Illustration by Emma Günther
What is spotting? Common causes and how to track it
How does spotting differ from other types of bleeding during your cycle?
Top things to know:
Spotting is any bloody vaginal discharge that doesn’t require the use of period products, like a pad or tampon (1).
Any unexplained spotting should be addressed with your healthcare provider (2).
Spotting can be a side effect of your hormonal contraceptive (3,4).
If you’re pregnant and spotting or bleeding, you should contact your healthcare provider (5).
What is spotting?
Researchers and healthcare providers define spotting as any bloody vaginal discharge that is not of a large enough volume to require sanitary protection (i.e. you don’t need to use a pad or a tampon) (1).
However, this definition can be confusing. Some people may choose to use panty liners when spotting. However, if you soak a panty liner, or need to use a pad or a tampon, then that likely isn’t spotting (1). In theory, spotting can happen at any time during your cycle, so around your period or between periods.
There are many different reasons why you could be spotting, from hormonal birth control to PCOS. It is thought that spotting a few days before your period starts, in the late luteal phase, may indicate higher levels of a form of progesterone, but more research is needed (6). Read on to find out what your spotting could mean.
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How does spotting differ from light period bleeding?
You can differentiate spotting from menstrual bleeding by examining the amount of blood (1). Spotting refers to a very small amount of bloody vaginal discharge that you may see as a few drops of blood on your underwear or toilet paper (7).
Light bleeding, on the other hand, is a slightly heavier form of bleeding than spotting. You may need to use menstrual products, like a tampon, pad, or a higher absorbency panty liner (8).
Generally, if you have light bleeding at the beginning of your period, you can consider that part of your period, not spotting (9). However, if it’s very, very light—you only see a little on your toilet paper—that would be considered spotting (7).
For example, if you have spotting on Sunday, no bleeding on Monday, and bleed enough to require a tampon on Tuesday, you should consider Tuesday the start of your period.
Tracking tip: What if you initially logged spotting in the morning and then it turns into your period in the afternoon? No problem, you can always go back and change what you tracked in the Clue app. It’s important that the first day of your period is recorded correctly in order to provide more accurate predictions for your next cycle.
What is the difference between your period, spotting, and intermenstrual bleeding?
Menstrual bleeding is associated with the shedding of the endometrium at the beginning of the menstrual cycle (10). It typically occurs every 24–38 days and lasts up to eight days (11).
Spontaneous bleeding (typically lighter than a regular period) that happens between regular menstrual periods is called intermenstrual bleeding (9). If you experience intermenstrual bleeding, you should speak to your healthcare provider as this may be a sign of an underlying condition (12).
You can track intermenstrual bleeding with a custom tag in Clue. To create a custom tag, go to ‘Track’ and select ‘Tags’. Get Clue Plus to track an unlimited number of custom tags.
How can I track bleeding in the Clue app
If you track period bleeding and it’s been more than 10 days since you last tracked your period, that day will be counted as the first day of a new menstrual cycle.
When tracking your period in Clue, there are four tracking options: light, medium, heavy, and super heavy.
In Clue, there are two tracking options for spotting: red and brown.
Blood changes depending on how long it has been exposed to air, due to a process called oxidation (if you cut your finger you’ll notice the blood is bright red, but then it looks brown on the band-aid later—that same process can happen to menstrual blood as it moves out of your body) (13). Fresh blood often appears red, or pink if it’s mixed with other bodily fluids, while older blood tends to look brown, like uterine bleeding, which is commonly red or brown (14).
Clue users are more likely to track red spotting than brown spotting; around 3 out of 10 users track brown spotting, and around 4 out of 10 users track red spotting.
What are the common causes of spotting
Spotting can come from your upper reproductive tract (like your uterus) or your lower reproductive tract (like your vagina) (14,15), and can be cause by many different reasons:
Hormonal birth control
Spotting is a common side effect of hormonal contraception, especially during the first few months of starting a new method (16).
Pill
When you first start taking combined oral contraceptives, or birth control pills, you may experience spotting or breakthrough bleeding that goes away with time (16,17). Bleeding or spotting outside of your usual withdrawal bleed time can sometimes happen even if you take your birth control pills continuously (17).
Patch
Hormonal patches are effective as a contraceptive method but may cause spotting in between your regular withdrawal bleed (18). The longer you’re on the patch, the fewer spotting days you may have (18). Some people may stop spotting altogether with time (19).
IUD, implant, injection, mini-pill
Spotting and unpredictable bleeding are possible with the hormonal IUD, the contraceptive implant, the contraceptive shot (injection), and the mini-pill (a progestin-only pill), but it typically improves over time (18,20,21).
Pregnancy
Spotting is a common symptom in early pregnancy (5). About 1 in 4 people experience spotting in the first trimester (5). Spotting is usually nothing to worry about—research has shown that pregnant people who experience spotting are not more likely to have a miscarriage than people who don’t experience spotting (22). However, heavy bleeding during pregnancy may be more of a concern (5). If you’re pregnant and bleeding, call your healthcare provider to check in so they know what’s going on.
While many sources call spotting in early pregnancy “implantation bleeding,” there isn’t strong evidence that it’s associated with an embryo’s implantation in the uterus. It may actually be related to hormonal changes, as the production of progesterone switches from the ovary to the forming placenta (7).
Miscarriage
Bleeding accompanied by pain while pregnant may indicate a miscarriage (5). After an early pregnancy stops developing, the inner tissue of the uterus, along with any new tissue that has grown, usually sheds by itself via the vagina. By the time you notice the bleeding, the pregnancy has already ended and there is nothing you can do to “stop” the miscarriage (23). Light spotting, especially when it only lasts 1–2 days, is typically not associated with miscarriages (7,22).
