Why Am I Bleeding or Spotting Between Periods?

Vaginal bleeding at abnormal times is a symptom needing medical attention

Woman running to the toilet
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Bleeding or spotting between regular monthly periods can alarm you. When this happens, you may see just a spot or two of blood on your underwear or toilet tissue, or you may be bleeding as if you have started your period. While there are benign reasons for this symptom, it can also point to more serious problems that will need treatment.

Should You Call Your Doctor?

Any unexplained vaginal bleeding between periods is a reason to call your healthcare provider.

While it needs to be reported at any age, it is especially a concern for girls who haven't yet go through puberty and for women who are past menopause. If you are pregnant and you have spotting or bleeding, you need to see your doctor.

You should seek immediate medical help if the bleeding is heavy, or if you also have pain, dizziness, or fatigue.

If you are unsure about where the blood is from your vagina or another source, insert a tampon. If you continue to have bleeding, it may be coming from your anus or urinary tract instead of your vagina. You should see your doctor in these cases as well.

What Is Normal Menstrual Bleeding?

Normal menstrual bleeding lasts about five to seven days. While menstruation usually occurs an average of every 28 days, anywhere from 21 to 35 days between periods is considered normal. Most women get to know their own cycles after a few years of menstruating. Although it may seem like you are losing a lot of blood, it usually only measures between two and eight tablespoons.

About 14 days after the start of your period, you ovulate and release an egg from the ovary. Some women note spotting during ovulation, which is normal, although it should be discussed with your doctor. The uterine lining is ready for the implantation of a fertilized egg, and there can be spotting at the time of implantation if that occurs and pregnancy begins.

If no fertilized egg implants, the uterine lining is shed during menstrual bleeding approximately two weeks later. 

What Causes Bleeding Between Periods?

Some women may experience spotting during ovulation which is normal. Although the reasons for irregular bleeding can vary according to individual health situations, some of the more common causes include:

Pregnancy

  • Implantation bleeding/pregnancy: Spotting may occur at the time the fertilized egg implants in the uterus and begins to grow.
  • Miscarriage: You may or may not have known you were pregnant, and the bleeding is a sign that the pregnancy has ended.
  • Abortion: Bleeding can be a sign that the pregnancy was terminated using medication or a procedure.
  • Ectopic pregnancy: This occurs when a fertilized egg implants outside of the uterus.

Hormonal Fluctuations and Birth Control Methods

  • Starting, stopping, or missing oral contraceptives (birth control pills) or estrogen can lead to spotting or bleeding.
  • Irregular vaginal bleeding might be seen when using the contraceptive patch, implant, or injection.
  • IUDs are known to cause occasional spotting.
  • Low thyroid levels and high thyroid levels can both be a cause.
  • Polycystic ovary syndrome (PCOS) is a hormone imbalance that affects ovulation and can cause bleeding.
  • Vaginal dryness or atrophy after menopause.

Infection 

  • Vaginal, cervical, and uterine infections and inflammation conditions
  • Sexually transmitted infections including chlamydia, gonorrhea, and genital warts
  • Pelvic inflammatory disease

Other Causes

  • Stress
  • Injury to the vagina from insertion of foreign objects or sexual trauma
  • Uterine fibroids (noncancerous growths in the uterus)
  • Malignant cancers, including cervical cancer, uterine cancer, uterine sarcoma, ovarian cancer, and vaginal cancer
  • Certain drugs, particularly anticoagulants and tamoxifen
  • Certain gynecological procedures
  • Urethral prolapse or polyps

    How Your Doctor Will Diagnose the Cause of Vaginal Bleeding

    You should expect to give your full medical history when you visit your healthcare provider for diagnosis of bleeding or spotting between periods. Also expect to have a pelvic exam, including a Pap smear if you haven't had one recently.

    If you've kept a menstrual cycle calendar, it will help answer any questions your healthcare provider may have about your bleeding. These questions may include:

    • How long have you experienced bleeding between periods?
    • Does it happen every month or is this the first time?
    • At what point during your menstrual cycle did the bleeding begin and how long did it last?
    • Do you experience menstrual cramps when bleeding between periods occurs?
    • Does anything make the bleeding worse or better?
    • Is the bleeding worse with increased physical activity?

    In addition, your healthcare provider may ask about your stress level and whether you have other symptoms such as pelvic pain, increased bruising, difficulty swallowing and pain or burning during urination.

    If there’s blood in your stool or urine, this is definitely something to bring to your healthcare provider’s attention.

    Remember to inform your healthcare provider about any prescription or over-the-counter medications (including herbal supplements) that you are taking.

    Vaginal Bleeding and Your Medical History

    If you’re visiting a new healthcare provider who isn’t familiar with your medical history, she’ll want to know how old you were when you started having periods, whether you’re sexually active, and what birth control method you may be using.

    Obviously, she’ll want to know about any history of bleeding between periods, and whether this is a symptom other women in your family may have suffered. It's also important to advise your physician if you are pregnant or recently had a miscarriage or abortion. If you have had a D&C procedure, your healthcare provider should know this as well.

    If you have experienced any injuries or had medical or surgical treatments, this is also important to tell your physician or nurse practitioner.

    Recommendations for Irregular Vaginal Bleeding

    The treatment for your vaginal or uterine bleeding will depend on the answers to your healthcare provider’s questions, as well as the findings of your pelvic exam. Based on the initial evaluation there may be additional tests or treatment needed. But always treat unexplained or unfamiliar vaginal bleeding as the serious symptom it is.

    Bed rest may be recommended if the bleeding occurring between your periods is heavy. Use your menstrual cycle calendar to record the number of tampons or pads you use. This information can help your doctor determine whether or not you are bleeding excessively.

    Unless your doctor specifically advises otherwise, don’t take aspirin while you are menstruating. Aspirin can thin the blood, which may cause bleeding to last longer and flow more heavily.

    A Word From Verywell

    You are right to be concerned about abnormal vaginal bleeding, and you should discuss it with your doctor. While it may have a cause that is only a minor concern, it can also be a sign of a condition that needs attention, including pregnancy.

    Sources:

    Mayo Clinic. Vaginal Bleeding.

    MedlinePlus. Vaginal Bleeding Between Periods.

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