Spotting is any light vaginal bleeding that occurs at any time other than when a period is due. Spotting between periods is reasonably common. There can be a few reasons why it happens but the most common are hormonal changes and it being due to an implantation bleed. This is what can happen when the newly formed embryo nestles and embeds into the blood thickened lining of the womb.
Common reasons why spotting happens
Implantation of the embryo – this is known as an ‘implantation bleed’.
Post coital bleeding (after sex) – this can happen because even in very early pregnancy the blood vessels in the cervix become engorged with blood, making it more likely to become irritated and bleed.
Miscarriage – spotting can happen very early in pregnancy, before a woman even realises she is pregnant.
An ectopic (tubal) pregnancy
Some forms of contraception – Implanon, patches and hormonal-based devices increase the likelihood of spotting occurring. This often settles after an initial couple of months of starting hormonal-based contraception and may reappear when ceasing it. This is also known as breakthrough bleeding because it happens in-between periods.
Ovulation – this is known as ovulation spotting. This is normal for some women who can experience predictable, light spotting every month at the same time as they ovulate.
General hormonal imbalance – due to thyroid or ovarian problems, as well as diabetes.
Medication side effects – spotting is more common in women who are taking (some) anti-depressant and corticosteroids (anti-inflammatory) drugs.
Taking blood thinning medications – such as Heparin, Warfarin or Aspirin.
Infection of the vagina, uterus or cervix
Rarely, spotting is due to more serious conditions – such as uterine, ovarian or cervical cancer, endometriosis, polyps, fibroids or lesions.
Polycystic Ovarian Syndrome (PCOS)
After a vaginal examination – such as having a pap smear.
On-going stress – this can affect all body systems and spotting is one vague but very real symptom of body imbalance.
What causes an implantation bleed?
Spotting can occur a week or even a few days before a period is due. When this happens and the woman has not been using contraception, it is more likely that it is due to an implantation bleed rather than a menstrual period. But because of the timing, many women interpret the spotting as a very light and early period and don’t consider themselves to be pregnant.
An implantation bleed is different to a period because there is less bleeding, and it usually appears as a pink or brownish discharge rather than a blood flow. It does not increase in volume and does not involve the passing of clots. Generally there is no associated pain with an implantation bleed, unlike a period when cramping and backache is common. Generally, an implantation bleed occurs 11-12 days after conception has occurred.
A period however, continues for 4-5 days, may involve clots and cramping and increase in volume before it reduces and stops altogether. It is also predictable, unlike spotting, which can occur sometimes, be sporadic and generally peters out after a day or two.
But I’ve never had any spotting before!
For women who usually have regular and predictable cycles, spotting can create confusion and worry. If you have never had any spotting before then you may be feeling very concerned. It is important not to pass off spotting as ‘one of those things’, but to be checked by your doctor or healthcare professional. Having an examination, getting tests done and seeking reassurance is very important.
You may even be confused about where the spotting is coming from. Urinary tract infections can cause the urine to become blood stained and this can be the cause of blood appearing on toilet paper. In women who have haemorrhoids or bleeding which originates from their bowel or rectum, this can also cause internal and external bleeding. If you are unsure if the blood is coming from your vagina, use a tampon to help you work it out. A check with your healthcare professional will help you to identify the source of the bleeding.
How common is spotting before a period?
It is estimated that around 10-15% of pregnant women will have some degree of spotting or vaginal bleeding in their early pregnancy. Sometimes this is due to a miscarriage. As disappointing as this can be, there is little that can be done to prevent an inevitable miscarriage from occurring. In the early stages of spotting, a wait-and-see approach is usually recommended by healthcare professionals. Some women will progress to having a spontaneous miscarriage and others will not.
Although the incidence of miscarriage occurs in 10-25% of pregnancies, the reality is that most pregnancies will result in the birth of a live and healthy baby.
Depending on what day of your cycle the spotting is occurring, different hormones will be circulating in your body and these contribute to physical as well as emotional symptoms.
What is the difference between spotting and a period?
Essentially, the quantity of blood loss during spotting episodes is the primary difference between spotting and having a period. Though it can still be very easy to confuse spotting with a period it is important to know that the two are different and are caused by different things.
Spotting tends to be irregular and light and not as heavy in volume as a period. You might experience only faint staining or streaking in your vaginal mucous. Small amounts of blood might be present sometimes and not at other times. Spotting may be more obvious when first getting up in the morning, after intercourse or exercise.
You may only be aware you are spotting when you go to the toilet and after wiping when you may notice some old brown blood or fresh pinkish-red staining on the toilet paper. Alternatively, you may see some blood on your underwear.
There should not be so much blood that you need to use a tampon or a pad to absorb it. But you may choose to use a panty liner just to stay fresh and avoid staining. If you are bleeding so much that you do need to use pads or tampons, then you are unlikely to be spotting, but having a period instead.
If you experience a lot of spotting or there seems to be a pattern happening, then consider keeping a spotting diary. This can help with recall of dates and where in your cycle it is occurring. It also provides an accurate and objective picture when describing your history of spotting with your doctor.
What is the difference between spotting and a miscarriage?
If vaginal bleeding becomes heavier, clots are passed or there is a change in the colour of the blood then this is no longer spotting. Back pain, uterine cramping and lower abdominal pain can all be signs of miscarriage. For some women this may be the first indication that they are pregnant.
Having a medical check-up is important even if you are not too concerned yourself. Often, it becomes necessary to have an ultrasound to see if an embryo is present, is still viable and whether a heartbeat is present. This is usually visible via ultrasound between 5–6 weeks of pregnancy.
Alternately, if there are still some products of conception in the womb after a miscarriage this can lead to infection and continual bleeding. Many women need to have a curette if they have had an ‘incomplete miscarriage’.
Women who have an Rh Negative blood group may need to have an injection of Anti D to prevent problems in subsequent pregnancies. Around 20-30% of all pregnancies can experience some bleeding in early pregnancy and still continue to have healthy babies.
When should I have a pregnancy test?
The general recommendation is to wait until you have missed your period, just to be accurate. The hormone – human Chorionic Gonadotrophin (hCG) – is detectable in urine and blood pregnancy tests and has its highest level in the first urine passed in the morning.
The accuracy of current home pregnancy tests is very high, so you don’t have to wait until the morning if you really can’t wait to find out. But be aware that the combination of very early pregnancy and diluted urine can give a false negative result and you might need to repeat the test if the result is negative.
A negative result can also result from not using the test kit correctly; waiting too long or not long enough to see the test result. It may also mean that you are not pregnant. If you still feel you may be pregnant and, you have not had your period for another week, then take another pregnancy test.
It is possible to have a false negative pregnancy result but not a false positive. If hCG is present, in even the smallest concentration, then it will be detected by the pregnancy test.
Where to go for help
Any time that you feel concerned about vaginal bleeding unrelated to your period, seek medical advice from:
Your General Practitioner or gynaecologist
Your local clinic
The local hospital
If your spotting is related to hormonal-based contraception, then arrange a review with the healthcare practitioner who recommended it.
