Spotting, what causes it?

What is spotting?

Spotting (or intermenstrual bleeding if we’re using jargon) is bleeding from the vagina that occurs in between menstruations. It’s a pesky thing, since it happens unexpectedly and always occurs when the timing is wrong. Should you be worried if you suffer from this?

There usually isn’t a reason to panic if you have a bit of spotting now and again. But if it happens more often or even frequently, it is smart to find the cause of this intermenstrual bleeding. We’ve listed a few of the most common causes for you here.

The most common causes of spotting

Spotting when using the pill

Intermenstrual bleeding when using the pill is often a so-called ‘breakthrough bleeding’. This means bleeding outside of the pill-free week. For the first three to four months of you using the contraceptive pill, you might have some bleeding in between the withdrawal bleedings. You usually lose much less blood in these breakthrough bleedings than you would in a regular period, which is why it is also called ‘spotting’. You usually have spotting since your body has to get used to the pill. But that isn’t the sole reason. Spotting can also happen more frequently if you don’t have a pill-free week, if there's too much progesterone or too little estrogen in your pill, or if you’re switching which pill you use.

Spotting when using an IUD

Just like with the pill, the IUD can cause you to have these bleedings for the first few months. Your body has to adjust to the IUD, and this can take up to six months! For some types of IUDs, intermenstrual bleeding occurs more often than for others. That’s because they don’t contain as many hormones. The copper coil IUD will often make you have a heavier blood loss for the first few months. That should adjust back to normal after a few months.

Spotting during ovulation

If you’re not on the pill, it might also mean that you’re ovulating - one of your ovaries is releasing an ovum - or that an ovum is settling into your endometrium. Sometimes the ovulation comes paired with spotting and belly pain. That doesn’t necessarily have to be a serious problem, but if it happens every month there is reason to discuss it with your GP.

Intermenstrual bleeding during perimenopause

During the perimenopause, the cycle becomes more irregular due to the hormonal fluctuations. This means that you’ll often be surprised by bleedings, and that these - if you’re unlucky - can be much heavier and longer than they used to be. By the way, this won’t happen to everyone. There is a group of lucky few whose menstruation suddenly stops without or with only a few further complaints. If you suffer from heavy menstrual blood loss or intermenstrual bleeding with clots then it’s a good idea to contact your GP about this.

Intermenstrual bleeding due to an abnormality or inflammation of the cervix

Sometimes, an inflammation of the cervix or an abnormality of the cervix or uterine cavity can cause blood loss. An inflammation of the cervix (cervicitis) can develop as a result of a sexually transmitted disease, though this isn’t always the case. Sometimes it is due to an allergy to condoms, for example, or as a result of the chemicals in tampons or swimming pools, for example. An abnormality of the uterus can be a polyp or a fibroid. These can cause bleeding.

Blood loss during or after sex

Blood loss during or after sex is not the same as a breakthrough bleeding, it’s actually something called a contact bleeding. A contact bleeding is often caused by different things than a breakthrough bleeding is. It could be a sign of an infection/STD, and in the worst case it could be a sign of early-stage cervical or vaginal cancer. In any case, it is important to participate in the population screening and to have smear tests made from the age of 30 onwards. If you regularly suffer from these contact bleedings, do not wait until you’re 30 or until you are called up again to participate in the population survey. Go to the doctor and have a pap smear done.

Photocredits: Berlin_Boudoir