Whether you’re trying to get pregnant or not, spotting between periods can be a sign of pregnancy. Some women experience spotting when the fertilized egg is implanted in the lining of the uterus — an event known as implantation bleeding.
However, it’s worth noting that implantation bleeding isn’t the only explanation. So if you notice spotting after your menstrual period ends, don’t jump to the instant conclusion that you’re pregnant. While it’s possible this is a sign of the beginning of pregnancy, it could be other things too...
What Is Implantation Bleeding?
Approximately every month, a woman’s uterine lining thickens to prepare for pregnancy. If impregnation does not occur, the uterus sheds that lining. This shedding is what we call a period or menses.
Most women have a period on a monthly cycle (on average, the cycle is 28 days). The duration of their period is usually 5-7 days. Every woman’s cycle is different and some women experience irregular periods, heavier periods and/or spotting between periods.
Let’s understand a little more about implantation bleeding.
During reproductive ages, the ovary releases an egg every month. This event occurs when ovary follicles rupture and release the oocyte which travels to the fallopian tube and becomes an ovum or egg.
The egg stays in the fallopian tube for about 24 hours, waiting for a single sperm to fertilize it.
If the egg is not fertilized during that time, it disintegrates (breaks down) and menstruation (your period) begins 11-16 days later.
But if the egg is fertilized, it travels to the uterus, the egg travels down the fallopian tube toward the womb, or uterus, where it will implant in the uterine wall or endometrium. Doctors refer to the fertilized egg as an embryo after implantation.
Implantation bleeding is thought to happen when the fertilized egg attaches to the lining of the uterus (endometrium), sometimes causing little blood vessels to burst.
The endometrium recovers easily from implantation, but some women experience light spotting as a result of the event in their pregnancy.
It’s worth noting that many women who are pregnant do not experience implantation bleeding. So some spotting or bleeding is neither a guarantee you’re pregnant nor one that pregnancy hasn't occurred.
Implantation Bleeding Versus Period Bleeding
It’s easy for women to confuse implantation with a period. This can lead to further confusion about the date of conception. And it’s entirely possible that implantation bleeding is indistinguishable from your usual period blood, or menses. Remember, after all, that women experience their period or menstrual cycle very differently from each other.
However, for the vast majority of women who experience implantation bleeding or spotting, there are some notable differences, which we’ll outline in the table below.
When Does Implantation Bleeding Happen?
According to the American Pregnancy Association, “About 6-12 days after conception (when the sperm joins with the egg), the embryo will implant itself into the wall of the uterus. This movement may break down some blood vessels within the uterus wall and cause some bleeding.”
This timing explains why so many women confuse implantation bleeding for an early period. Menstruation (your period) occurs around 11-14 days after ovulation. Implantation bleeding typically happens within the week before your period is expected.
Other Symptoms That Accompany Implantation Bleeding
Implantation can also be accompanied by other symptoms. Again, it is worth reiterating that implantation can go wholly unnoticed for many women.
These symptoms might also be confused for usual premenstrual symptoms. Women, who are used to experiencing their monthly cycle and period with these symptoms, may not realize pregnancy has occurred.
According to the American Pregnancy Association, some of the symptoms that can accompany implantation bleeding include:
- Light or faint cramping (less than a normal period cramp)
- Mood swings
- Breast tenderness
- Lower backaches
Implantation Bleeding or Period: How to Tell…
Given the timing and list of accompanying symptoms, it’s evident it can be very difficult to tell the difference between implantation bleeding and period.
The absolute best way to tell if the bleeding is your period is to wait a few days and take a pregnancy test (or have one administered by your doctor). The timing of your last sexual encounter can also help. If it was more than two weeks ago, it’s unlikely you’re experiencing implantation bleeding.
According to the American Pregnancy Association, “Often, taking a pregnancy test before the missed period or during implantation bleeding is just too soon for tests to offer conclusive results. Ideally, waiting a week after the spotting or missed period is most desirable as the results should prove more accurate.”
However, even if the bleeding is not implantation bleeding, that doesn’t necessarily mean it’s your period either. Intermenstrual bleeding may be caused by many things. And there are other reasons women could experience spotting. Let’s look at some of the other things that might cause spotting.
Spotting: There Can Be Other Causes….
As we said at the start of this article, implantation bleeding is just one explanation of spotting between periods. Spotting does not mean pregnancy, necessarily.
The truth is there are many possible explanations of light bleeding or spotting between periods. Some of these, you’ll be able to rule out on your own (e.g. if you’re not on medication). 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 light bleeding or spotting between periods.
