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Spotting in the Menstrual Cycle: Assessing the Health Risks Associated with Unexpected Vaginal Bleeding

© Lori Ramsey

Spotting occurs when a small amount of blood passes through the vagina between periods. Normally it doesn’t reach the underwear, but is swiped with toilet paper after a bowel movement or urination. The spots can be pink-tinged mucus, rust brown, or bright red.

Spotting can happen once, or it can last for several hours or even several days. Spotting does NOT define the first day of menstruation, which begins on the first day of full bleeding generally every 28 days.

Normal Spotting Following Your Period

Normal spotting may occur following your period. A day or two of spotting after 3 to 5 days of menstruation is normal.

Spotting in the middle of your cycle, or ten to fourteen days prior to the start of the next cycle, is normal too. This spotting may occur during ovulation. Mid-cycle spotting may occur for several reasons. When the egg bursts through the follicle, some bleeding may occur. Alternatively, during ovulation, levels of estrogen rise,  sometimes prompting the uterus to shed a bit of lining, which shows up as spotting.

Spotting that occurs about a week before the cycle is due, and lasts for less than one day, could be implantation spotting, which happens when a fertilized egg burrows into the uterine lining.

Another cause of implantation spotting may be the slight rise in estrogen and drop in progesterone before the corpus luteum takes over the production of progesterone. This happens when the implanted fertilized egg signals the body that pregnancy has occurred and that the lining must be maintained. However, spotting that continues for days is not implantation spotting.

Abnormal or Prolonged Spotting

Abnormal spotting is long-lasting, and happens at times other than those mentioned above. One common cause of spotting several days before a period is low progesterone. Progesterone helps to maintain the uterine lining for pregnancy, and when progesterone levels drop, the menstrual cycle occurs. Progesterone-deficient women will see spotting several days to a week before their period is due. This can affect fertility and in some cases causes miscarriage.

Uterine fibroids can also cause abnormal spotting. They are often harmless, but should be monitored. Other potential causes are endometriosis and birth control pills. The most dangerous causes of spotting are sexually transmitted diseases and cancer.

If you have recurrent spotting, see your health care provider. He/she can help pinpoint the cause and advise you on how to remedy it.