What is Spotting? - Causes, What's Normal, & What's Not
Female Body

What is Spotting? - Causes, What's Normal, & What's Not

Jasmine Chiam Jasmine Chiam

You do a quick wipe and notice a bit of blood on the toilet paper. A quick runback of your cycle reveals that your period isn't due for another two weeks. 

Is this normal, or does this call for a visit to your doctor? 

Well, this occurrence is something termed spotting. Spotting is essentially bleeding from the vagina outside your normal period. It is usually not a cause of concern, so you won't need any medical treatment. In rarer cases, though, there may be a more serious underlying cause. 

We'll walk you through the possible causes for spotting and what's considered normal. We'll also take a look at when it's best to make a trip to the doctor for further investigation. 

The Difference Between Spotting and Periods 

You may find it a little difficult to differentiate between spotting and your periods. 

According to the World Health Organisation (WHO), spotting is light bleeding outside your menses [1]. You won't stain your white jeans, and you won't require the aid of a tampon or pad. Sometimes, you'll notice one or two brown spots on your toilet paper or underwear. The bleeding is so light that it usually won't even fill up your panty liner. 

On the other hand, periods are part and parcel of the menstrual cycle, where the shedding of the uterus lining occurs and a woman bleeds through her vagina. The average duration of a menstrual flow is around 3-5 days, but anywhere between 1-8 days can be normal for a healthy female [2]. 

The amount of blood loss during your menses can go up to 80 mL. On average, you should expect somewhere around 30 mL of blood [2]—but it's enough for you to require pads or tampons to avoid staining your clothes. 

This kind of bleeding is tightly regulated by the interactions between your hypothalamus (part of the brain), pituitary gland, and ovaries [2]. 

How Can You Tell If You're Spotting? 

Here are some characteristics and symptoms of spotting you can look out for: 

  • Light bleeding outside normal periods. Women typically won't require sanitary protection for spotting. 
  • Irregular timing. Unlike your normal periods, spotting can start and stop throughout the month. However, some women may notice spotting associated with different events in the menstrual cycle. Spotting may occur around the time of ovulation or nearing their period [1]. 
  • Characteristic differences. Blood emitted from spotting may have a different colour from your normal menses. While period blood is typically red, some women may notice brown or pink blood from spotting. However, healthy period blood can still vary in colour. The key is to look out for differences in colour, smell, or texture from your normal period blood [3]. 

Keeping track of your monthly cycles and menses will make it much easier to differentiate spotting from periods. Cycle tracking also keeps you informed of any abnormal changes or irregularities in your cycle. 

There are various at-home cycle tracking kits and devices available that use either urine or saliva tests to track your hormonal curve and menstrual cycle. The inne Minilab is one such cycle-tracking device that utilises saliva tests to track your monthly hormonal fluctuations and predict when your menses are going to start.  

What Causes Spotting?

Spotting can be due to several reasons. Before you jump the gun and go down a Google rabbit hole, do note that spotting isn't necessarily a sign of a medical condition or infertility. 

Here are some possible causes of spotting:

Ovulation 

You may notice some spotting during ovulation, which is when your ovary releases a mature egg for fertilisation. Not every woman experiences spotting during ovulation, and it does not dictate your overall fertility [4]. 

Spotting during ovulation could be due to the changes in your hormones during this time of the month. One study has found that women with a greater amount of progesterone and luteinizing hormone (LH) around the time of ovulation present in women who experienced ovulation spotting [1]. 

Pregnancy

Any bleeding or spotting during pregnancy may understandably be concerning. But more likely than not, your baby will be perfectly fine, and you'll go on to have a healthy delivery. 

It can be pretty common, especially in early pregnancy. In fact, one study has demonstrated that around 27% of women report some form of bleeding in the first trimester [5]. 

Spotting during pregnancy could be due to the embryo implanting itself onto the wall of your uterus, commonly termed as 'implantation spotting'—this is harmless bleeding. However, spotting could also signify more serious causes, such as a miscarriage or ectopic pregnancy [5]. 

Research has shown that spotting or light bleeding episodes that only last a day or two and are not accompanied by pain do not signify an increased risk of miscarriage. On the other hand, heavier bleeding that goes hand in hand with abdominal pain is associated with a heightened risk of miscarriage [5]. 

An ectopic pregnancy is a pregnancy where the fertilised egg implants itself outside the womb. This fertilised egg will not be able to survive, and if left untreated, an ectopic pregnancy could be life-threatening. Light bleeding and abdominal pain are possible signs of ectopic pregnancy [6]. 

Again, we'd like to reiterate that light bleeding does not necessarily mean you're experiencing a miscarriage or ectopic pregnancy. But if you experience spotting during pregnancy, it's best to get it checked by your healthcare provider. 

A miscarriage or ectopic pregnancy is generally not caused by something you did or did not do. 

Birth control

If you've just started on birth control, you could experience some spotting. Spotting or light bleeding is a common side effect of various birth control methods, including intrauterine devices (IUD), birth control pills, birth control injections, and hormonal implants [7]. 

Additionally, forgetting pills, skipping pill-free intervals, and using emergency contraception (the morning after pill) may also be causes of spotting. 

Any irregular bleeding or spotting is usually harmless and would typically resolve or improve after three to six months [7]. If the spotting persists after this duration, it may be best to seek your doctor's advice. This could be due to an underlying condition, such as a sexually-transmitted infection (STI). 

