Spotting Between Periods: Causes, Symptoms & When to See a Doctor

What Is Spotting Between Periods?

Spotting between periods is any vaginal bleeding that occurs outside your normal menstrual period. It typically appears as light pink, red, or brown discharge and is lighter than a regular period. Also called intermenstrual bleeding or breakthrough bleeding, it affects approximately 10-30% of women at some point during their reproductive years.

Intermenstrual bleeding differs from your regular period in several important ways. Normal menstrual bleeding follows a predictable pattern, typically lasting 3-7 days and occurring every 21-35 days. Spotting, by contrast, occurs unexpectedly between these regular periods and is usually much lighter in flow. The blood may appear pink (fresh blood mixed with cervical fluid), bright red (active bleeding), or brown (older blood that has oxidized).

Understanding the distinction between spotting and irregular periods is important for proper medical evaluation. While spotting involves small amounts of blood—often only noticeable when wiping or as a light stain on underwear—irregular periods involve changes to your menstrual cycle's timing, duration, or flow. Some women experience both conditions, which may indicate different underlying causes that require separate evaluation and treatment.

The medical term for bleeding between periods is metrorrhagia, while menorrhagia refers to heavy menstrual bleeding. Healthcare providers use the umbrella term "abnormal uterine bleeding" (AUB) to describe any bleeding that deviates from normal patterns, including spotting. The International Federation of Gynecology and Obstetrics (FIGO) has developed the PALM-COEIN classification system to help identify and categorize causes of abnormal uterine bleeding.

Normal vs. Abnormal Bleeding Patterns

A typical menstrual cycle lasts between 21 and 35 days, with menstrual bleeding lasting 3-7 days and a blood loss of approximately 30-40 milliliters (about 2-3 tablespoons). While some variation is normal, certain bleeding patterns warrant medical attention. These include bleeding that occurs more frequently than every 21 days, cycles longer than 35 days, bleeding lasting more than 7 days, and significant bleeding between periods.

Light mid-cycle spotting around ovulation (approximately day 14 of a 28-day cycle) is considered normal and occurs in up to 3-5% of women. This type of spotting typically lasts 1-2 days and results from the hormonal fluctuations associated with egg release. However, spotting that occurs at other times, persists for longer periods, or is accompanied by pain or other symptoms should be evaluated.

What Causes Spotting Between Periods?

The most common causes of spotting between periods include hormonal contraceptives (especially during the first 3-6 months), ovulation, pregnancy (implantation bleeding), perimenopause, cervical ectropion, polyps, infections like chlamydia, and IUD use. Less common causes include endometriosis, uterine fibroids, and rarely, cervical or uterine cancer.

Understanding the potential causes of intermenstrual bleeding helps in both identifying when to seek medical care and communicating effectively with healthcare providers. The causes can be broadly categorized into hormonal, structural, infectious, and pregnancy-related factors. Most cases have benign explanations, but thorough evaluation is important to rule out more serious conditions.

Hormonal Causes

Hormonal fluctuations represent the most common cause of spotting between periods. The endometrium (uterine lining) responds to estrogen and progesterone levels throughout the menstrual cycle. When these hormones are imbalanced or fluctuating, the endometrium may shed unpredictably, causing breakthrough bleeding.

Hormonal contraceptives are a leading cause of intermenstrual bleeding, particularly during the first 3-6 months of use. This includes combined oral contraceptives, progestin-only pills (mini-pills), hormonal IUDs (such as Mirena or Kyleena), contraceptive implants, patches, and vaginal rings. The spotting occurs as your body adjusts to the new hormone levels. Missing pills or taking them at inconsistent times can also trigger breakthrough bleeding.

Ovulation spotting occurs in some women when the egg is released from the ovary. This typically happens around day 12-16 of the menstrual cycle and is caused by the rapid hormonal changes during this time. The spotting is usually light, lasting only 1-2 days, and may be accompanied by mild cramping (mittelschmerz) or increased cervical mucus.

Perimenopause—the transitional period before menopause—commonly causes irregular bleeding and spotting. As ovarian function declines, hormone levels become unpredictable, leading to various bleeding patterns. This transition typically begins in a woman's 40s but can start earlier. Any bleeding that occurs after menopause (12 consecutive months without a period) should be evaluated promptly.

