What Causes Spotting Right Before My Period?

Bleeding during your period can already be inconvenient for you, interrupting social plans and staining your favorite clothes. When spotting occurs outside your normal period, it can be inconvenient and cause for concern. Spotting is considered abnormal vaginal bleeding, and if it persists, it can be an indication that something isn’t right.

Are you experiencing persistent spotting, heavy bleeding between periods, or spotting in conjunction with other signs and symptoms? Make an appointment with our knowledgeable physicians at Tidewater Physicians for Women to ensure your spotting between periods is not a symptom of an underlying problem.

What is Spotting?

Bleeding between periods, called intermenstrual bleeding, is called spotting when it’s light.

As a general rule, you can differentiate between bleeding and spotting based on what kind of product you need to absorb your bleeding. If you notice it only when wiping or can easily absorb any light bleeding with a pantyliner (or even just underwear), it’s spotting. If you need a pad or tampon to absorb bleeding between periods, it generally wouldn’t be considered spotting.

Bleeding outside of your menstrual cycle that requires a pad or tampon is typically abnormal and requires discussion with your healthcare provider. He or she can investigate further to determine what’s causing heavy bleeding between periods and whether there is cause for concern.

Is Spotting Normal?

If you are accustomed to a regular period with no breakthrough bleeding in between periods, spotting can be alarming. However, it’s actually very common. In most cases, this is not an indication of an underlying condition.

In some cases, spotting can signify something going on inside your body: a sexually-transmitted disease, pregnancy, uterine fibroids or polyps, polycystic ovary syndrome (PCOS), perimenopause, or your body adjusting to hormonal birth control.

If you have certain risk factors or other signs and symptoms along with spotting, seeing an OBGYN can help rule out more serious underlying causes and give you peace of mind about spotting outside of your menstrual cycle.

What If Spotting Occurs a Week Before My Period?

There are a variety of reasons that you might experience bleeding before your period, but the most common is hormonal imbalance. Your menstrual cycle is regulated by the reproductive hormones estrogen and progesterone. When these hormones are balanced, you’ll have a predictable cycle. Progesterone levels are high until your period begins, and then they drop, causing your uterus to shed its lining, which is menstruation.

In many cases, progesterone levels begin dropping a little prematurely, leading to cramping, tender breasts, mood swings, and spotting before your period.

It’s common to mistake bleeding associated with a premature decline in progesterone as implantation bleeding. Implantation bleeding occurs when a fertilized egg attaches itself to the lining of the uterus. This is about 10-14 days after conception or around the time you would expect your period to start.

When is Spotting Not Normal?

Spotting that occurs rarely and without other symptoms or risk factors is typically normal, but spotting can also be a sign of a more nefarious issue. Spotting might be abnormal if:

• You are pregnant or think you might be pregnant.
• It happens consistently for several months (even if there are breaks in spotting) or becomes heavy.
• You are worried about your spotting because of risk factors like family history or sexual activity.
• You have other symptoms like pelvic pain, abdominal pain, abnormal discharge, or a foul odor.

The best course of action if you think your spotting might be abnormal or an indication of a problem is to schedule an appointment with your women’s health physician.

What Causes Spotting?

Many women automatically think of sexually transmitted infections or STIs (formerly known as STDs) when they experience spotting between periods, but STIs rarely cause spotting. In most cases, the cause is either harmless or something else. Some of the more common culprits include pregnancy, birth control, ovulation, trauma, cervical polyps, and rarely, cancer.

Pregnancy

While bleeding is often associated with lack of conception, spotting mid-cycle can be an early sign of pregnancy.

When a fertilized egg attaches to the uterine lining, some women experience some light spotting called implantation bleeding. Implantation bleeding occurs at or just before the time you expected your period to start and is a sign of pregnancy. Implantation bleeding should never be more than a little spotting, noticeable when you wipe or easily absorbed by a panty liner.

No treatment is required for implantation bleeding, but it can be hard to differentiate this type of spotting from others until you see a positive pregnancy test. Once the pregnancy is confirmed, you’ll want to schedule an appointment to explore next steps and ensure you receive the best care possible if you choose to move forward with the pregnancy. If you choose not to move forward, now is the best time to connect with your provider to discuss that, too.

Birth Control

It can take your body several months to adjust to hormonal birth control. In the first several months that you use hormonal contraceptives — whether it’s a pill, patch, injection, or intrauterine device (IUD) — it’s common to experience breakthrough bleeding while your body adjusts. In fact, you might bleed on and off the entire time, depending on the form of birth control and the way your body responds.

Additionally, it’s common to experience breakthrough bleeding if you miss one or more pills or take your birth control pills inconsistently in general. Birth control should be taken every day, around the same time of the day, to ensure consistency. When you skip a pill, it’s just like taking a ‘period pill’ — it will trigger withdrawal bleeding to begin regardless of the time of the month. The cause of this type of bleeding is different from menstrual bleeding, but it still concerns many women.

