12 Reasons You're Spotting Before Your Period

Some people who menstruate might discover that they are spotting before, after, or between periods. Spotting is vaginal bleeding that's light and may be accompanied by cramping. It's usually normal, as some people experience spotting one to two days before their period starts.

Sometimes spotting happens because of certain medications, stress, or perimenopause. Other times, spotting can be a sign of a serious condition like a sexually transmitted infection (STI) or, rarely, cancer. Read on to learn more, including when to see a healthcare provider.

What Is Spotting?

Spotting is generally defined as vaginal bleeding that happens at any time other than during your period. Episodes of spotting also occur irregularly.

1. Hormonal Birth Control

Using hormonal birth control like the pill, implant, injection, or intrauterine device (IUD) is a common cause of spotting. With IUDs and the pill, spotting will typically get better in three to six months after starting. Spotting with implants and injections may or may not decrease with continued use.

This side effect is generally not harmful, but if it's particularly bothersome, check with an OB-GYN. They may suggest treatment options including changing birth control methods, taking ibuprofen, or adding short-term estrogen treatment.

2. Certain Medical Conditions

Some underlying health conditions that disrupt hormone levels may cause spotting. This includes hypothyroidism, when the thyroid gland produces too few hormones, and polycystic ovary syndrome (PCOS), a hormone imbalance that affects ovulation. Once diagnosed, these conditions can be treated with medication to help regulate hormones, reducing the spotting episodes.

3. Pregnancy

Your period stops when you're pregnant, but it's fairly common to experience some spotting, particularly in the early stages of pregnancy. Data has suggested that about one in four pregnant women experiences spotting during the first trimester.

The process of the fertilized egg implanting into the uterine lining is what can first cause spotting. The spotting can happen one to two weeks after fertilization. Early spotting might also occur because more blood vessels are developing in the cervix, making it more susceptible to bleeding.

While bleeding later in pregnancy can be cause for concern, bleeding early in pregnancy often isn't. It's still important to contact a healthcare provider if you notice bleeding at any point in your pregnancy.

4. Medications

Several types of medication can prompt spotting, including:

• Blood thinners
• Certain antidepressant and antipsychotic drugs
• Hormone therapy
• One-time-use emergency contraception pills, like Plan B
• Tamoxifen, a medication for early-stage breast cancer

Always check with a healthcare provider if you think medications may be the reason why you're spotting. You don't want to stop taking any prescribed medications on your own.

5. Uterine Fibroids or Polyps

Two different types of growths on the uterus—known as uterine fibroids and uterine (endometrial) polyps—can cause spotting and, sometimes, cramping. These masses are typically small, non-cancerous, and otherwise not very bothersome. Both are more likely to develop as you age and can be treated with medications or, in severe cases, surgery.

6. Sexually Transmitted Infection

Certain sexually transmitted infections (STIs), such as chlamydia and gonorrhea, can cause abnormal vaginal bleeding. You'd likely also notice unusual vaginal discharge and sometimes a burning sensation while you're urinating if these STIs are the cause. STIs can be diagnosed through testing with a healthcare provider who can then recommend treatment options to clear up the infection.

7. Sex

It's not uncommon to notice spotting after sex. Up to 9% of women are believed to experience it. This can be attributed to several factors, such as:

• Endometriosis
• Inflammation, such as from an infection
• Non-cancerous polyps
• A thin or dry vaginal wall
  

8. Injury or Trauma

Any type of injury to your vaginal area can prompt spotting. While sexual trauma is a possible cause, know that routine activities like getting a Pap smear or having rough sexual intercourse can lead to bleeding. Keep an eye on the spotting and contact a healthcare provider if it doesn't stop or is accompanied by pain.

9. Perimenopause

The years leading up to your last menstrual period are known as perimenopause. It usually starts when someone is in their mid to late 40s.

During this time, hormone levels can fluctuate more than normal. This prompts period changes, potentially including spotting. Unlike flow changes and skipped periods, spotting is not considered a normal part of perimenopause and should be brought up to a provider as it can be a sign of a medical condition.

Other signs and symptoms of perimenopause include vaginal dryness, sleeping problems, and hot flashes. All of these symptoms can be treated with options like medication, hormone therapy, and lifestyle changes.

10. Stress

Physical and emotional stress can take a toll on your body—and your menstrual cycle. Experts think elevated stress levels can disrupt your cycle's hormone regulation, causing spotting. Spotting between periods can also happen with lifestyle changes, such as dieting or a new exercise routine.

11. Miscarriage or Ectopic Pregnancy

Heavier spotting, along with cramps, could potentially signal a miscarriage or an ectopic pregnancy if you are pregnant. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus.

Other signs of a miscarriage include abdominal pain and fluid or tissue coming from the vagina. Other signs of an ectopic pregnancy include low back pain and mild pain in the abdomen or pelvis.

Both can be emergencies. You will want to call a healthcare provider right away to get appropriate medical attention if you are experiencing any of these symptoms.

12. Endometrial, Cervical, or Ovarian Cancer

In rare cases, spotting can be a symptom of certain cancers, such as endometrial (uterine), cervical, or ovarian cancer. With gynecological cancer, you'd likely also notice other severe symptoms, such as pain, that may get worse over time. It's best to see a healthcare provider if you're past the menopause phase or have a family history of these cancers, as this risk might be higher.

Spotting vs. Period

One of the main differences between spotting and periods is the amount of vaginal bleeding that occurs. Spotting usually entails a light amount of vaginal bleeding, while a period may include vaginal blood loss of 5 to 80 milliliters.

Spotting is also a typical sign that your period is about to begin. One study indicated that, among 116 women, 41.7% reported having a minimum of one day of spotting before their period started.

When to Contact a Healthcare Provider

While the occasional spotting doesn't usually signal a serious issue, it's a good idea to check with an OB-GYN if you notice any vaginal bleeding that's unusual for you.

Consider keeping track of your symptoms to help an OB-GYN form a diagnosis. Jot down:

• Details about your typical menstrual cycle, such as the length and consistency of the flow
• The number of times you've noticed spotting
• Any additional symptoms, such as cramps

Seek medical care as soon as possible if the spotting is:

• Severe, persisting, or getting worse
• Linked to other symptoms, such as dizziness, fever, fatigue, or abdominal pain
• Happening after menopause

A Quick Review

Spotting typically isn't a cause for alarm, especially if you recently started taking hormonal birth control. In some cases, there is a chance that it could be the sign of something more serious, like a sexually transmitted infection, thyroid condition, or—in rare cases—cancer.

It's worth consulting with an OB-GYN if your spotting is unusual or bothersome because there are treatment options or birth control alternatives available. In the meantime, try tracking your spotting days and symptoms.