Structural Causes

Physical abnormalities of the reproductive tract can cause intermenstrual bleeding. These structural causes often require medical imaging or procedures for diagnosis.

Cervical ectropion (also called cervical erosion) occurs when the soft cells from inside the cervical canal extend onto the outer surface of the cervix. This condition is harmless but can cause spotting, particularly after intercourse. It's more common in younger women, those taking hormonal contraceptives, and during pregnancy.

Uterine polyps are growths that develop from the endometrial lining. They can range from a few millimeters to several centimeters in size and may cause irregular bleeding, heavy periods, or bleeding between periods. While most polyps are benign, they should be evaluated, especially in women over 40.

Uterine fibroids are benign muscular tumors that grow in or on the uterus. Depending on their size and location, they can cause heavy menstrual bleeding, spotting between periods, pelvic pressure, and other symptoms. Submucosal fibroids (those growing into the uterine cavity) are most likely to cause abnormal bleeding.

Adenomyosis occurs when endometrial tissue grows into the muscular wall of the uterus. This condition often causes heavy, painful periods and can also lead to spotting between periods. It's most common in women in their 30s and 40s who have had children.

Infectious Causes

Infections of the reproductive tract can cause inflammation that leads to bleeding. These causes often require treatment with antibiotics or antifungal medications.

Sexually transmitted infections (STIs), particularly chlamydia and gonorrhea, are important causes of intermenstrual bleeding. These infections cause inflammation of the cervix (cervicitis) or uterus (endometritis), which can lead to spotting, abnormal discharge, and pelvic pain. Because these infections can have serious complications if untreated, including pelvic inflammatory disease (PID) and infertility, testing is important for sexually active women with unexplained spotting.

Pelvic inflammatory disease (PID) is an infection of the upper reproductive tract that can cause bleeding between periods, pelvic pain, fever, and abnormal discharge. PID often results from untreated STIs and requires prompt antibiotic treatment to prevent complications.

Bacterial vaginosis (BV) is an imbalance of vaginal bacteria that can sometimes cause light spotting along with its characteristic gray discharge and fishy odor. While not technically an infection, BV increases susceptibility to other infections and may require treatment.

Pregnancy-Related Causes

Implantation bleeding occurs when a fertilized egg attaches to the uterine lining, typically 10-14 days after conception. This spotting is usually light pink or brown, lasts 1-2 days, and is lighter than a normal period. About 25-30% of pregnant women experience some bleeding in early pregnancy.

Ectopic pregnancy, where the fertilized egg implants outside the uterus (usually in a fallopian tube), can cause vaginal bleeding and abdominal pain. This is a medical emergency requiring immediate treatment. Any woman with a positive pregnancy test who experiences bleeding or pelvic pain should seek urgent medical care.

Miscarriage may present as bleeding during early pregnancy. While some light spotting can be normal in pregnancy, heavy bleeding with cramping may indicate a miscarriage. Any bleeding during pregnancy should be reported to a healthcare provider.

What Are the Symptoms of Intermenstrual Bleeding?

Symptoms of spotting between periods include light pink, red, or brown vaginal discharge occurring outside your regular menstrual period. The blood may be visible when wiping, on underwear, or requiring a panty liner. Additional symptoms depend on the underlying cause and may include pelvic pain, abnormal discharge, cramping, or bleeding after intercourse.

The primary symptom of intermenstrual bleeding is vaginal bleeding that occurs between expected menstrual periods. However, the characteristics of this bleeding—including timing, amount, color, and duration—can vary significantly and often provide clues about the underlying cause. Recognizing these patterns helps both in self-monitoring and in communicating with healthcare providers.

Blood Characteristics

The appearance of spotting can vary considerably. Fresh blood appears bright red and indicates active or recent bleeding. Older blood that has been in the vagina or uterus longer appears brown or dark red due to oxidation. Pink discharge typically indicates a small amount of blood mixed with cervical mucus or vaginal fluid. Each color may suggest different causes: bright red spotting after intercourse might indicate cervical ectropion, while brown spotting mid-cycle could be ovulation-related.

The amount of bleeding also varies. Some women experience only a few drops of blood visible when wiping, while others may have enough bleeding to require a panty liner or light pad. Generally, spotting is lighter than a regular menstrual period, but any bleeding significant enough to soak through a pad within an hour warrants medical attention.

