“There are a number of reasons someone might be spotting before their period or between their periods (intermenstrual spotting),” explains Jennifer Linhorst, MD, a gynaecologist practicing in Denver. “Some of these reasons are not concerning, but can certainly be annoying to women. However, it is important to rule out pathologic causes before settling in on a benign diagnosis.”
What Is Spotting?
Spotting is any light vaginal bleeding that happens when you're not on your period — and by light, we mean a few drops. You might see a little bit of blood on your underwear or on the toilet paper when you wipe after peeing, but it won't be enough blood that you'll need a pad or tampon.
If You Recently Had Your First Period And You're Spotting...
If you started your period in the past year or two, you might have something called an “immature HPO axis.” HPO axis stands for hypothalamic-pituitary-ovarian axis — meaning how the hypothalamus (a part of your brain), the pituitary gland, and the ovaries work together to control your menstrual cycle. Basically, what this means is that as your body gets used to having a period, your period might change from month to month — you might go without a period for a month or a few months, your period might last two days one month and seven the next, and you might see spotting in between periods.
“During the first one to two years after menarche (the start of periods), young women may not ovulate every month,” Dr Linhorst explains. “This might be characterised by a couple months of no period, followed by spotting or even heavier flow. It could also just be a normal variant. Not all women will start right off with regular or heavy flow during their monthly period, and the spotting may just be the uterine lining getting ready to shed.”
Spotting is very common in young people, Dr Linhorst adds. “I see abnormal bleeding across the age spectrum, but age definitely determines what might be at the top of my list,” she explains. “In a young woman who has recently started having periods and who is not sexually active, an immature HPO axis may be at the top of my list, but taking a thorough history is important to help determine what investigations may be necessary."
Is It Normal To Spot While On Birth Control?
Spotting is a common side effect of starting or stopping hormonal birth control, changing the form of hormonal birth control you use, or missing a dose of hormonal birth control. Remember, hormonal birth control comes in many forms — the pills, the patch, the shot, the vaginal ring, the implant, and hormonal IUDs.
“It can happen when pills are forgotten,” Dr Linhorst explains. “With any hormonal method, it might occur when a woman first starts using that method or switches from one to another, but it can also happen years into use.”
If I'm Spotting Before My Period, Could I Have An Infection Or STD?
Some vaginal infections can lead to spotting. These include sexually transmitted infections such as gonorrhoea, chlamydia, trichomoniasis, as well as infections that aren’t sexually transmitted, such as yeast infections or bacterial vaginosis. “These can be diagnosed with cervical and vaginal swabs and then treated accordingly,” Dr. Linhorst explains. “I strongly recommend STD testing to women who present with new onset spotting.”
Does Spotting Mean You're Pregnant?
Spotting is common during the first trimester of pregnancy — according to the American Pregnancy Association, about 20% of women see spotting during their first 12 weeks of pregnancy. If spotting happens very early in your pregnancy, it could be implantation bleeding, which happens when the fertilised egg attaches to the uterine lining.
Spotting during pregnancy could also indicate a cervical polyp. “Polyps are small outgrowths of tissue (think about a larger skin tag) and can bleed easily,” Dr. Linhorst explains. While cervical polyps are a common cause of spotting during pregnancy because of increased eostrogen in your body, they can also appear outside of pregnancy, as can uterine polyps. "In young women, these are usually benign growths; in older women, they can sometimes be a site for abnormal cells," Dr. Linhorst says.
If you're spotting later in your pregnancy, one possible cause is cervical ectropion, in which soft cells from inside the cervix spread to outside the cervix. This can happen during any hormonal change, and some people are born with it. It's also the most common cause of bleeding during the later months of pregnancy. According to the American Pregnancy Association, although spotting during pregnancy is often not a cause for concern, you should contact your doctor if you notice spotting, just to be safe.
Does Spotting Mean There's Something Stuck In Your Vagina?
Any foreign object left in the vagina — such as a forgotten tampon, or a condom that slipped off — can also lead to spotting. This will usually be accompanied by other symptoms, such as an abnormal odour or discharge. “I have seen my fair share of forgotten tampons in women who present with abnormal bleeding,” Dr Linhorst says.
Could Spotting Be A Sign Of Cancer?
Spotting is one symptom of cervical cancer — but if you’ve been getting pap smears regularly and you're not seeing any other symptoms, that's probably not be the case. “Guidelines have changed and a pap smear is not recommended every year (though an annual exam is), but I always check when someone last had their pap smear,” Dr Linhorst says. “In women who are up to date with this, cervical cancer is an unlikely reason for abnormal bleeding.”
If you’ve gone through menopause — meaning you’ve gone at least a full year without having a period — “any kind of bleeding should be investigated,” Dr Linhorst says. "The most likely reason is due to a thin, delicate uterine lining (in women who still have a uterus), but that can also be a sign of uterine cancer.”
When Should I See A Doctor About Spotting?
Although spotting is common, there are cases in which you should see an gynaecologist. “If it is a new symptom and persists, that would be a good time,” Dr. Linhorst says. “And if there are other symptoms associated with the spotting (foul odour, irritation, abnormal discharge), I would certainly recommend being seen.”