Spotting that occurs at different times of the menstrual cycle can be confusing. As a general rule, spotting can occur any time there is a drop in hormone levels and in most cases is not a cause for concern, especially if it is a once off. Chronic spotting, is usually not a cause for concern either however it can indicate some underlying hormonal imbalances or potential infections.
Spotting Before Period:
Experiencing spotting a few days before your period is common and often harmless. This is usually due to a drop in both estrogen and progesterone as the body prepares for menstruation. Spotting for 1-2 days before period is considered normal, spotting for 3 days or more prior to menstruation is usually a sign of low progesterone. Progesterone is responsible for maturing the uterine lining and keeping it in place, spotting means that progesterone might have dropped off too soon or levels are not sufficient enough. Addressing low progesterone takes looking at the entire menstrual cycle and addressing any problems with ovulation. If ovulation was not robust enough due to poor follicular development then the corpus luteum that forms after ovulation is unlikely to have enough energy to support adequate progesterone production. Boosting progesterone involves improving egg quality, managing energy intake and output, addressing stress and trauma and adequate nutrition.
Implantation Bleeding:
Implantation bleeding occurs when a fertilized egg attaches itself to the uterine lining. This typically happens 6-12 (usually day 8-10) days after ovulation and is sometimes accompanied by very light spotting or discharge. Unlike a regular period, implantation bleeding is shorter in duration and usually lighter in flow. Although some women may experience a light flow at implantation, most women simply see a small amount of spotting or nothing at all. Some women might mistake it for an early period, but the timing and characteristics can help distinguish between the two. Implantation bleeding is usually not a cause for concern and may indicate the early stages of pregnancy.
Spotting at Ovulation:
Mid-cycle spotting, often around ovulation, is also quite normal. It’s caused by a small drop in estrogen levels just before the egg is released, leading to a slight disruption in the uterine lining. This spotting is usually light and brief. If bleeding occurs right around ovulation, ovulation spotting is usually red colour. Ovulation spotting can occur as much as 3-4 days after ovulation but will usually be brown in colour which indicated older blood. Most women will have mid cycle spotting at some point during their menstruating years.
Spotting at the End of Period:
Some women experience light spotting as their period comes to a close. This is generally the result of residual shedding of the uterine lining. It’s nothing to worry about, as long as the spotting is minimal and stops within a day or two.
Spotting on Birth Control:
Using hormonal birth control methods, such as pills or IUDs, can lead to spotting, especially during the first few months of use. Your body needs time to adjust to the new hormone levels. However, persistent spotting, more than 1-2 months might mean the method isn’t a good fit for you, and discussing alternatives with your doctor is advised. Spotting is more common on birth control that contain synthetic progestins only such as the mirena IUD, arm implant (implanon), hormonal injection and progestin only pill (mini pill).
Spotting and Underlying Infections/STIs:
Spotting outside your usual cycle could be a sign of an underlying infection or sexually transmitted infection (STI). Infections like bacterial vaginosis or certain STIs can cause irregular bleeding or spotting. This may especially be the case if you also notice, pain, itching, burning, unusual discharge and a foul smell. If you suspect an infection or have unusual discharge accompanying the spotting, seek medical attention promptly. Some STI’s do not show any symptoms until they are fairly advanced so it is important to get regular screenings if you believe your sexual behaviours put you at greater risk of STI’s.
Random Spotting at Any Time:
Spotting at any point in the menstrual cycle is usually not a cause of concern, especially if it is just a one off. Spotting is most commonly caused by stress in various forms because stress can cause drops in both estrogen and progesterone quickly. If there is an unusual drop in hormones it can lead to spotting. In the follicular phase spotting can be a sign that estrogen has dropped and it may be reasonable to expect that ovulation will be delayed. Spotting in the luteal phase can also sometimes occur at the mid luteal progesterone peak when progesterone first begins to drop. If you take any medication or natural herbal supplements or nutritional supplements that influence hormones, sometimes spotting can occur as the body adjusts to the changes. Spotting is also more common during times of hormonal transition such as puberty, pregnancy, post-partum and peri-menopause.
Spotting and Endometriosis, Adenomyosis, PCOS, Fibroids, Polyps and Cysts:
Chronic spotting or irregular bleeding can be linked to conditions like endometriosis, adenomyosis, fibroids, PCOS, polyps ovarian cysts. Any of these conditions are more likely to be associated with spotting. Endometriosis causes tissue similar to the uterine lining to grow outside the uterus, leading to irregular bleeding and spotting. Adenomyosis involves the uterine lining growing into the muscle of the uterus, often causing heavier bleeding and spotting. Fibroids, cysts and polyps can also disrupt the normal menstrual pattern, leading to spotting. These conditions are often also accompanied by heavy bleeds and pain. Read my article on endometriosis and adenomiosis here.
Spotting throughout the menstrual cycle can be attributed to various causes, ranging from normal hormonal fluctuations to underlying medical conditions. While some instances of spotting are harmless, others may require medical attention. If you experience persistent or unusual spotting, it’s recommended to consult a healthcare professional to determine the cause and receive appropriate guidance. Tracking your menstrual cycle and being in tune with your body will help you better understand what’s normal for you and when to seek help if needed.
References:
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Jacobson, M. H., Howards, P. P., Kesner, J. S., Meadows, J. W., Dominguez, C. E., Spencer, J. B., Darrow, L. A., Terrell, M. L., & Marcus, M. (2020). Hormonal Profiles of Menstrual Bleeding Patterns During the Luteal-Follicular Transition. The Journal of clinical endocrinology and metabolism, 105(5), e2024–e2031.
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Heitmann, R. J., Langan, K. L., Huang, R. R., Chow, G. E., & Burney, R. O. (2014). Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility. American journal of obstetrics and gynecology, 211(4), 358.e1–358.e3586. https://doi.org/10.1016/j.ajog.2014.04.041
Zhang, C. Y., Li, H., Zhang, S., Suharwardy, S., Chaturvedi, U., Fischer-Colbrie, T., Maratta, L. A., Onnela, J. P., Coull, B. A., Hauser, R., Williams, M. A., Baird, D. D., Jukic, A. M. Z., Mahalingaiah, S., & Curry, C. L. (2023). Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study. American journal of obstetrics and gynecology, 228(2), 213.e1–213.e22. https://doi.org/10.1016/j.ajog.2022.10.029