Timing and Duration

When spotting occurs within your cycle can be diagnostically helpful. Mid-cycle spotting (around day 12-16) is often related to ovulation. Spotting immediately before your period might indicate low progesterone levels or the start of an early period. Spotting immediately after your period could suggest that some menstrual blood is still being expelled.

The duration of spotting episodes also matters. Ovulation spotting typically lasts only 1-2 days. Contraceptive-related breakthrough bleeding may be more persistent but often improves within the first 3-6 months. Spotting that continues for weeks or recurs frequently throughout multiple cycles warrants evaluation.

Associated Symptoms

Other symptoms accompanying the spotting can help identify the cause:

• Pelvic pain or cramping: May suggest ovulation, infection, endometriosis, or ectopic pregnancy
• Abnormal vaginal discharge: Yellow, green, or foul-smelling discharge suggests infection
• Pain during intercourse: Could indicate cervical problems, infections, or endometriosis
• Postcoital bleeding: Bleeding after sex may suggest cervical ectropion, polyps, or infection
• Heavy menstrual periods: Combined with spotting, may indicate fibroids or polyps
• Systemic symptoms: Fever, fatigue, or weight changes may suggest more serious conditions

When Should You See a Doctor About Spotting?

See a doctor if spotting persists for more than 2-3 months, is accompanied by pelvic pain or abnormal discharge, occurs after menopause, happens consistently after intercourse, is very heavy or prolonged, or if you could be pregnant. Any unexplained change in your menstrual pattern warrants medical evaluation to rule out underlying conditions.

While occasional spotting is often harmless, certain patterns and accompanying symptoms warrant prompt medical evaluation. Understanding when to seek care helps ensure that serious conditions are identified and treated early, while also preventing unnecessary worry about benign causes.

Situations Requiring Medical Evaluation

Persistent or recurring spotting that continues for more than 2-3 months, especially if you've recently started hormonal contraception, should be evaluated. While breakthrough bleeding is common during the adjustment period, persistent bleeding may indicate that your contraceptive method needs adjustment or that another cause is present.

Postmenopausal bleeding is always abnormal and requires evaluation. Any vaginal bleeding that occurs after you've gone 12 consecutive months without a period should be investigated promptly. While most causes are benign (such as atrophic vaginitis or polyps), postmenopausal bleeding can be a sign of uterine cancer, which has good outcomes when detected early.

Postcoital bleeding (bleeding after sexual intercourse) that occurs repeatedly warrants evaluation, even if the amount is small. While cervical ectropion and minor trauma are common causes, postcoital bleeding can also indicate infections, polyps, or more serious cervical conditions.

Heavy intermenstrual bleeding that requires changing a pad or tampon every hour, or bleeding that lasts more than a few days, needs medical attention. This level of bleeding can cause anemia and usually indicates a condition requiring treatment.

Accompanying Symptoms That Require Evaluation

Even if the spotting itself seems minor, certain accompanying symptoms indicate that medical evaluation is important:

• Pelvic pain: Especially if severe, one-sided, or constant
• Abnormal discharge: Yellow, green, bloody, or foul-smelling
• Pain during intercourse: New or worsening
• Urinary symptoms: Pain, frequency, or blood in urine
• Systemic symptoms: Fever, fatigue, unintended weight loss
• New symptoms in perimenopause: Any change to previous bleeding patterns

How Is the Cause of Spotting Diagnosed?

Diagnosis involves medical history review, pelvic examination, and tests such as pregnancy test, pap smear, transvaginal ultrasound, blood tests for hormone levels, and STI screening. Additional tests like endometrial biopsy or hysteroscopy may be needed for women over 40 or with concerning symptoms.

When you see a healthcare provider about spotting between periods, they will conduct a systematic evaluation to determine the cause. This typically involves gathering your medical history, performing a physical examination, and ordering appropriate tests. The specific tests recommended will depend on your age, symptoms, and medical history.

Medical History

Your healthcare provider will ask detailed questions about your bleeding patterns, including when the spotting occurs, how much and how long, and any patterns you've noticed. They'll also want to know about your menstrual history, contraceptive use, sexual activity, pregnancy history, and any other symptoms. Being prepared with this information—ideally from a menstrual diary—helps make the evaluation more efficient and accurate.

