Spotting is usually harmless and can have various causes. In this article, you'll learn when you should see a doctor and what it means for your fertility.
Everything You Need to Know About Spotting
- Spotting refers to light bleeding that occurs outside of your normal period.
- It’s usually harmless and often hormone-related.
- Spotting involves losing much less blood than during your menstrual period.
- It can sometimes be an early sign of pregnancy (implantation bleeding).
- Persistent or recurring spotting should always be checked by a doctor.
Common and Usually Harmless
Light spotting is relatively common and, in most cases, nothing to worry about. It’s often noticed as light, irregular bleeding between periods (also called breakthrough bleeding) and can have various causes. Spotting is particularly common among younger women in the first few years after starting their periods, as well as in women going through the perimenopause or approaching menopause.
If you’re trying to conceive or are already pregnant, you should monitor any bleeding closely and see your gynaecologist sooner rather than later. In some cases, spotting can be a sign of more serious health conditions, such as pelvic inflammatory disease (PID) or endometriosis.
In this article, we explain what spotting is, how to tell it apart from your regular period, and when it’s important to see a gynaecologist.
What Is Spotting and How Can You Recognise It?
Spotting is a reddish-brown discharge that occurs outside your normal menstrual cycle. A typical menstrual cycle lasts around 21 to 35 days, and a period usually lasts a few days up to a week. Any bleeding that happens before or after your normal period is referred to as spotting or breakthrough bleeding.
Spotting, particularly when linked to hormonal fluctuations during the cycle, often occurs around mid-cycle. The second half of the menstrual cycle begins with the rupture of the Graafian follicle (the dominant follicle). This is when ovulation takes place and the egg can be fertilised. However, if not enough progesterone is produced, the uterine lining may not stay intact long enough to support implantation, which can lead to light breakthrough bleeding.
Is spotting or breakthrough bleeding normal when you're trying for a baby? And what should you look out for? Find out more in the following video:
Signs of Spotting
In most cases, spotting involves just a few drops of blood and clears up on its own after a day or two. Sometimes, particularly if your period is generally quite light, it can be difficult to tell whether you’re experiencing spotting or if it’s simply the start of your period.
Spotting vs. Period Bleeding
Are you wondering whether your period has just arrived a bit earlier this month, or if you’re experiencing spotting? If the bleeding is heavy enough that you need to use a sanitary pad or tampon, it’s most likely your period.
With spotting, the amount of blood is much less (usually less than two tablespoons or 30 millilitres a day). The discharge can appear pink, brown, or red. In contrast, period blood tends to be red to dark red, as it’s fresh blood.
A typical period usually lasts between three and seven days. It often starts off heavier, meaning you’ll need to change your panty liner, pad, tampon or menstrual cup every few hours. Spotting, on the other hand, usually only lasts for a day or two.
What Causes Spotting?
Spotting is often hormone-related, for example due to low progesterone levels (known as luteal phase defect). However, it can also have physical causes, such as uterine fibroids or polyps, inflammation in the genital area, thyroid disorders or liver disease. During pregnancy, spotting can also occur more frequently, often as a result of implantation bleeding or a small haematoma.
In the following section, we’ll introduce some possible causes of spotting:
Hormonal Causes
- Luteal Phase Defect: If spotting occurs shortly before your period, it’s often due to low progesterone levels. In such cases, hormone therapy with progesterone can help support the uterine lining and facilitate the implantation of a fertilised egg. Progesterone is a corpus luteum hormone (a type of progestogen) that strengthens the uterine lining and prepares the body for pregnancy. If there isn’t enough progesterone, the fertilised egg may not be able to implant properly. A luteal phase defect is a common cause of infertility.
- Ovulation Bleeding: Immediately after ovulation, oestrogen levels drop, and progesterone levels begin to rise. This hormonal imbalance can sometimes lead to spotting around the time of ovulation. Women using an IUD (intrauterine device) or other hormonal birth control methods may also experience spotting due to hormonal changes.
