So, You’re Spotting - Could You Be Pregnant?

Whether you’re trying to get pregnant or not, spotting between periods could be a sign of pregnancy. Some women experience spotting when the fertilized egg (embryo) is implanted in the lining of the uterus  — an event called implantation bleeding.

However, it’s worth noting that implantation bleeding isn’t the only explanation. So if you notice spotting, don’t jump to the instant conclusion that you’re pregnant. While this may be a sign of the beginning of pregnancy, it could mean 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 predictable cycle typically anywhere from every 21-35 days (for adults). The normal duration of a 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 bit more about implantation bleeding.

The Uterus, Fallopian Tubes, and More...

During your reproductive years—basically from when your period (menarche) begins to when it ends (menopause)—you ovulate once per month. This event, on approximately day 13 to 15 of a 28-day menstrual cycle, is when your ovary releases an oocyte from a follicle. The oocyte then travels to the fallopian tube and awaits fertilization with sperm.

Once ovulation occurs, the oocyte can be fertilized by sperm. At this point, timing is of the essence. After ovulation, you have about 12-24 hours for fertilization to occur. However, it’s worth noting that sperm can live inside a female body for up to 5 days so the window for intercourse to result in pregnancy is longer than just a couple of days. 

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 through 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 fertilization 

Implantation bleeding is thought to happen when the fertilized egg (embryo) 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 or brown discharge as a result of the event in their early pregnancy.

It’s worth noting that many women who are pregnant do not experience implantation bleeding as one of the telltale early signs of pregnancy. So some spotting or bleeding is neither a guarantee you’re pregnant, nor one that pregnancy hasn't occurred.

Implantation Bleeding Versus Menstrual 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 possible that implantation bleeding is similar to a normal period. However, there are key differences that can be helpful when trying to distinguish between the two. 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
• Headaches
• Nausea
• 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 your 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 light 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.

Brown Discharge, Light Bleeding or 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 Menstrual Cycle Related Causes

• Light or Irregular Periods: If your menstrual period is light or irregular, you may experience light bleeding, like spotting, or irregular bleeding, i.e. bleeding in between periods. This can be due to hormonal changes or many other causes.
• Ovulation: When an ovary releases an egg, a tiny follicle ruptures and allows 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 can occur in the first 3-6 months of taking a new birth control pill. Doctors sometimes refer to this as breakthrough bleeding. It is not necessarily normal, but it is common and should resolve with continued use and avoidance of missed pills.
• Morning-After Pill: According to the Mayo Clinic, the morning-after pill can cause bleeding between periods or heavier uterine bleeding.
• Intrauterine Device (IUD): Some women with an IUD for birth control may also experience irregular uterine bleeding, spotting, or breakthrough bleeding.

External Causes

• Trauma or Medical Examination: If you’ve experienced any vaginal trauma (rough sex, speculum exam during a doctor visit, etc), you may also experience brief vaginal bleeding or spotting.
• Certain 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 stress.

Common Infections

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, trichomoniasis 
• Pelvic Inflammatory Disease (PID), an infection of the upper female reproductive system.

Other Causes

• Uterine fibroids or Polyps: Symptoms of these benign tumors can include irregular or heavy periods and abnormal uterine 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 is a syndrome that includes abnormal uterine bleeding/irregular menstrual cycles, elevated androgen levels, and/or signs of elevated androgen levels and leads to unpredictable and infrequent ovulation.
• 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 changes 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, due to lack of estrogen after menopause, can cause vaginal bleeding.
• Cancer: According to the Dana-Farber Cancer Institute, spotting in postmenopausal 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 can be reluctant to consult medical professionals about menstrual or intermenstrual concerns, including spotting. However, if you’re experiencing unusual spotting or stress and 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 always 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 often: 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. If you receive a positive pregnancy test (especially if it is a blood test taken at the doctor's, versus a take-home test kit from the drug store) then you are most certainly pregnant. 

But, if spotting between periods is not explained by implantation or pregnancy, your doctor will want to know the following:

• How long has it been happening:
• Is it something you’ve always experienced or did it start recently?
• How often does it happen: 
• Does it follow a specific pattern? Monthly, multiple times per month, every couple of months? 
• Are there triggers to the bleeding? 
• Does it always happen after sex or exercise etc.?
• How long does it last:
• 1-2 days or more?
• How heavy was the bleeding:
• If you used menstrual products, which ones did you use and how many?
• Any bleeding through the product onto your clothes or underwear?
• Was there anything unusual about the blood: 
• Color, texture, or odor?
• Did you also experience pain while you were bleeding?
• Was there anything you did that seemed to make the spotting worse or better?

The doctor may also examine you. The tests ordered will depend upon your age, the information you provide them about the bleeding, and other factors. They’ll also likely order bloodwork to check your blood count and see if you’re anemic.

Other diagnostic 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 visualize inside your uterus through a camera in order to diagnose and treat some 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.

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 with 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 5 days leading up to and including ovulation. Having sex during the fertile window gives you the best chance of pregnancy.

In Conclusion

If you’re spotting before or in place of your period, implantation bleeding is one possible explanation, and therefore may be one of your early pregnancy symptoms. However, people 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, cramping or if the bleeding becomes heavy, it’s advised to seek medical advice immediately.

Medically reviewed by Dr. Chimsom T. Oleka, M.D. Written by Jane Flanagan — Updated on March 5, 2023.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.