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When it comes to your menstrual cycle, it’s normal to experience fluctuations in duration and symptoms from time to time. Menstruation is a complex process, and a variety of health conditions, lifestyle habits and external factors can affect your cycle.
One common symptom people might experience is spotting between periods, also known as intermenstrual bleeding. Spotting is characterized by light vaginal bleeding outside of your expected monthly cycle. But why does it happen and is it something to be concerned about? Learn the possible reasons for spotting between periods and when to talk with a doctor or clinician.
Is spotting between periods normal?
Yes, occasional spotting between periods can be common, and is typically not an immediate sign that something is wrong. However, if spotting between your periods happens more frequently or worsens over time, it’s time to talk with your primary care doctor, clinician or a women’s health specialist like an OB-GYN. That’s because frequent spotting or bleeding between periods can be a sign of an underlying health condition.
Hormone fluctuations are a common cause of spotting between periods
While there are many reasons why you might experience spotting between periods, hormone fluctuations are the most common cause. Your menstrual cycle is a reproductive process regulated by four main sex hormones: follicle stimulating hormone, luteinizing hormone, estrogen and progesterone. These hormones are constantly in flux, and it’s normal for levels to rise and fall depending on the stage of your cycle and your age.
However, hormones and their production can be disrupted by outside factors such as stress, diet, weight changes, too much or too little exercise, and exposure to environmental toxins – even things like cosmetics and air quality. Below are some of the most common causes of hormone fluctuations.
Perimenopause can change the frequency and duration of your periods
It’s not uncommon to experience spotting once you reach perimenopause, which is the months, or sometimes years, leading to your final menstrual period. This is because your body is beginning to produce less estrogen, making you more likely to experience menstrual cycle irregularities like unpredictable bleeding.
Occasional spotting that is less than a medium-heavy period flow can be common during perimenopause. However, if bleeding becomes frequent or blood flow becomes heavier over time, you should talk with your doctor.
Stress is a common hormone disrupter
Feeling stressed is a normal part of life, and not all stress is bad. There’s an evolutionary reason why it exists: safety. However, too much stress can affect the endocrine system’s production of cortisol.
Heightened levels of cortisol can disrupt your body’s production of sex hormones. Increased cortisol levels can cause a decrease in estrogen and testosterone, impacting your cycle and causing irregularities like spotting between periods.
Hormonal birth control side effects can also cause intermenstrual bleeding
It’s estimated that around 65% of women of reproductive age in the United States use some form of birth control. Contraceptives typically come in two forms: nonhormonal and hormonal.
Nonhormonal methods like condoms, fertility awareness and the copper IUD don’t directly affect your body’s endocrine system. But hormonal methods, by definition, use hormones to help regulate periods and prevent pregnancy. This includes combination birth control pills, progesterone only (“mini”) pills, the patch, contraceptive injections, hormonal IUDs and arm implants like Nexplanon.
Because these methods of birth control impact your hormones, they can sometimes have other side effects, especially for those who are just starting a new regimen or who have recently started using a different method of birth control.
What to know about IUDs and irregular bleeding
Nonhormonal copper IUDs tend to cause heavier bleeding and more cramping during your period. And hormonal IUDs can have a variety of effects on bleeding, from spotting to complete amenorrhea, which is the stopping of your period.
While bleeding changes and spotting can be common with an IUD, if you have an IUD and experience sudden bleeding changes, it’s possible the IUD has shifted. So it’s time to see a doctor. A pelvic ultrasound is the best way to check to make sure it’s in the right position.
Other reasons for spotting between periods may be underlying health conditions
Different hormonal and reproductive health conditions like polycystic ovary syndrome, fibroids and other uterine conditions, and thyroid conditions can also cause bleeding between periods.
If you have a chronic reproductive health condition, it’s important to have irregular period symptoms noted in your health chart and considered by your doctor or clinician. Reviewing your vaginal bleeding patterns with your doctor during routine care visits can help provide some insight into your overall health portrait.
Sexually transmitted diseases can cause vaginal bleeding
Sometimes, sexually transmitted infections (STIs) can cause a variety of symptoms, including vaginal bleeding. For example, chlamydia and gonorrhea can cause intermenstrual bleeding due to inflammation and tissue damage. Some STIs, like syphilis or herpes, might produce sores or lesions that may bleed during outbreaks or when ruptured.
If you think your spotting between periods might be due to an STI, and you’re experiencing other symptoms like pain, itching or discharge, your doctor may suggest a STI screening. Once identified, these symptoms can be managed or treated depending on the infection.
