You think your period is over and all of a sudden there’s blood on your underwear or toilet paper. What gives? We’re so used to blood meaning menstruation that the first conclusion most will jump to is that their period has gone a little haywire.
But vaginal bleeding isn’t always explained by a period. In fact, there can be many reasons you might experience spotting or bleeding between periods. Some of these are easily explained (and, if necessary, treated). Others are a little more complex to understand.
No unexplained bleeding is a nice experience - from any part of your body. And abnormal vaginal bleeding is no exception. But don’t panic. Most women experience spotting at some point in their lives, and some women experience it often.
Let’s unpack what might be going on...
Spotting or Period: What’s the Difference?
Your monthly period is, most likely, a familiar and regular occurrence. Over time, most women understand the rhythm and pattern of their cycle, and the characteristics of bleeding that occur over the 5-7 days of their monthly menses.
Spotting doesn’t necessarily follow any such pattern. The source of bleeding can also vary. Spotting can come from your uterus, cervix or vagina. It’s considered different from your period (the monthly shedding of your uterine lining, your endometrium).
Unusual bleeding between periods can be called spotting, intermenstrual bleeding and metrorrhagia.
Here’s an overview to help you tell the difference between your period and spotting:
What Causes Spotting?
The truth is there are many possible explanations of bleeding between periods. You'll see some that are not applicable to you and you can 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: According to Medical News Today, bleeding often occurs in the first 6 months of taking a new birth control pill. Doctors sometimes refer to this as breakthrough bleeding.
- Morning-After Pill: According to the Mayo Clinic, the morning-after pill can cause spotting between periods or heavier menstrual bleeding.
- Intrauterine Device (IUD): Some individuals with an IUD for birth control may also experience non-period bleeding.
- Trauma or Medical Examination: If you’ve experienced rough sex or a medical exam like a Pap test, you may experience vaginal bleeding.
- Medications: Certain medications may cause abnormal vaginal bleeding. Your pharmacist should advise you of any side-effects of medication.
- Stress: Stress can trigger many reactions.
The following infections can cause spotting between periods. It’s worth noting that most infections are treatable. However, infections can become more serious if ignored.
- Sexually Transmitted Infection (STI), including chlamydia, gonorrhea, and genital warts.
- Pelvic Inflammatory Disease (PID), an infection of the upper part of the female reproductive system.
- Ovulation: When the ovaries release the egg, a tiny follicle ruptures to allow the egg to be released. This can be a cause of bleeding or bloody discharge for a day or so.
- Implantation bleeding: After a sperm fertilizes an egg, the egg implants in the womb. Sometimes, implantation causes light bleeding 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 own individual hormones, spotting may occur before full periods return.
- Fibroids or Polyps: These benign tumours can cause irregular or heavy periods and vaginal bleeding between periods.
- Endometriosis: According to the Mayo Clinic, women with endometriosis may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
- Polycystic ovary syndrome (PCOS): PCOS can cause cysts in the ovaries and make it difficult to get pregnant. It can also cause irregular vaginal bleeding.
- Blood clotting disorders, like von Willebrand disease.
- Other health conditions, like hypothyroidism, liver disease, or chronic kidney disease.
- Cancer: Cancer or pre-cancer 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, hormones 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, especially due to lack of estrogen after menopause, 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.
How Serious Is Spotting: When to See Your Doctor
Keep track of the number of pads or tampons used when you’re spotting. Abnormal blood loss can be estimated by tracking the number of pads or tampons used and how quickly they become soaked.
If you’re taking pain medications, aspirin should be avoided, as it may prolong bleeding.
If irregular bleeding is is accompanied by any of the following symptoms, it warrants a trip to the doctor:
- Heavy periods with a lot of clotting
- Irregular periods
- Abdominal pain or cramping
- Pain or a burning sensation when peeing
- Unusual vaginal discharge and/or redness and itchiness
Even if you don’t have any of the above symptoms, don’t ever ignore 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 between periods 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.
- You are on medication that may also cause bleeding: If spotting can be a side-effect of any medication you are on, you should seek out professional help.
- Spotting occurs post-menopause: It is never considered normal for anybody post-menopause to experience spotting or vaginal bleeding.
Diagnosis: What to Expect
Seeking medical advice can be hard: Many of us dread a visit to the doctor. We imagine the news will be terrible. And so we subject ourselves to all kinds of anxiety and uncertainty instead of simply seeking reassurance or an explanation.
So, if you’re experiencing unusual bleeding and you know it’s time to bite the bullet and go to see your doctor, here are some questions you can prepare yourself to answer.
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 it happens: 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 bleeding happens certain days in your menstrual cycle or seemingly at random?
- How long did the bleeding 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 worse or better?
Based on your answers, the doctor might also perform certain tests etc. Treatment and outlook will always depend on the cause. Whenever you seek medical advice, you'll generally feel relieved afterwards for having taken action.