Breastfeeding 

If you're breastfeeding, you won't get your periods for a certain timespan, depending on various factors such as the duration and frequency of breastfeeding [8]. 

Once your menses start returning, they may be irregular at first, and you may notice some spotting. This is quite common, and one study has found that almost 50% of women experience some form of bleeding or spotting 6-8 weeks after giving birth [9]. 

As you gradually reduce your breastfeeding frequency, your period will eventually revert back to its original cycle and rhythm [8].

Perimenopause 

Perimenopause is also known as the menopausal transition. It is the time before menopause when you first start experiencing menstrual irregularities and lasts until you've gone 12 months without any periods (this is when you've reached menopause) [10]. 

During perimenopause, you'll likely experience changes in your menstrual cycle. And your periods become irregular until they stop altogether [10]. 

Throughout this time, some women may notice differences in their bleeding patterns, including spotting or heavy bleeding. This is due to the fluctuations in your hormone levels as you undergo perimenopause [10]. 

Underlying medical conditions 

Spotting may be a symptom of some medical conditions. They include the following:

  • Uterine fibroids. These are noncancerous growths found in the uterus. Many women with these growths do not experience any symptoms. But some may experience common symptoms such as prolonged or heavy bleeding. Other symptoms include spotting, bleeding between periods, and irregular periods [11]. 
  • Endometriosis. Endometriosis is a condition where the tissue lining your uterus begins to grow outside the uterus. This can lead to bleeding between periods, painful periods, painful defecation or urination, and painful intercourse [12]. 
  • STIs. Some STIs, such as those caused by a bacteria called chlamydia, may lead to an infection called pelvic inflammatory disease. This infection can cause bleeding after sex, abdominal pain, nausea, and vomiting [13]. 
  • Hormonal imbalances. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and diabetes can lead to irregular menses or bleeding between cycles [14]. 

If you notice spotting in combination with any of the symptoms mentioned above, have things checked out by your doctor as soon as you can. 

When Should You See A Doctor For Spotting? 

If you experience any unexplained spotting that cannot be attributed to causes like birth control or ovulation spotting, it's best to see a doctor.

You should also make a trip to the doctor if you experience spotting while pregnant, especially if the spotting does not resolve after a few days. Spotting and pain, while pregnant, could be a sign of a miscarriage or ectopic pregnancy. 

Any additional symptoms in conjunction with spotting, such as abdominal or pelvic pain, should also warrant an examination by a healthcare professional. The same goes for any bleeding or spotting after sex. This could be an indicator of an underlying condition, such as cervical polyps (noncancerous growths found on the cervix), an infection, STIs, or cancer [15]. 

In most cases, though, spotting is temporary and is not associated with any harmful underlying condition. 

Final Takeaway: How To Tell If You're Spotting 

Spotting is light bleeding that does not develop into a heavier flow, as would your regular menses. The bleeding is light enough that you won't need pads or tampons. But some women who experience spotting may still wish to use a panty liner for protection. 

One way you can differentiate your menses from spotting is by tracking your regular menstrual cycle. You can do this using period tracking apps or a personal period diary. 

Cycle tracking devices, such as the inne minilab, will be able to paint out your personal hormonal curve, pinpoint your ovulation date, and help you predict when you'll get your menses. This enables you to differentiate between spotting and your period and keep a record of valuable information, which could be helpful for your healthcare provider. 

 

References

1. Dasharathy SS, Mumford SL, Pollack AZ, et al. Menstrual bleeding patterns among regularly menstruating women. Am J Epidemiol. 2012;175(6):536-545. doi:10.1093/aje/kwr356

2. Thiyagarajan DK, Basit H, Jeanmonod R. Physiology, Menstrual Cycle. [Updated 2021 Oct 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500020/

3. Jeanmonod R, Skelly CL, Agresti D. Vaginal Bleeding. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470230/

4. Hasan R, Baird DD, Herring AH, Olshan AF, Jonsson Funk ML, Hartmann KE. Association between first-trimester vaginal bleeding and miscarriage. Obstet Gynecol. 2009;114(4):860-867. doi:10.1097/AOG.0b013e3181b79796

5. Tahmina S, Daniel M, Solomon P. Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study. J Clin Diagn Res. 2016;10(10):QC13-QC16. doi:10.7860/JCDR/2016/21925.8718

6. Villavicencio J, Allen RH. Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates. Open Access J Contracept. 2016;7:43-52. Published 2016 Mar 31. doi:10.2147/OAJC.S85565

7. Chao S. The effect of lactation on ovulation and fertility. Clin Perinatol. 1987;14(1):39-50.

8. Visness CM, Kennedy KI, Gross BA, Parenteau-Carreau S, Flynn AM, Brown JB. Fertility of fully breast-feeding women in the early postpartum period. Obstet Gynecol. 1997;89(2):164-167. doi:10.1016/S0029-7844(96)00483-8

9. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332-339. doi:10.1089/jwh.2015.5556

10. Paramsothy P, Harlow SD, Greendale GA, et al. Bleeding patterns during the menopausal transition in the multi-ethnic Study of Women's Health Across the Nation (SWAN): a prospective cohort study. BJOG. 2014;121(12):1564-1573. doi:10.1111/1471-0528.12768

11. Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health. 2012;12:6. Published 2012 Mar 26. doi:10.1186/1472-6874-12-6

12. Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. doi:10.1007/s13669-017-0187-1

13. Mohseni M, Sung S, Takov V. Chlamydia. [Updated 2022 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537286/

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