When Spotting Is Normal & When It’s Not

Spotting is light bleeding from the vagina that occurs outside of your normal period. In most instances, spotting is so light that it doesn’t transfer onto your underwear but is visible on toilet paper after wiping. When spotting is heavy enough to stain your underwear, it can often be easily managed with a light pad or a pantyliner.

Also known as abnormal uterine bleeding, spotting occurs most frequently during a female’s first period or during perimenopause, a condition that affects almost one-third of women.

Spotting can be a nuisance, given that it’s unexpected and occurs when you think you’re safe from bleeding. You may wonder why it’s happening, and whether it’s indicative of an underlying health issue.

Before you rush to the doctor, though, it may be reassuring to know that spotting can be caused by a number of factors and it’s common.

The reason you’re spotting

The first thing to do when you notice spotting is to consider whether you currently have a condition that may be causing it. Spotting often coincides with other symptoms that may help you deduce the cause:

Implantation bleeding

Some women may experience implantation bleeding when they become pregnant. This occurs when the fertilized egg attaches itself to the inner lining of the uterus, usually a few days before your period is scheduled to arrive. Implantation bleeding may be accompanied by other pregnancy symptoms, including nausea, breast tenderness and fatigue.

Polyps

Spotting that occurs between periods and after penetrative sex may be caused by uterine and cervical polyps, which are benign growths of tissue that your doctor can identify during a routine pelvic exam. They can be easily removed with forceps. Polyps may also cause unusual discharge.

Uterine fibroids

Uterine fibroids—another kind of benign growth, specifically on the uterus—can be another cause of spotting. Your doctor may notice them during a routine pelvic exam. Uterine fibroids typically shrink on their own over time, but they can also be removed by surgery. Medications and embolization can cause fibroids to shrink and be less symptomatic. In addition to spotting, uterine fibroids may cause symptoms including painful intercourse, heavy and longer periods, and pain in the pelvis or lower back.

Endometriosis

Spotting is a common symptom of endometriosis, which affects 10 to 15 percent of all women of reproductive age, according to Current Obstetrics and Gynecology Reports. Endometriosis is a condition in which tissue that normally lines the inside of the uterus grows outside the uterus instead. With endometriosis, tissue that normally exits the vagina during menstruation becomes trapped in the pelvis, causing spotting and other symptoms, including cramping, diarrhea, and painful and heavy periods.

Hormonal birth control

When you first start using hormone-based birth control, or when you switch to a different type or dosage, spotting can occur. Spotting is very common during the first three months of birth control use. Studies show that 30 to 50 percent of women who use hormonal birth control experience spotting during the first three to six months of initiating treatment.

A good rule of thumb is to give a new birth control pill a three-month trial. Be compliant and take the pill every day around the same time. Skipping or missing doses can result in spotting.

When you need a doctor

Most spotting is temporary and will resolve on its own. If you experience regular spotting or spotting that doesn’t go away, make an appointment to see your doctor.

Many serious conditions may also cause spotting, including miscarriage, menopause, pelvic inflammatory disease (PID), sexually transmitted infections (STIs), thyroid problems, cancer and the use of certain medications. Your doctor can help you identify which is the cause and treat the core problem.

Contact your doctor immediately if your spotting is accompanied by symptoms that include fatigue, dizziness, pelvic pain, fever, abdominal pain or heavy bleeding. Your doctor can perform an examination to identify and rule out serious medical conditions linked to spotting, and initiate appropriate treatment if necessary.

More than likely, your doctor will be able to quickly figure out the source for spotting and ease any worries you may have.