Spotting - a map (with legend) of your body

Not all spotting should be a cause for concern – but how can you tell the difference between a potential threat and a temporary and harmless imbalance?

We have prepared a compendium of knowledge about spotting for you. We know perfectly well how easy it is to get lost in all the intricacies of the body's functioning and sometimes miss the signs it gives us. You can count on us - but remember that in the case of spotting that worries you, a substantive consultation and a meeting with a doctor may be necessary, who after a preliminary analysis of your symptoms will perform professional diagnostics and decide on further action - if such is necessary.

What is spotting?

At the very beginning, it is worth briefly discussing the issue of terminology itself - even the most experienced observers may have problems with identifying mucus and other types of secretions from the genital tract.

Spotting is usually a scanty and irregular vaginal discharge. It is brown or dark brown in color (due to the small amount of blood it contains) and lasts for several days (but it can also be scanty, intense, and red – for example, after intercourse, in the case of uterine ectopia). Spotting can occur at any time – in the middle of the cycle, before menstruation, after menstrual bleeding, as well as during pregnancy or in the postmenopausal period. Its causes are difficult to determine unequivocally – spotting is caused by many different factors, which we will try to explain to you in a systematic way.

Spotting before period

Period Eve is just around the corner, and a few days before it you notice small stains on your underwear…

Spotting before your period is often due to natural processes occurring in your body that prepare it for the start of menstrual bleeding.

• Pink spotting before a period may be a consequence of damage to the blood vessels in the vaginal wall. Just before menstrual bleeding, the congestion of the genitals increases, which causes the vaginal tissues to swell and become more susceptible to micro-injuries (e.g. caused during intercourse).
• Brown spotting before your period may indicate luteal insufficiency . This term refers to a decrease in progesterone levels that occurs when the corpus luteum responsible for its production is inefficient. Low levels of this hormone in the luteal phase of the menstrual cycle may result from, among other things, hypothyroidism or dysfunction of the hypothalamus, which is one of the centers of the system regulating hormone levels in the body.

In addition, spotting before a period can be caused by infections or injuries that are rampant in the reproductive tract. It is often observed by people with the so-called strawberry cervix , which is the result of infection with a parasite: Trichomonas vaginalis . This disease owes its charming name to pinpoint petechiae of the uterine epithelium and the vagina, which in their appearance somewhat resemble a strawberry fruit. Trichomoniasis, in turn, is a sexually transmitted disease that requires pharmacotherapy prescribed by a doctor.

Spotting before a period can be one of the symptoms of endometriosis . It is an extremely complex disease entity, which is most often accompanied by long, heavy menstrual bleeding and intense pain (also during physiological functions or intercourse). The symptoms associated with endometriosis are caused by the presence of cells of the uterine lining outside its cavity, which causes local inflammation. Spotting from the genital tract in endometriosis can be the result of its occurrence in the scar after an incision/rupture of the perineum or on the cervix - however, this happens rarely.

Spotting after period

You've dealt with your menstrual bleeding, but stains still appear on your underwear...

Spotting lasting a few days after your period is most often the result of hormonal fluctuations and a drop in estradiol levels in the body.

Other causes of spotting after your period may vary:

• discontinuing hormonal contraception – especially after long-term use; this may cause temporary cycle disturbances that result in spotting; it usually disappears when the body gets used to the change in sex hormone levels;
• ovarian cyst (occurring, among other things, as a result of hormonal disorders or endometriosis);
• endometrial polyp .

Spotting and benign neoplastic lesions

Sometimes spotting is a symptom associated with benign changes in the reproductive organs .

They are often responsible for brown spotting instead of a period (or for longer, heavier menstrual bleeding). If the changes are too small, they only need to be observed; if they are larger, your doctor may suggest removing them.

Brown vaginal discharge may be caused by the presence of:

• cervical polyps,
• endometrial polyps,
• uterine fibroids.

A word about prolonged/heavy periods – it is worth remembering that they can also be caused by the aforementioned benign uterine cancers, as well as endometriosis or adenomyosis . Do not delay testing if you have noticed any deviations from your menstrual norm.

Spotting instead of period

What does spotting that appears instead of your expected period mean? What could be its causes?

Spotting is often confused with scanty periods . People whose previous menstrual bleeding was rather heavy may be particularly dismayed. We write about the causes of such a condition and its characteristics here .

Light spotting instead of a period may be due to:

• strong reaction to stress,
• weakening of the body (for example due to infection),
• sudden weight loss (due to a drastic diet, increased physical activity).

Spotting instead of a period during your period may be a sign of pregnancy.

Brown spotting instead of period

Implantation bleeding is often confused with menstrual bleeding because it most often occurs around the time of the expected period.

