Spotting essentially means light bleeding and refers to bleeding that occurs between menstrual periods. When you spot, you may see small amounts of red or dark brown blood in your underwear or notice a tiny amount of blood on toilet tissue when you wipe. Seeing blood when you aren’t expecting it can be frightening. Not surprisingly, many girls and women with this problem quickly assume something must be wrong. The good news? Spotting between menstrual periods is fairly common and something most girls and women experience at some point in their lives.
Is the Blood Coming From Your Vagina?
If you notice blood on the toilet tissue or in your underwear, the first order of business is to make sure it’s coming from your vagina and not your urinary tract or rectum. The best way to confirm vaginal spotting is to insert a tampon into your vagina and see if it comes back with blood on it. If the tampon comes back clean, the bleeding may be coming from your rectum or bladder or kidneys due to urinary tract infection. If you have a urinary tract infection, you may experience other symptoms: having to urinate more often, pain or burning when you urinate and abdominal discomfort. The most common cause of bleeding from the rectum is hemorrhoids, although there are other more serious causes you see more often in women over the age of 40. If the blood isn’t coming from your vagina, it’s important to see your doctor to find out where it IS coming from and the cause.
What if the Blood is Coming from Your Vagina?
If the tampon test is positive, you can be pretty sure the bleeding is from your vaginal tract. Should you be concerned? Spotting before a period can happen for a number of reasons. If you’re still in your teens and haven’t been having your period for more than a year or two, your periods may not have established a set pattern. As a result, the hormones that regulate your menstrual cycle may be slightly unbalanced, leading to a small amount of bleeding prior to your period. This type of spotting is often due to “anovulatory bleeding“, related to the fact that you haven’t started ovulating yet. Failure to ovulate is common during the first few months or years after you begin to menstruate. Factors like excessive dieting, stress and excessive amounts of exercise can also create a hormone imbalance that contributes to spotting.
If you’re in your 20s or 30s, and are taking oral contraceptives, you may experience spotting for a few months after starting them. This is referred to as “breakthrough bleeding” and is fairly common. You may also have breakthrough bleeding if you forget to take your birth control period for a day or two. If this is a persistent problem, talk to your doctor about adjusting your prescription.
When Should You Be Concerned about Spotting Before a Period?
Assuming you’re premenopausal and still having menstrual periods, a small amount of spotting just before a period is usually not cause for concern unless you have other symptoms like unpleasant-smelling vaginal discharge, abdominal cramping, vaginal burning or vaginal itching. These may be signs of a vaginal infection or a sexually transmitted infection. If you have symptoms other than light spotting, it’s important to see your doctor.
The other time spotting before a period is concerning is when you’re pregnant. If you’re sexually active and having persistent spotting or other symptoms like abdominal pain, see your doctor to rule out an ectopic pregnancy. An ectopic pregnancy is one where the egg deposits in an area other than the uterus, where it should be. An ectopic pregnancy is a serious condition that needs evaluation. In women who are pregnant, spotting prior to a period can be a sign of a very early miscarriage. If there’s any possibility you could be pregnant, see your doctor right away if you experience spotting. Spotting early in pregnancy may be entirely normal.
Women who are pregnant may experience “implantation bleeding“, spotting or bleeding that occurs when a fertilized egg attaches to the lining of the uterus. Implantation bleeding often happens right around the time when a period would be expected.
Spotting is more concerning if you’re middle-aged or older. In people in their 30s and over, spotting can be related to a uterine fibroid, a common, non-cancerous growth or enlargement of the uterus, or other problems that don’t typically affect teens and women in their early 20s. Also, spotting can be a sign of endometriosis, a condition that can affect women of all ages. Rarely, it can be also be a tip-off to more serious health problems, including polyps, cancer or an under-active thyroid gland.
Some signs that you need to see your doctor for further evaluation include:
Possible pregnancy
Bleeding more than a small amount
Excessive or malodorous vaginal discharge
Abdominal pain or cramping
You’re past the age of menopause
The Bottom Line
Spotting prior to a period is often not a cause for concern, especially if it’s light and you’re still in your teens or early 20s. For peace of mind, check in with your doctor to be sure.
References
Am Fam Physician. 1999 Oct 1;60(5):1371-1380.
Family Practice Notebook. “Abnormal Uterine Bleeding Causes”
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