Vaginal spotting is a common complaint in non-pregnant, reproductive-age women. There are several reasons you might be experiencing vaginal spotting and based on your symptoms, you may be able to tell what the cause is. Below we will delve into some of the most common causes of spotting before and after your period.
Changes in Hormone Levels
A common cause of spotting before or between periods is changes in hormone levels. Women’s cycles are ruled by hormones and any sudden fluctuations in those hormone levels can cause unexpected bleeding or spotting.
Among the reasons for hormonal changes—many of which are entirely benign—is the use of hormonal birth control. If you have recently started a new birth control pill or other hormonal birth control (such as certain types of IUDs, injections, the patch, etc.) it may take a few months for your body to adjust. The changing levels of hormones can cause spotting for a week or a few days. Failing to take your pill at the same time every day may also lead to spotting.
Many women report spotting during ovulation, which is attributable to the changes in estrogen levels at that time of the month. Just before ovulation (which is when the ovary releases an egg each month), levels of estrogen rise. Once the egg is released, estrogen decreases as progesterone increases. It is this shift in balance between the two hormones that can cause ovulation spotting. For some women who are trying to conceive, this can be a useful sign to help them know when ovulation is occurring.
Uterine Fibroids
A uterine fibroid is a non-cancerous growth in or on the uterus. Fibroids are very common and 20-80% of all women will experience fibroids by age 50, with the majority of cases presenting in women in their 40’s and early 50’s. While some women never experience symptoms, fibroids can cause spotting between periods. Fibroids can also cause longer and heavier periods.
Other symptoms of fibroids include a feeling of fullness in the pelvis, frequent urination, pain during sex, and lower back pain. A doctor can usually confirm the presence of a fibroid during a physical exam or with an ultrasound.
Infection and Vaginal Bleeding
Spotting can be caused by an infection in the reproductive organs. If this is the cause of your spotting between periods, it will likely be accompanied by a fever, pelvic pain which gets worse during sex, and foul-smelling vaginal discharge. This type of infection is caused when bacteria makes its way up the vagina and into the uterus or fallopian tubes. This usually occurs during menstruation, but it can also happen at other times during the month.
If you suspect that you have any sort of infection, you should consult with a doctor for treatment. You can also use the K Health app and chat with a doctor to help you determine what is causing your symptoms.
The following types of infections can also cause spotting:
Cervicitis - Cervicitis is an inflammation of the cervix, often, but not always, caused by a sexually transmitted disease. Symptoms include bleeding between periods, bleeding/spotting after sex, increased vaginal discharge, and painful urination, although some women experience no symptoms at all.
Chlamydia Trachomatis - Chlamydia is a common sexually transmitted infection caused by a bacteria. It is easily treated once diagnosed, but because people are often asymptomatic or have only mild symptoms it can be missed. Symptoms include spotting between periods and/or after sex, abdominal pain, painful urination, and pain during sex.
Gonorrhea - Gonorrhea is another sexually transmitted infection caused by bacteria. Spotting caused by Gonorrhea would likely occur after sexual intercourse. Other symptoms include painful urination, pain during sex, increased vaginal discharge, and abdominal or pelvic pain.
Pelvic inflammatory disease (PID) - PID is an infection of the female reproductive organs, usually caused by a sexually transmitted disease. Similar to other infections, there may not be any noticeable symptoms, and it is often diagnosed when either chronic pelvic pain develops or when a woman is having issues with infertility. When there are symptoms, they include spotting in between periods, spotting after sex, fever, painful urination, abdominal pain, and heavy vaginal discharge.
Vaginitis - A change in the balance of vaginal bacteria or an infection can cause inflammation of the vagina known as vaginitis. It is characterized by light spotting, change in color, odor or amount of vaginal discharge, and pain during sex and urination.
Implantation Bleeding -Some women experience very light spotting when a fertilized egg attaches to the lining of their uterus. You may think that you are spotting when your period is due, but then no period arrives. This could actually by implantation bleeding, one of the earliest signs of pregnancy.
There are 4 key signals to differentiate between implantation bleeding and your period:
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Color - implantation bleeding tends to range from light pink to dark brown, as compared to the bright red of a period.
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Clotting - there are no clots with implantation bleeding, while menstrual blood may contain clots in a variety of sizes.
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Time - implantation bleeding can last anywhere from a few hours to three days, unlike a period which typically lasts from 3-7 days.
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Amount - implantation bleeding is a very small amount that does not require a tampon or pad. It can be intermittent or a constant flow, but it will be very light and not easily mistaken for the flow of a menstrual cycle.
Trauma
Blunt trauma to the vagina can cause spotting or more intense bleeding, whether from an accidental injury, sexual intercourse, or sexual assault. If you have been sexually assaulted, please seek help and support immediately.
Uterine or cervical polyps
Both uterine and cervical polyps can cause spotting before periods. Cervical polyps are growths on the cervix that are usually benign (but should be checked to be sure) and produce symptoms such as spotting, increased vaginal discharge, heavier periods, and bleeding after sex. Uterine polyps are similar, but grow in the uterus and are more common in women who are 40-50 years old than in younger women. Symptoms include irregular periods, heavy periods, spotting between periods, spotting after menopause, and infertility.
Endometriosis - Endometriosis is a condition where the lining of the uterus grows outside of the uterus, instead of on the inside. It is very painful, particularly during the menstrual period, and it can cause spotting between periods.