Why Spotting Occurs: Causes, Timing and When to Seek Help

What is Spotting?

Spotting is light vaginal bleeding that occurs outside of your regular menstrual period and is much lighter than a normal flow. It is a clinically recognised type of abnormal uterine bleeding and does not follow the regular cyclical pattern of menstruation.

Spotting is different from a full period in both timing and intensity. Common causes include:

• Hormonal changes
• Alterations in the uterine lining
• Issues with the cervix or vagina
• Other underlying health conditions

Why Does Spotting Occur Between Periods?

Spotting between periods, also called intermenstrual bleeding, can have several causes. Mid‑cycle spotting often occurs around ovulation, when brief hormonal changes can cause light shedding of the uterine lining. This type of spotting is usually light, short-lived and may be accompanied by mild pelvic discomfort.

Spotting can also result from structural issues in the uterus or cervix, such as fibroids, endometrial or cervical polyps or adenomyosis. These conditions are part of the PALM‑COEIN classification for abnormal uterine bleeding, where “PALM” includes polyps, adenomyosis, leiomyomas (fibroids) and malignancy or hyperplasia.

Is Spotting a Sign of Pregnancy?

Yes, spotting can sometimes indicate early pregnancy, though not all women experience it and it is not a definitive test for pregnancy. Light “implantation bleeding” may occur when a fertilised egg attaches to the uterine lining, usually 6-10 days after ovulation, often near the expected period. This bleeding is typically light, short-lived and pink or brown rather than bright red.

In early pregnancy, spotting can also occur after sex because increased blood flow makes the cervix more sensitive. However, it is important to note that bleeding in early pregnancy can sometimes signal miscarriage or an ectopic pregnancy, so any pregnancy-related spotting should be monitored by a doctor.

Could Spotting be Linked to Infections or Structural Causes?

Yes. Spotting can result from infections or structural issues in the reproductive system.

Infections:

• Sexually transmitted infections like chlamydia and gonorrhea can inflame the cervix (cervicitis), leading to spotting.
• Pelvic inflammatory disease (PID) affects the upper reproductive tract, causing bleeding, pain and sometimes fever.

Structural causes:

• Uterine fibroids, cervical or endometrial polyps and adenomyosis can disrupt the lining of the uterus or cervix, causing irregular bleeding or spotting, often after sex or between periods.
• Endometriosis can trigger spotting before a period as tissue similar to the uterine lining responds to hormonal changes outside the uterus.

When Does Spotting Become a Concern?

Mild, occasional spotting is often normal, especially around ovulation, when starting a new contraceptive or just before a period.

However, you should consult a doctor if spotting:

• Becomes frequent, prolonged or heavier than a few spots
• Repeatedly occurs after intercourse
• Is accompanied by pelvic pain, fever, unusual discharge or painful urination
• Occurs after menopause (no periods for 12 months)
• Happens during pregnancy or if you may be pregnant

Spotting with very heavy bleeding, bleeding lasting longer than a week or bleeding associated with dizziness or fainting may indicate a more serious underlying condition and requires prompt medical attention.

How Do Doctors Investigate Spotting?

When you consult a healthcare professional about spotting, the evaluation starts with a detailed review of your symptoms and medical history.

To determine the cause, your doctor may:

• Perform a pelvic examination to check the vagina and cervix
• Offer a pregnancy test if there is any chance of pregnancy
• Take blood tests to check for anaemia, thyroid function and hormone levels
• Collect vaginal swabs to test for sexually transmitted infections
• Recommend an ultrasound to evaluate for fibroids, polyps or other uterine irregularities
• Suggest cervical screening or colposcopy if there are changes in cervical cells

How Can You Track and Manage Spotting?

Tracking spotting can help you understand patterns and provide valuable information for your doctor. You can:

• Record the dates, duration, colour and amount of spotting
• Note associated symptoms, such as pain, discharge or mood changes
• Log medications, hormonal contraception and fertility treatments
• Observe if spotting recurs at similar points in each cycle

Tracking helps determine whether spotting is linked to ovulation, hormones, contraception, infections or structural conditions like fibroids and polyps. Management depends on the underlying cause and may range from simple monitoring to targeted treatment.

When Should You Seek Urgent Help?

Most spotting is not an emergency, but you should seek urgent medical care if you experience:

• Sudden, severe lower abdominal or pelvic pain with spotting or heavier bleeding
• Feeling very unwell, dizzy, faint or a racing heart alongside bleeding
• Heavy bleeding that soaks pads or tampons quickly, or passes large clots
• Heavy bleeding in early pregnancy or suspected ectopic pregnancy

In these situations, prompt evaluation is crucial to rule out serious conditions such as ectopic pregnancy, significant haemorrhage or severe infection and to receive timely treatment.

Final Thoughts

Spotting between periods is often harmless, but it can understandably cause worry, especially if you are trying to conceive or tracking your cycle closely. The key takeaway is that observing and understanding your body matters more than stressing over occasional light bleeding.

By tracking patterns, noting associated symptoms and knowing when to seek medical advice, you can distinguish normal hormonal or contraceptive-related spotting from signs that may require attention. Empowering yourself with this awareness allows you to take control of your reproductive health, seek timely care if needed and make informed decisions about your body with confidence.