Spotting can be common during pregnancy
While it can be scary, some people experience spotting during pregnancy, especially in the first trimester. It’s usually not a reason to worry, but it’s important to see your doctor if it occurs.
Bleeding can sometimes be a sign of something more serious like an ectopic pregnancy, miscarriage or a problem with the way the placenta is developing. Although light spotting doesn’t always indicate these issues, make an appointment with your doctor to be evaluated.
Uterine fibroids may cause irregular bleeding
Uterine fibroids are growths that can appear in the lining or muscle tissue of the uterus. Fibroids, also called leiomyomas, are common during reproductive age. They grow in the muscular tissue of the uterus and are usually noncancerous, nor do they typically develop into cancer.
Some women who have a uterine fibroid may never know, because the fibroids can stay very small and cause no symptoms. But for others, a fibroid can grow to the size of a lemon or bigger. Depending on location, some fibroids can physically change the shape and function of the uterus, causing menstrual issues.
Uterine and cervical polyps can also cause intermenstrual spotting
Polyps begin in the inner lining of the uterus or the inner lining of the cervix due to an overgrowth of the cells lining those structures. While typically noncancerous, polyps can sometimes have precancerous or cancerous cells within them. If polyps are identified during an evaluation for bleeding, removal is typically recommended. Polyps usually affect those who are postmenopausal but can also happen to younger people.
Polycystic ovary syndrome (PCOS) can affect hormone production
Polycystic ovary syndrome is a hormonal condition that effects the ovaries. For many with PCOS, the hormones that regulate and lead to ovulation are disrupted. And when ovulation doesn’t occur, the endometrial lining continues to grow rather than being shed during your period. The longer the lining grows without being shed, abnormalities within the lining can develop.
Dysregulated hormones can lead to menstrual irregularities, like unpredictable periods and occasional spotting. PCOS can also cause other physical symptoms like hair growth, fertility issues, acne and more.
Endometriosis can sometimes cause spotting between periods
Endometriosis is a reproductive health condition characterized by tissue growth outside of the uterus. Endometriosis tissue is similar to the tissue that lines the uterus. During your period, uterine lining, also called endometrial lining, thickens to prepare for pregnancy. When a pregnancy doesn’t happen, that tissue breaks down and sheds, leading to bleeding during your menstrual cycle.
The problem with endometrial tissue is where it grows. Since it develops outside of the uterus, it can’t be shed so it stays in the body. Because of this, endometriosis can be very painful, affecting the function of the ovaries, fallopian tubes and pelvis. While painful periods are the most common symptom of endometriosis, sometimes light bleeding or spotting between periods can also be a sign.
Hypothyroidism might increase your period flow and duration
Hypothyroidism is a chronic condition in which your thyroid gland doesn’t produce enough of the thyroid hormones that regulate your metabolism and other processes in the body. Untreated hypothyroidism can cause symptoms like high cholesterol and heart issues, as well as affect the menstrual cycle.
Irregular hormone production can affect other hormonal pathways, in turn affecting your menstrual cycle. This can lead to a heavier period flow, menstrual cessation or spotting between cycles.
Blood conditions and your menstrual cycle
There are different types of conditions that affect the blood, impacting how red blood cells and platelets function. Some people may have clotting issues, like hemophilia, or abnormal blood composition, like anemia.
Each type of blood condition has its own set of symptoms, but for those with periods, these conditions can often contribute to heavy menstrual bleeding, longer periods, clotting issues and more frequent intermenstrual bleeding.
Often, blood disorders are chronic conditions that can be appropriately managed with medication and treatment.
Cancers are rarely tied to intermenstrual bleeding
While cancer is a rising cause of abnormal vaginal bleeding, it’s still rare. Intermenstrual bleeding can sometimes be one of a few symptoms associated with cervical cancer, endometrial cancer or ovarian cancer, but it’s typically due to other reasons.
This is why regular gynecological care is important. Routine visits to your provider can help with early detection, catching issues before they become a problem. Your provider will prioritize preventive care by conducting regular exams and screenings to ensure you’re in good reproductive health.
When to see a doctor for spotting between periods
Spotting between periods can be common and a response to stress, aging or other lifestyle factors. However, if you notice an increase in the frequency or severity of spotting, especially if intermenstrual bleeding is painful or heavy, make an appointment with your primary care doctor or women’s health specialist.