If you’ve been using the same type of birth control, consistently and as prescribed, for more than three months, and you’re still experiencing irregular periods or menstrual bleeding outside of your regular cycle, let your provider know. It’s typically a strong indication that the birth control you’re using is the wrong one for you, and we can help you evaluate and explore other options, including non-hormonal birth control, that might alleviate those symptoms.

Ovulation

Ovulation itself doesn’t typically cause spotting, but it triggers hormonal changes in your body that can lead to some spotting outside of your normal cycle. Once you release an egg or eggs, which is called ovulation, your progesterone levels start rising, preparing your body for conception and implantation. As you transition from increased estrogen levels to increased progesterone levels, it’s normal to experience some spotting. This would occur mid-cycle, or about two weeks after your last period if you have a 28-day cycle.

If this happens occasionally, there is no cause for concern. If it happens more frequently, sporadically, or bleeding becomes heavy, it might be an indication of a hormonal imbalance that could be causing more problems than intermittent spotting. Your provider may want to investigate frequent or heavy mid-cycle bleeding to ensure your hormone levels are balanced and your body is working as intended.

Cancer

Rarely, certain reproductive cancers, like uterine and cervical cancer, can lead to spotting. Cancer is not often the explanation for women under 40, but becomes slightly more likely as you approach or pass menopause.

Many women worry about cancer when they notice spotting outside of their cycle, but in the vast majority of cases, the cause is benign. However, women who are at higher risk of reproductive cancers due to age, family history, genetics, or other factors should let their provider know about any new spotting between periods, especially after age 40 and even if there are no other symptoms. While it’s one of the least likely causes, it is important to be screened to ensure early detection and intervention when cancer is to blame. The best way to ensure early detection is to get your Pap smear according to the recommended schedule.

Trauma

Spotting between periods can be a side effect of an injury to your cervix or vagina, caused by abuse, sexual activity, a medical procedure, or an accident. If your bleeding results from sexual abuse, seek medical attention immediately. If bleeding becomes heavy, you experience unmanageable pain, or your symptoms worsen instead of improve, also seek medical attention.

If you notice spotting after a minor injury, no treatment is typically required. Take special care to keep the area clean to avoid infection or further injury while it heals.

Cervical Polyps

Cervical polyps are small growths originating from the cervix, which is the lower end of the uterus that connects to the vagina. Polyps are very common, especially in women over 40 who have had children. Some women don’t have any symptoms at all, while others experience heavy bleeding during their periods, abnormal bleeding between periods, or bleeding after sexual intercourse or douching.

Many women live with cervical polyps and don’t require treatment. For those who have symptoms that interfere with their quality of life, though, medical treatment can help treat heavy periods, breakthrough bleeding, and bleeding after sex.

Other Causes

Miscarriage, ectopic pregnancy, pelvic inflammatory disease (PID), polycystic ovary syndrome (PCOS), endometriosis, thyroid disease, and infections like chlamydia and gonorrhea can also cause spotting between periods. Additionally, it can take girls about a year to settle into a regular menstrual pattern after they start their periods. If you are worried about spotting in the first year of menstruation, know that it is common while your body grows and changes and your hormones adjust.

When Should I Consult a Physician About Spotting?

Knowing when to consult your doctor about spotting between periods can be challenging. It’s important to know that it’s always okay to reach out, even if you think your symptoms might not be cause for concern.

You should reach out to your doctor if:

• You think you might be pregnant or know that you are pregnant.
• Your spotting has been consistently happening between periods for several months now.
• The spotting becomes heavier and requires a pad or tampon.
• You have a family history of reproductive cancer.
• You are having other symptoms that might indicate an underlying problem.
• You are worried about it for any other reason.

Other symptoms that might indicate that it is time to see a gynecologist include abdominal pain, green or yellow vaginal discharge, foul odor, heavy periods, pain with urination, or constipation.

Additionally, if you have had an endometrial ablation in the past and have new pelvic pain and spotting or bleeding, you should see a gynecologist.

Is Your Spotting Normal or Cause for Concern?

Bleeding between periods can be worrisome, especially for women who have personal or family history of reproductive problems or women who are trying to conceive. If you’re like many of the women we treat at Tidewater Physicians for Women, you might be reluctant to schedule an appointment for something like spotting, which can be normal in many cases.

Our providers believe that peace of mind is just as good a reason as any to see your healthcare provider. Whether we provide peace of mind by confirming that there is no cause for concern or we identify and treat an underlying cause, the appointment was well worth your time and ours.

If you’re experiencing irregular bleeding or spotting between periods and you feel worried about it for any reason, schedule an appointment at Tidewater Physicians for Women. If there is an underlying cause, your provider can identify the diagnosis and develop a treatment plan to help you get back to your normal routines.