Other Cycle-Related Causes
- Light or Irregular Periods: If your menstrual period is light or irregular, you may experience spotting. This can be due to hormonal changes or many other causes.
- Ovulation: When the ovaries release the egg, a tiny follicle ruptures to allow the egg to be released. This can also be a cause of light bleeding or spotting for a day or so.
Birth Control & Hormonal Contraceptives
- Hormonal Contraceptives & Birth Control Pills: According to Medical News Today, light bleeding between periods 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 bleeding between periods or heavier menstrual bleeding.
- Intrauterine Device (IUD): Some women with an IUD for birth control may also experience non-period bleeding or breakthrough bleeding.
- Trauma or Medical Examination: If you’ve experienced rough sex or a medical exam like a Pap test, you may also experience vaginal bleeding or spotting.
- Medications: Certain medications may cause abnormal vaginal bleeding or spotting. Your pharmacist should advise you of any side-effects of medication.
- Stress: Increased stress may trigger many reactions. Stress may cause all kinds of changes in your body, including irregularities in your menstrual cycle. Some women may experience vaginal spotting due to high levels of emotional stress.
The following infections may cause irregular bleeding or spotting between periods. It’s worth noting that most infections are treatable. However, infections can become more serious if symptoms are 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.
- Uterine fibroids or Polyps: Symptoms of these benign tumours can include irregular or heavy periods and vaginal bleeding.
- Endometriosis: According to the Mayo Clinic, women with endometriosis may experience occasional heavy menstrual periods or irregular bleeding (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, 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 spotting 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.
When to Seek Medical Advice
Many of us avoid consulting medical professionals about menstrual or intermenstrual concerns, including spotting. However, if you’re experiencing stress or anxiety due to uncertainty it’s always worth talking to your healthcare provider.
If there’s nothing to worry about, they’ll be able to set your mind at ease. However, there are times when spotting or bleeding between periods could be a cause for concern. And if that’s the case, the sooner you see a doctor, the better.
If spotting is accompanied by any of the following symptoms, it warrants getting some medical advice.
- 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 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.
- If 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: 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.
What to Expect at Your Doctor’s Visit
If you suspect you might be pregnant you should visit your doctor as soon as possible to be administered a pregnancy test.
But, if spotting between periods is not explained by implantation or pregnancy, your doctor will want to know the following:
- 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 spotting happens 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 or leakproof underwear insufficient?
- Was there anything unusual about the blood: Color, texture or odor?
- Did you also experience pain while you were bleeding?
- Did the spotting coincide with any increased physical exertion (sex, exercise etc.)?
- Was there anything you did that seemed to make the spotting worse or better?
They will also likely examine you. The tests they might administer will depend on your age and other factors. They'l also likely order bloodwork to check your blood count and see if you’re anemic.
Other tests 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 causes of abnormal bleeding. Learn more from The Cleveland Clinic.
- Pelvic Ultrasound: A pelvic ultrasound allows quick visualization of the female pelvic organs and structures including the uterus, cervix, vagina, fallopian tubes and ovaries. Learn more from Johns Hopkins Medicine.
Track Your Cycle in a Journal or App
It’s a really good idea to start tracking your cycle and any other non-period bleeding in a journal or app. This can help you understand the rhythms of your own body and track the likelihood of pregnancy. Remember, everybody has their own cycle and flow and it may be affected by many factors, both internal and external.
When you’re tracking, pay attention to spotting, but also other symptoms, including:
- Vaginal discharge
- Cramps or abdominal pain
- Breast tenderness
You can even make notes about sudden increases in libido or mood changes. Remember that spotting may be a symptom of many different causes.
If spotting continues, seek medical advice. Have the information you've tracked in your diary medically reviewed by your doctor. This will help you speak to your doctor with more certainty and provide them valuable information to help with a diagnosis.
For women trying to get pregnant, tracking their cycle in an app or journal will also help track ovulation and understand the "fertile window". Your most fertile days ("the fertile window") are the 3 days leading up to and including ovulation. Having sex then gives you the best chance of pregnancy.
If you’re spotting after your period, implantation bleeding is one possible explanation. However, as we’ve seen women can experience spotting for many reasons. Spotting or bleeding may be caused by implantation. But it’s also possible there’s another explanation.
While implantation can cause spotting, there’s a long list of other reasons women may experience spotting. It’s also possible to confuse implantation bleeding or spotting with a period.
The best course of action is to wait a few days and take a pregnancy test or see your doctor. If spotting is ever accompanied by pain, nausea of cramping or if the bleeding becomes heavy, it’s advised to seek medical advice.