Spotting is just any vaginal bleeding that happens does not during the periods. It is not a normal phenomenon, though a common thing. Studies show that almost 5% of women may have spotting time to time, more particularly about a week before the expected period [1].
Fortunately, spotting is rarely the reason for concern. Nonetheless, it is something to be investigated, as sometimes it may be due to more severe reasons. There can be numerous reasons for spotting, and this article looks at some of the most common causes.
Ovulation
It is not normal to have spotting during ovulation, but studies show that it happens in about 3 percent of cases [1]. It is a time when the ovary releases the egg.
In most such cases, spotting would occur more than seven days before the period. But can be even close to seven days in those with shorter duration of periods.
Spotting due to ovulation is light. There may be other symptoms of ovulation like an increase in basal body temperature, increased sex drive, increased cervical mucus, altered consistency of cervical mucus, and so on.
If spotting happens just now and then, it is perhaps not a reason for worry. However, recurrent spotting or even heavier bleeding may indicate something more severe. Like females with a deficiency of clotting factor may have heavy bleeding during ovulation [2].
Implantation bleeding
It is not rare for women to report bleeding after implantation. Since this bleeding happens just a few days before the expected period, sometimes it may be confused with the last menstrual period by women looking to get pregnant.
This kind of bleeding is only probable in those having unprotected sex, and more often in cases when a woman is planning to get pregnant. Studies show that such bleeding is not a cause to worry, as most women can expect to have a successful pregnancy [3].
For ladies not looking to get pregnant, and who had unprotected sex, spotting 7 days before periods could be a reason for some worry as it may indicate early pregnancy bleeding, meaning unplanned pregnancy.
Changes in the bleeding pattern due to birth control methods
Studies show that birth control methods cause changes in bleeding patterns and unexpected spotting. Spotting is more common when birth control methods are initiated. Studies show that during the first three months, most women can expect spotting [4].
Spotting during the first few months of initiation of birth control methods is not a reason for concern; it happens due to hormonal changes in the body. Women who take birth control pills irregularly are more likely to have these issues.
Sometimes, women may need to change the dose or type of birth control pills to prevent spotting.
Perimenopausal
Spotting is not rare during this phase as women transition to menopause. As the menstrual cycles start to become irregular, most women would experience spotting now and then.
Many may have spotting between the periods, a week before the expected period, and so on. These changes happen due to fluctuations in hormone levels.
In most cases, it is not a reason to worry. However, heavy bleeding, presence of numerous physical symptoms, mood swings may require pharmacological therapy. Hormone replacement therapy may also help prevent spotting in this particular group [5].
Trauma
It may be due to rough sex, sexual assault, or even due to some medical procedure. Sometimes it may happen due to tampon use. Spotting after blunt trauma of lower abdomen is a cause to worry.
Endometrial polyps
It is not a rare condition among women of childbearing age, particularly those over 30. However, most of them, perhaps more than 80% of them, are asymptomatic, and thus frequent spotting may help diagnose the condition. These women may experience spotting, particularly after a sex [6].
Polycystic ovary syndrome (PCOS)
It is one of the most common hormonal disorder among women of reproductive age that causes severe changes in the menstrual cycle. It is also a kind of metabolic disease.
Those living with PCOS may not only experience menstrual irregularities but also bleeding in between the periods. Other symptoms of the condition are infertility, hair thinning, weight gain, poor sleep, mood swings [7].
Sexually transmitted diseases (STIs)
In this particular condition, there would not be any fixed pattern of spotting, and may not essentially happen 7 days before periods, but may occur.
A person with STIs would have other symptoms of infection like painful urination, vaginal discharge, genital itching, pelvic pain, and so on.
Stress
Sometimes stress may cause spotting during specific days of the menstrual cycle. It happens due to hormonal fluctuations. Further, monthly cyclic hormonal changes also predispose women to stress disorders.
It is not rare for women to have spotting now and then, yet most commonly used lab tests may fail to identify the cause.
It is also worth knowing that spotting may also occur due to other chronic ailments like diabetes, liver disease, kidney problem, as many of these conditions cause hormonal changes.
What measures to take?
Studies show that in the vast majority of cases, it is just a sporadic event caused due to unexpected hormonal changes, and thus, there is no need to worry. Only if it is repeated that one should start exploring its causes, those who had unprotected sex should consider taking a pregnancy test.
Unexplained and repeated spotting is a reason for consulting a specialist. One may even seek medical attention after first spotting if there are other signs and symptoms.
Some of the symptoms accompanying spotting may point towards more severe health issues like fever, dizziness, abdominal pain, heavy bleeding, pelvic pain, and so on.
References
- Dasharathy SS, Mumford SL, Pollack AZ, et al. Menstrual Bleeding Patterns Among Regularly Menstruating Women. Am J Epidemiol. 2012;175(6):536-545. doi:10.1093/aje/kwr356
- Girolami A, Lombardi AM, Candeo N, Scarparo P, Paternoster A. Control of Ovulation-Induced Hemoperitoneum by Oral Contraceptives in a Patient with Congenital Hypoprothrombinemia and in Another with Congenital Factor V Deficiency. AHA. 2008;119(4):236-240. doi:10.1159/000141782
- Harville EW, Wilcox AJ, Baird DD, Weinberg CR. Vaginal bleeding in very early pregnancy. Hum Reprod. 2003;18(9):1944-1947. doi:10.1093/humrep/deg379
- Westhoff C, Osborne LM, Schafer JE, Morroni C. Bleeding Patterns After Immediate Initiation of an Oral Compared With a Vaginal Hormonal Contraceptive. Obstetrics & Gynecology. 2005;106(1):89–96. doi:10.1097/01.AOG.0000164483.13326.59
- Astrup K, Olivarius N de F, MØller S, Gottschau A, Karlslund W. Menstrual bleeding patterns in pre- and perimenopausal women: a population-based prospective diary study. Acta Obstetricia et Gynecologica Scandinavica. 2004;83(2):197-202. doi:10.1080/j.0001-6349.2004.00401.x
- Dreisler E, Sorensen SS, Ibsen PH, Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years. Ultrasound in Obstetrics & Gynecology. 2009;33(1):102-108. doi:10.1002/uog.6259
- Hoeger KM, Legro RS, Welt CK. A PATIENT’S GUIDE: Polycystic Ovary Syndrome (PCOS). J Clin Endocrinol Metab. 2014;99(1):35A-36A. doi:10.1210/jc.2014-v99i1-35A
Dr. Preet Pal SB is a physician (M.D. Medicine) with a specialization in diabetes (Fellowship in diabetes, Royal Liverpool Academy). He has a particular interest in metabolic disorders, considering that they are rising in every corner of the world, more so in India.