Physical Examination

A pelvic examination allows your provider to visually inspect the vulva, vagina, and cervix for any visible abnormalities. They can identify conditions like cervical ectropion, polyps protruding through the cervix, or signs of infection. A bimanual examination, where the provider uses fingers in the vagina and a hand on the abdomen, helps assess the uterus and ovaries for enlargement, masses, or tenderness.

Common Diagnostic Tests

Pregnancy test: A urine or blood test to rule out pregnancy is often the first step for women of reproductive age, as pregnancy-related bleeding requires different evaluation and management.

Pap smear (cervical screening): This test collects cells from the cervix to check for precancerous or cancerous changes. It may also identify infections or inflammation.

STI testing: Swabs or urine tests can detect chlamydia, gonorrhea, and other sexually transmitted infections that can cause bleeding.

Blood tests: These may include complete blood count (to check for anemia), thyroid function tests, and hormone levels (such as FSH, LH, estradiol, and progesterone) depending on your symptoms.

Transvaginal ultrasound: This imaging test uses sound waves to visualize the uterus, ovaries, and surrounding structures. It can identify fibroids, polyps, ovarian cysts, and other structural abnormalities. The probe is inserted into the vagina for clearer images than abdominal ultrasound.

Additional Tests

Depending on initial findings, additional tests may be recommended:

Endometrial biopsy: A small sample of the uterine lining is collected and examined under a microscope. This is particularly important for women over 40 or those with risk factors for uterine cancer.

Hysteroscopy: A thin, lighted camera is inserted through the cervix to directly visualize the inside of the uterus. This can identify polyps, fibroids, or other abnormalities and allows for tissue sampling or removal during the procedure.

Sonohysterography: Saline is injected into the uterus during ultrasound to better visualize the uterine cavity and identify polyps or submucosal fibroids.

MRI: Magnetic resonance imaging may be used in complex cases to better characterize uterine abnormalities like adenomyosis or fibroids.

How Is Spotting Between Periods Treated?

Treatment depends on the underlying cause. Hormonal contraceptive adjustments, waiting for the adjustment period to pass, treating infections with antibiotics, hormonal therapy to regulate cycles, or procedures to remove polyps or fibroids may be recommended. Most causes are treatable, and symptoms often resolve with appropriate management.

Treatment for intermenstrual bleeding is directed at the underlying cause. Once your healthcare provider has identified why you're experiencing spotting, they can recommend appropriate management. In many cases, simple interventions or watchful waiting are sufficient. More complex conditions may require medications, procedures, or occasionally surgery.

Treatment for Hormonal Causes

Contraceptive-related bleeding: If you've recently started hormonal contraception, your provider may recommend waiting 3-6 months for your body to adjust. Taking your pill at the same time each day can help. If spotting persists, options include switching to a pill with a different hormone balance, changing contraceptive methods, or using a short course of estrogen to stabilize the lining.

Hormonal imbalances: For women not using hormonal contraception who have hormonal imbalances, treatment may include combined oral contraceptives to regulate cycles, progestin therapy to stabilize the endometrium, or treatment of underlying conditions like thyroid disorders or polycystic ovary syndrome (PCOS).

Perimenopause: Irregular bleeding during perimenopause can often be managed with low-dose hormonal contraceptives (which also provide contraception during this still-fertile time), progestin therapy, or hormone therapy for eligible women.

Treatment for Structural Causes

Cervical ectropion: If causing bothersome symptoms, cervical ectropion can be treated with cauterization (burning) or cryotherapy (freezing) to destroy the excess cells. However, treatment is only needed if symptoms are troublesome.

Polyps: Uterine or cervical polyps can often be removed during hysteroscopy, a minimally invasive outpatient procedure. Removal typically resolves the bleeding and allows for pathologic examination to confirm the polyp is benign.

Fibroids: Treatment depends on size, location, and symptoms. Options include medications to shrink fibroids or reduce bleeding (such as GnRH agonists or tranexamic acid), uterine artery embolization, myomectomy (surgical removal of fibroids), or in some cases, hysterectomy.

Adenomyosis: Management includes pain medications, hormonal treatments (birth control pills, progestin-releasing IUD, or GnRH agonists), or in severe cases, hysterectomy.

