Is Spotting Between Periods Normal?

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You notice some bleeding between periods and wonder: Is spotting between periods normal or a sign of a problem?

Spotting in between menstruation isn’t normal, but it’s not always a sign of a serious issue, either. Spotting between periods could come from something as simple as switching birth control methods.

However, unusual bleeding often signals a medical condition that needs attention. Here, we look at gynecological guidelines on spotting and when to seek medical attention for spotting.

What Is Abnormal Uterine Bleeding?

A normal menstrual period lasts up to seven days. A typical menstrual cycle is between 21 and 35 days.

Any spotting after periods is a sign that something isn’t right. Doctors call it abnormal uterine bleeding (AUB), an umbrella term that includes other period problems.

According to the American College of Obstetricians and Gynecologists, AUB includes:

• Bleeding after menopause.
• Bleeding or spotting after sex.
• Bleeding or spotting between periods.
• Heavy bleeding during your period. That means bleeding that soaks through one or more tampons or pads every hour, or bleeding that lasts more than seven days.
• Irregular periods, in which cycle length varies by more than seven to nine days.
• Menstrual cycles longer than 35 days or shorter than 21 days.
• Not having a period for three to six months.

What Causes Spotting Between Periods?

There are many different causes of spotting between periods. They include:

• Bleeding disorders — If your blood doesn’t clot normally, you may have a bleeding disorder and notice spotting between periods. Other symptoms include frequent nosebleeds and easy bruising.
• Cancer — Bleeding after menopause is a possible early sign of endometrial cancer. The disease occurs most often in women over 60, but with early detection, doctors can treat this cancer effectively.
• Endometriosis — This condition happens when tissue similar to the uterine lining grows in other parts of the body, outside the uterus. It responds to hormonal changes the same way normal uterine tissue does, so it sheds and can lead to spotting.
• Hormonal birth control — Sometimes starting a new birth control method can cause spotting. That can include intrauterine devices (IUDs), birth control pills, patches, implants, and injections.
• Infections — Some sexually transmitted infections (STIs) can trigger bleeding between periods.
• Medications — Some medicines, such as blood thinners and aspirin, can cause heavy or irregular menstrual bleeding.
• Polycystic ovary syndrome (PCOS) — A condition of hormone imbalance, with low levels of the female hormones estrogen and progesterone. The hormone imbalance disrupts normal ovulation, so you might ovulate irregularly or not at all. That can lead to shedding of menstrual fluid and spotting between periods.
• Pregnancy complications — Spotting can signal a miscarriage or ectopic pregnancy. You should call your doctor right away if you’re pregnant and experience any bleeding or spotting.
• Uterine fibroids — These noncancerous growths form in the uterus and can cause pelvic pain, swelling, and irregular or heavy menstrual bleeding.
• Cervical issues—benign causes could include a polyp or something called an ectropion, which is when sensitive tissue from the cervical lining is close to the opening. Cervical cancer is a rare but possible cause as well.
• Ovulation—sometimes ovulation can trigger minor spotting.

Is Spotting After Menopause Normal?

Spotting after menopause isn’t normal. When you go through menopause, your periods stop and you don’t bleed anymore. Spotting after menopause is a possible sign of a serious problem like endometrial cancer.

You should see a doctor if you have any uterine bleeding after menopause. You’re officially in menopause when you haven’t had a period for at least a year.

When Should I Seek Medical Attention for Spotting Between Periods?

Sometimes, telling the difference between normal and concerning spotting is difficult. That’s why it’s always best to call your doctor if you have any bleeding between periods. Your ob-gyn can give you expert guidelines on spotting between periods.

The bleeding may come from an issue that’s easy to treat. But it’s also a possible sign of a more serious problem. You should seek medical care right away if you have:

• Acute heavy bleeding (when you’re changing pads or tampons every hour for more than two hours in a row).
• Heavy bleeding accompanied by chest pain, shortness of breath, or dizziness.

How Do Doctors Diagnose the Cause of Bleeding Between Periods?

It’s important to see your doctor for any unusual uterine or vaginal bleeding.

Your ob-gyn will ask about your medical history, taking note of any bleeding disorders that run in your family. They will ask about your symptoms, what medicines you take, and your surgical, gynecological, and obstetric history.

Your doctor will then run some tests to determine what’s triggering the bleeding. These might include:

• Blood disorder test, if you have risk factors for clotting or other types of blood disease.
• Blood tests.
• Pap smear.
• Pelvic exam
• Pelvic ultrasound if they suspect fibroids.
• Pregnancy test.
• Tests for STIs.
• Thyroid level test.

How Is Bleeding Between Periods Treated?

Treatment for spotting between periods depends on what’s causing the problem. The two main options are medical treatments and surgery.

Medical treatments

Your doctor is likely to try these methods first to control abnormal bleeding.

• Antibiotics — A possible appropriate treatment if you have an infection.
• Blood-clotting medications — If you have a bleeding disorder.
• Gonadotropin-releasing hormone (GnRH) agonists — Drugs that stop the menstrual cycle in order to reduce the size of fibroids.
• Hormonal birth control — Birth control pills, the skin patch, and the vaginal ring can help make your periods more regular. The hormonal IUD can also reduce bleeding.
• Hormone therapy — Can help with irregular menstrual bleeding during perimenopause. Hormone therapy can make periods lighter and more predictable.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) — Ibuprofen (Advil) can help control heavy bleeding and relieve menstrual cramps.
• Tranexamic acid — A drug for treating heavy menstrual bleeding.

Surgery

If medications don’t control your spotting between periods, your doctor may suggest surgery. This will depend on your condition, your age, and if you ever plan to become pregnant.

These are some of the procedures for controlling abnormal bleeding:

• Hysteroscopic surgery—Looks for polyps, small fibroids, or other structural issues of the uterine cavity
• Endometrial ablation — Destroys the lining of the uterus. It will reduce or stop bleeding.
• Hysterectomy — Removal of the uterus after other treatments have failed. It’s also a treatment for endometrial cancer.
• MRI-guided ultrasound surgery — Uses ultrasound waves to destroy fibroids.
• Myomectomy — Removes fibroids but not the uterus. Fibroids can potentially grow back.
• Uterine artery embolization — Blocks the blood vessels to the uterus, so fibroids can’t grow.