Brown Spotting Between Periods: What Does It Mean?

Menstrual periods are sometimes unpredictable. Contrary to popular belief, not everyone has the “typical” 28-day menstrual cycle. If you were to chart your periods you might discover your periods are longer in length or shorter than average – or vary in length. Sometimes out of the blue you have a period when you weren’t expecting it! Sometimes you have heavy periods, and sometimes very light (Scanty Periods). And from time to time you find that you have brown spotting between your regular menstrual periods. What causes spotting between periods, and should you be concerned if you have it?

It’s not abnormal to have vaginal discharge. Spotting between periods is a symptom most women will experience at some point over the course of their reproductive life. The amount and consistency of that discharge varies depending on where you are in your menstrual cycle. In most cases, normal discharge from your vaginal tract is clear or cloudy, not colored. What if you experience brown spotting or discharge between your menstrual periods?

Brown, red, or pink spotting: what does it mean?

Spotting, by definition, means you’re only passing small amounts of blood and tissue from the lining of your reproductive tract. When you’re spotting, you may discover a small amount on the toilet tissue when you wipe or notice pink, red or brown spots of blood in your underwear. You might wonder why, if you’re bleeding or spotting, the blood looks brown in color. Blood becomes dark when it’s old. Spotting may be dark brown because it’s leftover blood from your last menstrual period and contains remnants of the lining of your uterus that wasn’t completely shed.

Seeing blood on toilet tissue when you wipe is alarming, but, there’s good news – most spotting between periods in younger women, is benign.

Spotting towards the end of a normal period is also usually normal and not cause for concern. Some women may also experience brown spotting right before a period starts. This type of spotting is often due to a hormone imbalance, typically low levels of the hormone progesterone.

Is the Brown Spotting Really Coming From Your Vagina?

When you see brown discoloration in your underwear, don’t assume it’s from your vaginal tract. It could be coming from your urinary tract or rectum. When you have a urinary infection, it’s not uncommon to pass small amounts of blood in your urine. Hemorrhoids or other problems in your colon or rectum can also cause bleeding that shows up on toilet paper when you wipe or in your underwear. To see if you’re dealing with vaginal spotting, insert a tampon into your vagina and see if it comes back with bright red blood or dark blood on it. If not, you may not be spotting from your vaginal tract after all and should consult your doctor.

What Causes Spotting Between Periods?

Hormones

Spotting between periods can be a sign that the hormones that regulate your menstrual cycle are “out of sync.” Certain medications, particularly birth control pills, can trigger hormonal fluctuations that lead to spotting. It’s not uncommon for women who take birth control pills to experience bleeding between scheduled periods. It takes your body time for your body to adapt to the hormones in birth control pills. Until this adjustment takes place, you may experience red or brown spotting. If it’s a persistent problem, you can ask your doctor to change your birth control prescription. Forgetting to take your birth control pill for a few days can also cause breakthrough bleeding or spotting.

If you’ve taken birth control pills for a while and are still experiencing spotting, your doctor may need to adjust your prescription to bring your hormones back into balance. Sometimes severe stress can trigger hormonal changes that lead to spotting between menstrual periods. Crash dieting, severe calorie restriction or excessive exercise can also disrupt your body’s hormone balance and lead to irregular bleeding or spotting. Less commonly, a medical problem like a hypothyroidism (an underactive thyroid) is the culprit. Your doctor can check your thyroid function using a blood test.

Any form of hormonal birth control, including intravaginal rings, injectables, implantables and patches can cause spotting, especially when you first begin using them. Intrauterine devices, or IUDs, are another form of birth control that causes spotting in some women. One type of IUD called Mirena contains a progesterone-like hormone that can bring on spotting. Some women also experience spotting with copper IUDs during the first few months.

A number of women have a condition called polycystic ovary disease that triggers hormonal imbalances. These imbalances are often linked with irregular menstrual periods and, sometimes, bleeding or spotting between periods. You’re a higher risk for this condition if you’re overweight, have a family history of PCOS or have diabetes or a pre-diabetic condition called insulin resistance.

Ovulation Bleeding

Some women experience a small amount of bleeding mid-cycle, around the time of ovulation. Ovulation, the release of an egg from the ovaries, usually occurs 10 to 16 days after your last period. Light bleeding or spotting during this time is due to the sudden rise in estrogen, a female hormone that helps regulate your menstrual cycle, which happens at the time of ovulation. Ovulatory bleeding is usually light and lasts no more than 2 or 3 days. Around 20% of healthy women experience light bleeding or spotting mid-cycle as ovulation takes place.

Pregnancy

Light bleeding and spotting can also happen during early pregnancy, when the fertilized egg implants itself in the wall of the uterus; it can irritate the lining and cause loss of small amounts of blood. When this takes place, it’s not uncommon to experience spotting for a day or two. This type of brown spotting usually happens a few days to a week after an egg is fertilized, so you can experience it before you even know you’re pregnant.

If there’s any chance you could be pregnant, take a pregnancy test and see your doctor right away if you’re bleeding. Spotting in pregnant women can sometimes be an early sign of miscarriage. Sometimes an egg implants in a part of the reproductive tract where it shouldn’t be. This is called an ectopic pregnancy. Spotting, in combination with abdominal pain, are two common signs you see with ectopic pregnancy. Any time you have abdominal pain or cramping along with spotting, see your doctor immediately.

Other Causes of Spotting Between Menstrual Periods

Most spotting between periods is related to hormonal fluctuations and ovulation bleeding, although there are some more serious causes of between period spotting. Infection or inflammation of the cervix, cervical polyps or even cervical cancer can all cause pink, red or brown spotting. The spotting may be brought on or made worse by sexual intercourse. Sexually transmitted diseases like chlamydia and gonorrhea can also trigger spotting in some cases. Fibroid tumors of the uterus (almost always non-cancerous) and cancer of the uterus are other possible causes of spotting, although these are more common in women around the age of menopause or older.

Brown Spotting versus Brown Vaginal Discharge

As mentioned, brown “spotting” could really be dark colored vaginal discharge that contains red blood cells. In some cases, brown discharge is caused by an infection in your cervix or a sexually transmitted disease like chlamydia or gonorrhea. If you have other symptoms such as abdominal discomfort, burning when you urinate or foul-smelling vaginal discharge or itching, check with your doctor.

If you recently had an abortion, please see our articles about brown discharge after abortion, blood clots after abortion, and bleeding after abortion.

The Bottom Line

Most “normal” brown spotting that happens just before or after your period is painless, and it is a relatively common problem that happens in normal women, especially young women and women using hormonal methods of birth control. Although between-period spotting usually isn’t serious, it’s important to find out WHY you’re spotting. See your doctor or gynecologist for a full exam. It’s important to be aware of changes in your body, including changes in your menstrual cycle, and report them to your doctor promptly.

If you have other symptoms, like pain or itching or if there’s a chance you could be pregnant, get it checked out as soon as possible. If you have large amounts of persistent brown spotting or discharge that doesn’t clear up in a day or two, let your doctor know. Even if you don’t have these symptoms, a consultation with a doctor will give you added peace of mind.

References

Medscape Family Medicine. “Toward Optimal Health: The Experts Discuss Abnormal Uterine Bleeding”
Up to Date. “Approach to abnormal uterine bleeding in nonpregnant reproductive-age women”
Am Fam Physician. 1999 Oct 1;60(5):1371-1380.
Family Practice Notebook. “Abnormal Uterine Bleeding Causes”