- Hormonal Contraceptives: Spotting can also occur when you start using hormonal contraception, such as the hormonal coil (IUS) or the contraceptive pill, or when switching to a different type of pill. This is usually harmless and often settles down with time.
You can find out more about hormonal causes of spotting, especially progesterone deficiency, in the podcast episode "Spotting before your period".
Organic Causes
- Thyroid disorders: Since thyroid-stimulating hormone (TSH) helps regulate progesterone and estrogen levels, an overactive or underactive thyroid can lead to hormonal imbalances, which in turn may cause spotting and irregular menstrual cycles. Blood tests can help diagnose these conditions.
- Fibroids: Fibroids are noncancerous growths in the uterus. They can not only cause unusually heavy periods but may also lead to spotting between periods.
- Polyps: Cervical polyps, which are growths on the cervix, are often asymptomatic but can sometimes cause spotting. A pelvic exam may help identify these growths.
- Endometriosis: Endometrial lesions can make it harder to conceive by causing scarring and adhesions in the fallopian tubes and ovaries. They may also disrupt hormonal balance, leading to spotting.
- Polycystic ovary syndrome: Polycystic Ovary Syndrome (PCOS) can cause spotting due to imbalanced hormone levels and an excess in androgens. This imbalance can lead to irregular bleeding, including spotting.
- Infections and other health conditions: If spotting is accompanied by itching, burning, or pain, sexually transmitted infections (STIs) such as chlamydia or gonorrhea may be the underlying cause. Pelvic inflammatory disease (PID) can also cause abnormal uterine bleeding and should be evaluated by a healthcare provider.
- Liver disease: Liver conditions can also contribute to menstrual irregularities and breakthrough bleeding.
- Cancer: In some cases, spotting may be a symptom of cancer affecting the reproductive organs, such as cervical cancer or ovarian cancer.
Mechanical Irritation
When the uterine or vaginal lining is irritated or injured — for example, through friction during sexual activity — small blood vessels can rupture, leading to brief, harmless spotting.
Miscarriage and Abortion
Spotting can also occur after a miscarriage or an abortion (whether medical or surgical, such as a dilation and curettage). In these cases, it’s normal for light or brownish bleeding to continue for several weeks as the uterus heals.
However, if the bleeding is very heavy, has a foul odor, or is accompanied by pelvic pain or fever, it’s important to seek medical attention to rule out retained tissue or an infection.
Menopause
Spotting during menopause is completely normal and results from hormonal changes. However, bleeding after menopause (postmenopausal bleeding) is no longer considered part of normal hormonal fluctuations and should always be evaluated by a gynecologist.
What Does Spotting During Pregnancy Mean?
Bleeding during pregnancy — especially in early pregnancy in the first trimester — can happen for a variety of reasons. A study involving 4,510 pregnant women found that 27% experienced spotting in early pregnancy, and 8% had heavy bleeding.
While bleeding isn't always a sign that something is wrong, it’s important to have any bleeding checked by a healthcare professional. Here are some possible reasons for bleeding during pregnancy:
Implantation bleeding
When the fertilized egg implants in the uterine lining, small blood vessels can be damaged, leading to light spotting. Unlike a regular period, implantation bleeding is usually very light and the blood tends to be pink, light red, or brownish.
Hematoma
A blood clot (hematoma) is one of the most common reasons for bleeding during pregnancy. According to one study, 17.9% of pregnant women were found to have a subchorionic hematoma (SCH) during routine pregnancy checkups. This refers to bleeding between the outer fetal membrane (chorion) and the uterine wall.
Progesterone deficiency
If the body doesn’t produce enough progesterone (the "corpus luteum hormone"), it can put the pregnancy at risk. To prevent this, progesterone supplements — in the form of tablets, suppositories, gels, or injections — can be prescribed until the placenta takes over progesterone production.
