Vaginal spotting is light bleeding that occurs outside of a regular menstrual period, often appearing as a few drops of red or brown discharge. While spotting is common, when it lasts for an extended time or occurs frequently, it signals a disruption in the body’s normal cycle regulation. Prolonged spotting is a type of abnormal uterine bleeding. Understanding the potential origins, from hormonal shifts to physical changes, is the first step toward addressing the issue.
Spotting Related to Hormonal Shifts
The most frequent cause of prolonged spotting involves fluctuations in the body’s endocrine system, primarily concerning estrogen and progesterone. These hormones regulate the growth and shedding of the uterine lining, and any imbalance can lead to irregular bleeding. A common scenario is the adjustment period following the initiation, discontinuation, or change of a hormonal contraceptive method. Nearly 30% of women experience “breakthrough bleeding” during the first month of starting birth control pills, which can persist as the body adapts to the new hormone levels.
Spotting is also a characteristic symptom during perimenopause, the natural transition leading up to menopause, which typically begins between the ages of 45 and 55. During this phase, the ovaries produce estrogen and progesterone erratically, often leading to skipped ovulation. The uterine lining may thicken unevenly under unopposed estrogen, eventually shedding in an unpredictable manner that results in prolonged spotting.
External factors can also temporarily disrupt the delicate hormonal balance, causing prolonged spotting. Significant fluctuations in body weight or a drastic change in exercise routine can impact the production of estrogen and progesterone. High or chronic stress levels trigger an increase in cortisol, a hormone that can interfere with the signals governing ovulation. When ovulation is affected, the resulting hormonal environment can cause the uterine lining to shed irregularly.
Physical Causes in the Reproductive Tract
When hormonal causes are ruled out, prolonged spotting can often be traced to structural issues within the reproductive tract. Noncancerous growths like uterine fibroids and polyps are common culprits, as these masses can irritate the uterine lining, leading to bleeding between periods. Polyps are overgrowths of cells in the lining of the uterus, while fibroids are benign tumors made of muscle and tissue. Both conditions disrupt the normal shedding process of the endometrium, causing prolonged spotting.
The presence of an Intrauterine Device (IUD) is another physical factor that may cause persistent spotting. The copper IUD is known to cause increased bleeding or spotting between periods. Even hormonal IUDs can cause breakthrough bleeding initially as the body adjusts to the localized release of progestin.
Inflammation or infection of the cervix or vagina can also result in prolonged spotting due to tissue irritation. Conditions such as cervicitis (inflammation of the cervix) or pelvic inflammatory disease (PID) can cause the tissue to become sensitive and bleed easily. Bleeding after intercourse or a persistent, unusual discharge alongside spotting may indicate the presence of an infection.
Pregnancy Related Spotting
For any person of reproductive age experiencing unexplained prolonged spotting, a pregnancy test is often recommended. Bleeding can be one of the earliest signs of a complicated or non-viable pregnancy. While some light bleeding in early pregnancy is common, prolonged spotting must be medically investigated. Spotting that occurs around the time a period would be due may be implantation bleeding, which is usually light and lasts only a couple of days.
Spotting that persists or is accompanied by other symptoms can be a sign of a threatened miscarriage (bleeding in the first 12 weeks of pregnancy). Although many women who experience a threatened miscarriage go on to have a healthy pregnancy, it requires medical evaluation. A more serious cause of prolonged spotting is an ectopic pregnancy, where the fertilized egg implants outside the uterus, most commonly in a fallopian tube. Ectopic pregnancy symptoms tend to develop between six and eight weeks and can include abdominal pain and brown, watery discharge.
When to Seek Medical Attention
While many causes of prolonged spotting are not serious, certain symptoms require immediate medical evaluation. If the spotting transforms into heavy bleeding that requires changing a pad or tampon every hour for two to three hours, seek prompt medical care. Unexplained spotting accompanied by severe abdominal pain, a fever, or foul-smelling discharge also warrants an urgent visit.
A sudden onset of dizziness, lightheadedness, or fainting alongside the bleeding are signs of significant blood loss or a serious internal issue. Generally, if spotting persists for longer than three menstrual cycles or six weeks without a clear explanation, a healthcare provider should be consulted. Any bleeding that occurs after a person has gone through menopause must also be immediately reported to a doctor.