What Does Spotting Look Like and Should I Be Concerned?

Many women experience spotting—or light vaginal bleeding—throughout their reproductive years. For the most part, the reasons for such bleeding are benign, but there are times when, pun intended, red spots are serious red flags.

Let's take an in-depth look at spotting, how to know if it's normal or abnormal, and when to get in touch with your healthcare professional.

Spotting defined

In general, spotting refers to any light vaginal bleeding outside of a woman's expected menstrual period. Note the term "light"; gynecologists consider a bleeding incident spotting if it's too light to require a regular sanitary pad or tampon.

According to New York-based OB-GYN Kecia Gaither, M.D., M.P.H., the amount of blood you see is the most telling symptom, along with the time it occurs. Women who have typically regular menstrual cycles know it's a period when it lasts for several days and requires absorbent products to stem the flow. Conversely, spotting results in less blood and may occur only for a day or so.

Likewise, even the color of the blood coming out of you may be considered an indicator. For example, menstrual blood tends to be darker; blood from spotting is usually pink or a lighter shade of red.

How common is spotting?

Spotting is pretty common among women. Mid-cycle spotting occurs in 5 percent of women of reproductive age, according to a 2012 study published in the American Journal of Epidemiology. For pregnant women, the incidence rate is higher. The American Pregnancy Association estimates that around 20 percent of pregnant women experience spotting during the first 12 weeks of their pregnancy.

Does spotting affect pregnancy?

Spotting is also considered an early symptom of pregnancy, which is sometimes called implantation bleeding. A 2003 study reported that 10 percent to 15 percent of women have bleeding within the first 16 weeks of pregnancy. Usually, spotting at this stage is caused by a shift in hormones that starts upon pregnancy.

Spotting often manifests between the fifth and eighth weeks of gestation and is not usually a cause for concern. Indeed, many women who report spotting during the first weeks of their pregnancy eventually carry to full term. However, if the spotting is particularly heavy, you must see your healthcare practitioner as soon as possible.

What causes spotting?

Aside from pregnancy, mid-cycle spotting may be caused by any of the following factors:

Hormonal shifts

Many women report spotting around the time of ovulation, along with a throbbing pain on one side of the lower abdominal region, a condition known as mittelschmerz, but note that this does not occur in all women.

Seattle fertility specialist Lora Shahine, M.D., said hormonal imbalances can also cause spotting, as in the case of people with estrogen dominance. On the other hand, women who experience spotting just before a period may need to check on their progesterone levels.

Hormonal imbalances can lead to bleeding between periods. Since the body depends on a balance of hormones to regulate the menstrual cycle, disruptions to it may trigger spotting. For example, women with an excess of male hormones or polycystic ovary syndrome (PCOS) may experience spotting from time to time. In addition, women who suffer from emotional and psychological stress can have their hormones thrown off cycle, triggering light bleeding.

Physical and gynecological disorders

Gaither explained that spotting might also occur in women suffering from uterine fibroids (benign growths on uterine tissue), uterine or cervical polyps, or even endometriosis, where tissue similar to the lining of the uterus grows outside the uterus. Mid-cycle bleeding may also be chalked up to pelvic inflammatory disease (PID), a complication of several sexually transmitted diseases (STDs).

Hormonal or chemical contraception

Anyone using chemical or hormonal contraception, such as the pill, may experience spotting within the first few weeks of starting a regimen as their body adjusts to the formulation. Aside from the pill, spotting from contraceptive use can also occur among people using an intrauterine device (IUD), injectable contraceptives like Depo-Provera or a progestin-only regimen.

When is spotting a cause for concern?

As stated, spotting may be due to perfectly benign causes. However, contact your healthcare provider immediately in the event of the following:

• You have a fever
• Frequent bleeding during a month or bleeding between periods for more than a month
• Heavy bleeding resulting in anemia, dizziness and general weakness
• Lower abdominal pain
• Bleeding after sex or pain during sex
• You experience purulent discharge along with spotting
• The bleeding occurs when you're postmenopausal

Bleeding between periods or spotting is an experience shared by women of reproductive age. However, if you are bleeding abnormally, speak to your doctor to rule out a serious medical condition.