Miscarriage
Early signs of a miscarriage may include spotting or light bleeding that initially appears brownish but can turn bright red or dark red over time, often accompanied by severe cramping.
Ectopic pregnancy
If a positive pregnancy test is followed by vaginal bleeding along with lower abdominal pain and nausea, it could be a sign of an ectopic pregnancy. About 1–2% of pregnancies are ectopic; with assisted reproductive technologies, the risk can be slightly higher (2–5%).
Bleeding after placental separation
In the third trimester, the most common cause of bleeding is a premature separation of the placenta. The bleeding can range from light to very heavy. After delivery, bleeding from the uterus is normal as part of the postpartum discharge (lochia). However, heavy bleeding can occur if parts of the placenta remain in the uterus.
When Should I See a Doctor About Spotting?
Spotting accompanied by severe lower abdominal pain should always be evaluated by your healthcare provider. You should also visit a gynecologist if spotting lasts for more than a few days. Bleeding during pregnancy should never be ignored and checked by your OB/GYN.
While the cause of bleeding may sometimes be harmless, untreated bleeding can lead to a miscarriage or may already be a sign of one. Postmenopausal bleeding must also be investigated to rule out cancer.
What Can I Do About Spotting?
If your spotting is due to hormonal imbalances, you might first try natural remedies such as chasteberry (Vitex agnus-castus) or shepherd’s purse. Chasteberry can help regulate the menstrual cycle and is often used to treat premenstrual syndrome (PMS), while shepherd’s purse has blood-staunching properties and can offer relief for heavy or irregular bleeding.
However, it’s important to note that chasteberry can affect estrogen levels and may interfere with the effectiveness of birth control pills.
If you are trying to conceive and have been diagnosed with a luteal phase defect (low progesterone production), your gynecologist can prescribe a progesterone supplement to support your pregnancy.
For organic causes of spotting, such as uterine polyps, fibroids, or endometriosis, surgery may sometimes be necessary to manage the bleeding.
Spotting Can Be a Sign of Underlying Conditions
Spotting can have many causes and is usually harmless. However, if you are struggling to conceive, spotting could point to conditions that might affect fertility.
Spotting is also common during pregnancy and should always be evaluated by a doctor. In rare cases, spotting can be an early sign of cancer.
At our fertility clinic in Zurich, we offer comprehensive diagnostic services to investigate whether spotting may be affecting your fertility.
Frequently Asked Questions About Spotting
When is spotting normal?
Spotting can be completely normal if you’ve recently changed your hormonal contraceptive or just started using hormonal contraception. Additionally, during the hormonal changes of menopause, breakthrough bleeding is common and perfectly normal. Spotting can also occur up to a week before your menstruation. Ovulation bleeding is another harmless occurrence.
What does spotting before your period mean?
A brownish spotting before your menstrual bleeding is usually old blood that has stayed in the uterus or vagina longer than usual and has oxidised – that's why it appears brown rather than bright red. It can have various causes, many of which are completely harmless.
Spotting before your period could be a sign of luteal phase insufficiency (low progesterone) – but this isn’t always the case. In rare instances, it may indicate polyps, fibroids, an infection, or endometriosis.
If the brown spotting happens only occasionally and isn’t accompanied by any other symptoms, it is usually not a cause for concern. However, if it happens regularly, is heavy, or is associated with pain or other symptoms, you should seek medical advice.
Is spotting a sign of pregnancy?
Spotting can be a sign of pregnancy. Implantation bleeding can occur as light pink or brownish spotting about 10 to 14 days after fertilisation when the embryo attaches to the uterine wall. A study found that about 9% of pregnant women experienced implantation bleeding.
Can you be pregnant despite spotting?
While it’s not possible to be pregnant and have a period, it is possible to be pregnant despite spotting. Light spotting around the time of your expected period could indicate implantation bleeding, suggesting pregnancy. However, if you don’t want to become pregnant, you should still use reliable contraception, even if you experience spotting.
