Spotting is light vaginal bleeding outside of a regular menstrual period, appearing as a few drops of blood on underwear or toilet paper. It is typically brown or dark red and not heavy enough to require a pad or tampon. Experiencing spotting before an expected period is common for many individuals.
Common Non-Concerning Causes
Light bleeding before a period is often not a cause for concern, stemming from common physiological processes and temporary factors.
Ovulation spotting can occur around the middle of the menstrual cycle when an ovary releases an egg. This light bleeding is typically brief, lasting one to two days, and is caused by the hormonal shifts that take place during ovulation.
Implantation bleeding can happen if a fertilized egg attaches to the uterine lining. This light spotting usually occurs approximately one to two weeks after fertilization, often around the time a period would normally be expected. Implantation bleeding is often lighter in flow and shorter in duration than a typical period, usually lasting from a few hours to a couple of days, and may be pink or brown in color without clots.
Natural hormonal fluctuations throughout the menstrual cycle can also result in spotting before a period. The menstrual cycle is regulated by hormones like estrogen and progesterone, and imbalances in these can lead to irregular shedding of the uterine lining. For example, a premature decline in progesterone levels before a period is due can cause the uterine lining to begin shedding early. Individuals entering perimenopause, the transition phase leading to menopause, often experience irregular spotting due to fluctuating hormone levels.
Starting or changing hormonal birth control methods is another frequent reason for pre-period spotting, often referred to as breakthrough bleeding. This is particularly common during the first few months as the body adjusts to the new hormone levels. Low-dose birth control pills, implants, injections, and hormonal intrauterine devices (IUDs) can all cause this type of spotting. Missing doses of birth control pills can also trigger spotting due to the sudden decrease in hormone levels.
Underlying Medical Conditions
Spotting before a period can sometimes indicate an underlying medical condition.
Non-cancerous growths within the uterus, such as uterine fibroids or polyps, can cause irregular vaginal bleeding, including spotting. Fibroids are muscular growths, while polyps are typically softer tissue growths, and both can lead to spotting and sometimes cramping.
Polycystic Ovary Syndrome (PCOS), a hormonal imbalance, can cause irregular bleeding and spotting before a period. This condition affects ovulation and may lead to inconsistent menstrual cycles, sometimes with other symptoms like acne, excessive hair growth, or unexplained weight gain. Thyroid disorders, such as an underactive thyroid (hypothyroidism), can disrupt hormone levels and result in spotting. An excess of estrogen, which can occur with hypothyroidism, may contribute to irregular bleeding patterns.
Certain infections can also cause spotting before a period. Sexually transmitted infections (STIs) like chlamydia and gonorrhea, as well as pelvic inflammatory disease (PID), can lead to light bleeding. These infections may also present with additional symptoms such as pelvic pain, unusual vaginal discharge, or a foul odor. Spotting can also be a side effect of various medications, including blood thinners, certain antidepressants, chemotherapy drugs, and some nonsteroidal anti-inflammatory drugs (NSAIDs) or herbal supplements.
Spotting before an expected period can also be a sign of early pregnancy complications. While light bleeding is common in the first trimester and often harmless, it can be a symptom of an ectopic pregnancy, where a fertilized egg implants outside the uterus, or a miscarriage. In these situations, spotting is often accompanied by abdominal pain, cramping, or the passage of fluid or tissue.
When to Consult a Healthcare Professional
While often harmless, certain signs indicate when medical attention for spotting is warranted.
Consult a healthcare professional if spotting becomes persistent, occurs regularly, or increases in heaviness. Any spotting accompanied by other concerning symptoms should also prompt a medical evaluation. These include severe abdominal or pelvic pain, fever, unusual or foul-smelling vaginal discharge, or a sudden onset of symptoms not typical for the individual.
Spotting after sexual intercourse should also be discussed with a doctor. Any vaginal bleeding after menopause (12 consecutive months without a period) requires immediate medical review. If there is concern about a potential pregnancy, especially with spotting around a missed period, seek professional advice or take a pregnancy test. If spotting causes significant worry, disrupts daily life, or feels unusual, consulting a healthcare provider can provide reassurance and rule out any underlying conditions.