding.
  • Ectopic pregnancy: Signs and symptoms of an ectopic pregnancy include abdominal pain and vaginal bleeding.
  • Pregnancy: According to the American Pregnancy Association, 20% of women experience spotting during the first 12 weeks of being pregnant.
  • Miscarriage: Heavy spotting is one of the symptoms of miscarriage.
  • Breastfeeding: Depending on the frequency of breastfeeding and your individual hormone levels, spotting may occur before full periods return.

Other Causes

  • Fibroids or polyps: Symptoms of these benign tumors can include irregular or heavy periods and heavy bleeding between periods.
  • Endometriosis: According to the Mayo Clinic, women with endometriosis may experience occasional heavy menstrual periods and bleeding or spotting between periods (intermenstrual bleeding).
  • Polycystic ovary syndrome (PCOS): PCOS is a syndrome associated with abnormal ovulation that can sometimes make it difficult to get pregnant. It can also cause abnormal bleeding, including irregular menstrual periods or none at all.
  • Blood clotting disorders like von Willebrand disease—which affects the blood's ability to clot—can result in bleeding between periods. Warning signs include heavy bleeding after injury, frequent prolonged nosebleeds, or routine procedures such as dental work.
  • Other health conditions, like hypothyroidism, liver disease, or chronic kidney disease, can cause non-period bleeding.
  • Cancer: Cancer or precancer of the cervix, uterus, or (very rarely) fallopian tube can cause spotting or abnormal bleeding.

Perimenopause & Menopause

  • Perimenopause: The time before menopause is known as perimenopause. During perimenopause, hormone levels fluctuate greatly. These hormonal shifts can have an effect on ovulation and your entire menstrual cycle. Some women notice irregular or skipped periods and abnormal bleeding between periods during perimenopause. 
  • Vaginal dryness: As vaginal mucosa gets thinner due to lack of estrogen after menopause, it is also more vulnerable to irritation which can cause bleeding.
  • Cancer: According to the Dana-Farber Cancer Institute, spotting in post-menopausal women can, in some cases, be an early sign of cancer and should always be investigated further.

When to Seek Medical Advice

If experiencing persistent spotting or heavy bleeding outside of your period and/or your bleeding is accompanied by any of the following symptoms, it warrants getting some medical advice from your doctor or qualified health professional.

  • Heavy periods with a lot of clotting
  • Irregular periods
  • Abdominal pain or cramping
  • Pain or a burning sensation when peeing
  • Abnormal vaginal discharge and/or redness, irritation, or itchiness of the vagina or external genitalia (vulva)

Don't Ignore Spotting in These Situations

Even if you don’t have any of the above symptoms, don’t ever ignore spotting, abnormal vaginal bleeding, or abnormal uterine bleeding in the following situations:

  • If you think you’re pregnant: You should always see a doctor as soon as you think you may be pregnant to be administered a pregnancy test
  • When it happens inconsistently: If spotting seems to happen frequently and randomly, you should definitely look into it
  • It begins after unprotected sex: Unprotected sex can put you at risk for STIs and other infections, so if you notice spotting after unprotected sex, it’s wise to visit a doctor or qualified health professional.
  • You are on medication: If spotting can be a side effect of any medication you are on, you should seek out professional help from a healthcare provider.
  • Spotting occurs post-menopause: It is never considered normal for anybody post-menopause to experience spotting or vaginal bleeding.

What to Expect at Your Doctor’s Visit

When you see your doctor, she will want to know:

  • How long this has been happening: Is it something you’ve always experienced, or did it start recently etc.
  • How often does it happen: Is it monthly or irregular? Is this the first time it’s happened?
  • If there’s a pattern to the bleeding: Have you observed the spotting happens on certain days in your menstrual cycle or seemingly at random?
  • How long did the spotting last: 1–2 days or more?
  • How heavy was the bleeding: Did you use any protection? Was a panty liner insufficient?
  • Was there anything unusual about the blood: Color, texture, or odor?
  • Did you also experience pain while you were bleeding?
  • Did the bleeding coincide with any increased physical exertion (sex, exercise, etc.)?
  • Was there anything you did that seemed to make the spotting better or worse?

Your doctor may also examine you. The tests your doctor might recommend will depend on your age and other factors. If you could be pregnant, they will likely obtain a pregnancy test.

They will most likely order bloodwork to check your blood count and see if you’re anemic.

Other tests your doctor may recommend in order to determine a cause of abnormal uterine bleeding may include:

  • Endometrial biopsy: An endometrial biopsy is used to screen for abnormal cells in the uterus. Learn more from Johns Hopkins Medicine.
  • Hysteroscopy: A hysteroscopy allows your doctor to look inside your uterus in order to diagnose and treat the causes of abnormal bleeding. Learn more from the Cleveland Clinic.
  • Pelvic Ultrasound: A pelvic ultrasound allows quick radiographic visualization of the female pelvic organs and structures, including the uterus, cervix, vagina, fallopian tubes, and ovaries. Learn more from Johns Hopkins Medicine.

Conclusion

It can cause anxiety and stress when you start bleeding or spotting without explanation. However, as we’ve seen, there are a number of different causes of spotting. 

If this is happening to you, don’t jump to the worst possible conclusion. Track what’s happening and decide if you need to seek medical advice. 

Although many of us experience anxiety about the thought of a doctor’s visit, it might be the easiest way of finding reassurance. If there is something to be concerned about, you’ll be glad you acted.

Medically reviewed by Dr. Chimsom T. Oleka, M.D, Written by Jane Flanagan — Updated on November 1, 2021.