Spotting Between Periods: Should You Be Concerned?

Your period ends and you breathe a sigh of relief: Buh-bye for another month. Hello, white jeans, skimpy underwear and relief from raging hormones, cramps and more.

And then you may notice some blood on your underwear or toilet paper. What the heck!? For some women this may be an occasional experience that can cause consternation. For others it’s a regular reality.

Of course, unusual bleeding or spotting will cause you concern: Why is it happening, should you be concerned, is this your period run amok, or is there another explanation? Should you seek medical advice?

The truth is there can be many causes of spotting, some warrant concern and others don’t. The first step is to tell spotting apart from your period.

How to Tell the Difference Between Period and Spotting

Monthly menses typically happens on a regular cycle and includes lighter and heavier days. Some describe the lighter days at the start or end of their period as spotting. However, although it can be difficult to tell the difference, menstruation is different from bleeding between periods.

In general, spotting is any kind of light bleeding that occurs outside of menstrual bleeding (i.e. the shedding of the lining of the uterus). While spotting has a lot of different causes (see below), it is generally lighter and does not require more than a panty liner.

This article on the difference between bleeding and spotting goes into greater depth.

Causes of Spotting Between Periods

The truth is there are many possible explanations of 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, 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.

External Causes

• Trauma or Medical Examination: If you’ve experienced rough sex or a medical exam like a Pap test, 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.

Common Infections

The following infections may cause bleeding 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.

Pregnancy-Related Causes

• 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 for a day or so.
• Implantation bleeding: After a sperm fertilizes an egg, the fertilized 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 hormone levels, spotting may occur before full periods return.

Other Causes

• Fibroids or Polyps: Symptoms of these benign tumours can include 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, 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, 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 See Your Doctor

If bleeding 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 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 STI’s 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.

Treatment & Outlook

If you’re at all concerned, we recommend you see your doctor to rule anything serious out. 

Treatment will depend on the underlying cause. Keeping track of when spotting happens, how often it lasts, and how much blood is lost can help you when seeking an explanation from your doctor.

Most women will experience spotting between periods at some point. So rest assured this is not automatically a sign of something immediately concerning.