You think your period is over, you grab a new pair of knickers and then when you least expect it... There it is, only few spots, but enough to ruin your mood! It happens to many of us but discarded underwear aside, most times spotting is nothing to worry about.
However, it is useful to know what may be normal spotting and when may be time to see your GP, so read on to find out about the potential reasons for spotting.
First and foremost - what is spotting?
Spotting is when you have a bleeding in between your normal menstrual period. Normally it should be much lighter than your period but can vary between a few fresh blood spots or dark brown discharge to something heavier but should not be enough to fill a panty liner.
What can be the causes for spotting between periods?
There can be several causes for spotting, they include:
Changes in your contraceptive method
When you start taking a new form of contraception like the combined contraceptive pill, the contraceptive injection, an intrauterine hormonal coil or an hormonal implant, this can lower your oestrogen levels and cause some shedding of the uterine lining that leads to spotting. See here how oestrogen can affect your uterine lining during your cycle.
Taking the morning after pill
Emergency contraception like the morning after pill change your hormonal levels and can cause a bleeding. However, watch out - this is not your period and does not mean that you are not pregnant.
Missing your contraceptive pill
If you have forgotten to take your pill this can cause a sudden drop in your oestrogen and progesterone levels and lead to spotting. It also means you are no longer protected from a pregnancy so you would need to use other contraceptive method like a condom to avoid a pregnancy.
Ovulation spotting can happen often for some women. During ovulation an ovarian follicle containing an egg inside ruptures to release the egg into the fallopian tube. This can cause light pink spotting. An increase in oestrogen levels at the time of ovulation can also cause light spotting or bleeding from your uterine lining. Ovulation spotting is not to be mistaken for menstrual cycle, this is when you are most fertile during your cycle!
You may experience spotting during the initial stages of pregnancy. This is normally due to the implantation of the embryo in the womb and the changes in hormone levels associated with pregnancy.
Pregnancy complications such as a miscarriage or an ectopic pregnancy (when the embryo implants in the fallopian tube instead of the uterus) can also cause spotting.
Spotting associated with vaginal dryness is caused by a change in oestrogen levels that can result in irritation of the vaginal wall, loss of elasticity and moisture. In young women, the most common causes of vaginal dryness are hormonal treatments or contraception, antidepressants, anticoagulants, reaction to alcohol, friction during sexual intercourse and childbirth.
Some women can be born with cervical ectropion or develop it through hormonal changes. Ectropion, once refereed to as an erosion, happens when glandular cells from inside of the cervical canal are present on the outer area of the cervix. Glandular cells bleed more easily than the squamous epithelial cell normally found in this area, leading to spotting. Cervical ectropion is not a harmful and when necessary, can be easily treated.
Inserting an object such as a tampon into the vagina or having sex when the vagina is not lubricated enough can cause some spotting. It can also be happen when your partner has a large or thick penis. Deep penetration can also cause cervical bleeding and spotting.
Stress causes the release of a hormone called cortisol which can decrease the production of oestrogen and progesterone, creating an hormonal imbalance. This is why extreme stress can often change your cycle and cause spotting between periods.
Uterine fibroids (also called myomas or leiomyomas) are non-cancerous growths in the womb. The size of a fibroid can vary between very small and large, although many women do not show any symptoms. For women who do have symptoms, these can include heavy periods, spotting between periods, pelvic pressure and pain, having to pee often and constipation.
Uterine or endometrial polyps
Polyps are caused by an overgrowth of cells in the lining of the uterus and are usually non-cancerous. Polyps are usually associated with menopause but can also be found in younger women and are sometimes linked with fibroids. Polyps can cause irregular periods and spotting between periods.
Inflammation and infection
Certain sexually transmitted diseases (STDs) like chlamydia and gonorrhoea can cause spotting between periods. If left untreated, STDs can lead to pelvic inflammatory disease that can cause spotting, vagina discharge and pain in the lower abdomen. STDs can also cause inflammation or infection of the cervix (cervicitis), which again can cause spotting.
More serious causes for spotting periods include cervical, endometrial and ovarian cancers. In addition to spotting, these types of cancer have symptoms that include fatigue, bloating, abdominal swelling and pain, nausea, indigestion, change in bowel movement, urinary problems, heavy vaginal bleeding and discharges.
When should I be worried about my spotting?
In most cases, if you did something different with your contraception, are stressed or may have had a vaginal injury, there is nothing to worry about.
Tracking your menstrual cycle and your body’s reaction to the different stages of the cycle is one of the best ways to figure out if something unusual may be going on. However, if you think that you may be pregnant, have a miscarriage, an STD or cancer then it is time to book an appointment with your GP.