Just before ovulation, the uterine lining is very congested. Implantation of the embryo may therefore cause damage to its blood vessels. As a result, there is slight spotting, which usually lasts shorter than menstrual bleeding (from a few hours to a few days, counting from the moment of embryo implantation). What's more, in most cases it is not accompanied by other menstrual symptoms (mood swings, severe abdominal pain, etc.).

Spotting between periods

There's still a lot of time until my period is due, and out of the blue - unexpected spotting. What's going on?

For many people, menstruation is a permanent, monthly part of the program (read more about the menstrual cycle itself here ). As a result of many, seemingly trivial situations, such as a minor cold or stress, the balance can be disturbed and the entire carefully planned cycle becomes unregulated.

Light bleeding mid-cycle most often indicatesovulation .

Ovulation spotting

During ovulation (the day when the Graafian follicle bursts, releasing the mature egg), there may be light bleeding lasting up to 4 days.

Other causes of intermenstrual spotting include:

• use of hormonal contraception ,
• sexually transmitted diseases,
• endometrial polyps (mentioned many times in this text – remember that they are responsible not only for spotting between periods, but also for heavy periods!) and uterine fibroids,
• pregnancy (ovulation, implantation spotting, ectopic pregnancy),
• hormonal fluctuations.

Do you know the difference between withdrawal bleeding and menstruation ? Read our article.

Spotting during pregnancy

What does spotting during pregnancy mean?

Unusual spotting during pregnancy can be extremely stressful for expectant parents. Due to the specificity and uniqueness of this condition, any abnormalities should always be consulted with a gynecologist.

Spotting in early pregnancy may be a symptom of miscarriage (especially if accompanied by lower abdominal pain), while in the second half of pregnancy it increases the risk of premature birth.

Spotting during pregnancy is usually related to the previously mentioned implantation of the embryo. Another issue is the formation of a hematoma within the trophoblast (fetal membranes), but in most cases it does not affect the development of the fetus and is absorbed. In the case of glandular ectropion of the cervix, spotting may occur after sexual intercourse.

Other potential causes of spotting during pregnancy

Light red or brown spotting during pregnancy may be a sign of an ectopic pregnancy . This is when the embryo implants somewhere else instead of in the uterine body (usually the fallopian tube, or more precisely, its ampulla).

In addition to spotting, symptoms of an ectopic pregnancy include:

• cessation of menstruation,
• lower abdominal pain,
• positive betaHCG.

The diagnosis of an ectopic pregnancy does not always determine the need to remove the embryo located in the wrong place - pharmacological treatment (methotrexate) and spontaneous absorption of the embryo after its death are also possible.

Spotting after intercourse

Right after having sex you notice traces of blood on your bedsheets or underwear – what could that mean?

In some people, spotting appears after the first sexual intercourse due to the violation of the hymen (formerly: the hymen ). However, this is an individual matter, depending on the individual's structure. In most people, the hymen barely covers the entrance to the vagina - then its stretching does not cause any specific symptoms.

Spotting that occurs after sexual intercourse is called contact bleeding .

There can be many causes of vaginal spotting after intercourse:

• mechanical abrasions caused during intense penetration – may occur in people who lead regular sexual lives;
• benign hyperplastic changes of the uterus (glandular ectropion of the cervix, cervical polyps, true erosion – very rare!);
• cancers of the reproductive tract.

Spotting and intimate infections

Spotting during an infection may result from the infection itself (which causes damage to the mucous membrane) or from its unpleasant symptoms – for example, itching or burning, which are caused by scratching and rubbing the itchy areas, which results in mechanical damage.

Spotting and birth control pills

Taking hormonal contraception and possible spotting – what do you need to know?

People taking oral hormone therapy very often experience spotting or light bleeding in the middle of their cycle during the first few months of taking it. If this happens for more than the first 4 months – your doctor will usually prescribe an alternative medication.

Spotting may also occur if you miss a dose and this results in a sudden drop in sex hormone levels.

If you want to know how pills affect your menstrual cycle, read our dedicated article: birth control pills and your period .

Postmenopausal spotting

You've gotten used to the "charms" of menopause, when suddenly you notice strange and disturbing spotting.

Menopause is the last menstrual period in the life of menstruating people, after which, in the next 12 months, excluding any diseases or illnesses, menstrual bleeding does not recur. During the postmenopausal period , many hormonal changes occur, leading to the gradual loss of ovarian function and cessation of ovulation.

Postmenopausal bleeding is the most common symptom of endometrial cancer – therefore, in the event of its occurrence, a substantive consultation with a doctor and the implementation of diagnostic tests are always necessary!

Other causes of postmenopausal spotting include:

• atrophy of the uterine and vaginal mucosa,
• endometrial polyps, uterine fibroids,
• diseases outside the reproductive system (blood clotting disorders, hematological diseases).

We hope that our spotting vade mecum will help you more easily identify any irregularities in your cycle. Remember: if they occur, do not delay seeing a doctor.