Treatment for Infections

STIs: Chlamydia, gonorrhea, and other bacterial STIs are treated with appropriate antibiotics. Partner treatment is essential to prevent reinfection. Follow-up testing may be recommended to confirm cure.

Pelvic inflammatory disease: Requires antibiotic treatment, often with multiple medications to cover various possible organisms. Severe cases may require hospitalization for intravenous antibiotics.

Bacterial vaginosis: Treated with oral or vaginal antibiotics (metronidazole or clindamycin).

Medications Commonly Used

• Combined oral contraceptives: Regulate cycles and reduce bleeding
• Progestins: Stabilize the endometrium (e.g., medroxyprogesterone, norethindrone)
• Tranexamic acid: Reduces heavy bleeding when taken during bleeding episodes
• NSAIDs: Can reduce bleeding and pain (e.g., ibuprofen, naproxen)
• GnRH agonists: Create a temporary menopausal state to shrink fibroids or endometriosis
• Hormonal IUD (Mirena): Releases progestin locally, often reducing or eliminating bleeding

Can You Prevent Spotting Between Periods?

While not all causes of spotting can be prevented, you can reduce your risk by taking hormonal contraceptives consistently, maintaining a healthy weight, managing stress, practicing safe sex to prevent STIs, and keeping up with regular gynecological care including cervical screening.

Some causes of intermenstrual bleeding are preventable, while others are not. However, several lifestyle measures and healthcare practices can reduce your risk of experiencing spotting or help identify treatable causes early.

Consistent Contraceptive Use

If you use hormonal contraceptives, taking them consistently as directed minimizes the risk of breakthrough bleeding. For birth control pills, take your pill at the same time every day. For contraceptive rings or patches, follow the recommended schedule precisely. If you frequently forget pills, consider switching to a method that doesn't require daily action, such as an IUD or implant.

Lifestyle Factors

Maintain a healthy weight: Both being underweight and overweight can affect hormone levels and menstrual regularity. Achieving and maintaining a healthy weight through balanced nutrition and regular physical activity supports hormonal balance.

Manage stress: Chronic stress can disrupt the hypothalamic-pituitary-ovarian axis, leading to irregular cycles and spotting. Stress management techniques such as regular exercise, adequate sleep, meditation, or counseling can help maintain hormonal balance.

Quit smoking: Smoking affects estrogen metabolism and is associated with irregular bleeding. It also increases the risk of cervical abnormalities. Quitting smoking benefits both your reproductive and overall health.

Safe Sexual Practices

Using condoms consistently helps prevent sexually transmitted infections that can cause intermenstrual bleeding. Regular STI testing, especially if you have new or multiple partners, allows for early detection and treatment of infections before they cause complications.

Regular Healthcare

Keeping up with regular gynecological care, including cervical screening (Pap smears), allows for early detection of abnormalities. Report any changes in your menstrual pattern to your healthcare provider promptly. For women approaching menopause, discussing symptoms with a provider can help distinguish normal perimenopausal changes from conditions requiring evaluation.

How to Track Spotting and Menstrual Patterns

Track your spotting by recording the date, amount (light/moderate/heavy), color (pink/red/brown), duration, and any associated symptoms. Note potential triggers such as intercourse, medication changes, or stress. Use a calendar, journal, or period tracking app to maintain consistent records that you can share with your healthcare provider.

Keeping detailed records of your menstrual patterns and any spotting episodes provides valuable information for diagnosing the cause and evaluating treatment effectiveness. A menstrual diary or tracking app makes it easy to record and analyze your patterns over time.

What to Record

• Dates: First and last day of each period, and any days of spotting
• Amount of flow: Light (spotting only when wiping), moderate (requiring panty liner), heavy (requiring pad or tampon)
• Blood color: Pink, bright red, dark red, or brown
• Duration: How many hours or days the bleeding lasted
• Associated symptoms: Pain, cramping, discharge, breast tenderness
• Potential triggers: Sexual intercourse, missed contraceptive pills, new medications, stressful events
• Cycle day: What day of your menstrual cycle the spotting occurred

Useful Apps and Tools

Many smartphone apps are available for tracking menstrual cycles and symptoms. Popular options include Clue, Flo, Period Tracker, and Apple Health. These apps can help identify patterns, predict your next period, and generate reports to share with your healthcare provider. A simple paper calendar or notebook also works well if you prefer analog tracking.