Ectopic pregnancy
Spotting can be a symptom of an ectopic pregnancy (24). This is a pregnancy that is growing somewhere other than the uterus, usually the fallopian tube (24). Ectopic pregnancy bleeding may be coupled with other symptoms including abdominal pain on one side, shoulder pain, and/or dizziness (24). If you experience symptoms of spotting and suspect you may have an ectopic pregnancy, seek immediate medical help (24).
Physical conditions and issues
Spotting can also be caused by infections and physical changes in the reproductive tract, or hormonal imbalances (15).
Uterine or cervical polyps
Uterine polyps are typically non-cancerous growths within your uterus (25). Spotting is one of the most common symptoms of uterine polyps (25). Other symptoms of polyps include abdominal pain and difficulty becoming pregnant (25). Typically, any abnormal bleeding related to polyps improves after treatment (25).
STI’s
Sometimes, sexually transmitted infections (STIs) can cause spotting or bleeding (15). Most chlamydia infections have no symptoms, but some people may notice abnormal vaginal bleeding or discharge, pelvic pain, or painful urination (15). Similarly, gonorrhea can cause atypical vaginal bleeding and increased urination (15). Chlamydia and gonorrhea can both be treated with antibiotics from your healthcare provider (15).
Endometriosis
Endometriosis affects about 1 in 10 women of reproductive age (26). You may have endometriosis if you experience persistent pelvic pain, exceptionally painful periods, or painful intercourse (endometriosis). Spotting is another consistent symptom (27). For people with endometriosis, spotting is more common 2–3 days before their period starts (27).
Pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID) happens when certain pelvic infections (like STIs) spread upwards from the lower reproductive area (28). It can also be another cause of unscheduled bleeding (28). Other symptoms of PID can include pain in the lower abdomen, increased vaginal discharge, and fever (15). If you suspect you have spotting and other associated symptoms of PID or physical pelvic conditions, discuss this with a healthcare professional as soon as possible (28).
UTIs
Urinary tract infections (UTIs) can cause bleeding when you urinate (29). Urinary tract infections can be caused by infections somewhere in the urinary tract (29). Pain while urinating, paired with a small amount of blood on the toilet paper, might be signs of a UTI (29). Your healthcare provider can offer treatment for UTIs.
Fibroids
Fibroids are non-cancerous tumors within the uterus (30). They can cause changes to your bleeding pattern, including heavy menstruation and intermenstrual bleeding (30). Other symptoms of fibroids include abdominal pain and difficulty becoming pregnant (30). Your healthcare provider may be able to recommend a treatment option to manage your unexpected bleeding and uterine fibroids (30).
Penetrative sex
Bleeding after penetrative vaginal intercourse is not considered typical (31). Bleeding regularly after sex (postcoital bleeding) may be caused by an issue with the cervix, infection, or polyps (31). If you’re noticing spotting after sex, talk to your healthcare provider (31).
Trauma
Sometimes, trauma to the vagina can cause bleeding (31). This could be because of an abortion or pelvic exam, (32), after experiencing sexual assault (31), or when a foreign object is used to penetrate the vagina (33).
Cancer
Vaginal bleeding is a common symptom for people with endometrial cancer (34). With endometrial cancer, you may experience abdominal pains and changes to your bowel movements (35). If you notice bleeding when you urinate, it may rarely indicate bladder cancer (34). Report these symptoms to your doctor so that they can create an individualized treatment plan to manage your symptoms (34).
Ovulation
More research needs to be done to support the association between spotting and ovulation. Spotting can occur around the time of ovulation, however, it’s unclear why some people experience ovulation bleeding while others don’t—some research suggests it happens in people who have hormone levels that are higher (35).
Hormonal conditions and changes
In some instances, spotting can be a sign of a hormonal condition or change in your reproductive life stage. For example, very light and infrequent bleeding while not on hormonal birth control can be a sign of an ovulatory disorder (36).
PCOS
Polycystic ovary syndrome (PCOS) is a common disorder for people with cycles that causes atypical bleeding patterns. You may notice intermenstrual bleeding, irregular periods, or infrequent menstruation (11). Menstrual changes and infertility are the most common complaints for people with PCOS (36). Other symptoms include increased body hair, weight gain, and diabetes (36).
Thyroid disorders
People with hyperthyroidism, an overactive thyroid, or hypothyroidism, an underactive thyroid, can experience profound changes to their reproductive system (37). If you have hypothyroidism, you may experience heavy or long periods, frequent menstruation, weight gain, or hair loss (37, 38). If you have hyperthyroidism, you may notice heavier periods or weight loss (37,38).
Perimenopause
During perimenopause, your body is beginning to make the transition to menopause. On average, perimenopause begins in your 40s and can take about 4 to 8 years (39). While you’re going through perimenopause, you may notice changes to your normal bleeding pattern and your cycles may become longer or shorter (39). Vaginal dryness, difficulty falling asleep, and mood changes are additional symptoms of perimenopause (39).
The importance of tracking your spotting
You can use the Clue app to track your spotting. Tracking is important because it can help you determine the cause of spotting and if you should see a doctor.
Monitor how frequently you are spotting and see if it correlates with any other symptoms or activities (40). You can use data from the Clue app during your next appointment with your healthcare provider to advocate for yourself and feel confident in your menstrual experiences.
When to contact a doctor
Visit your doctor immediately if you notice any of the following symptoms alongside your bleeding or spotting:
Abdominal pain that is not typical for you (43)
Dizziness or fainting (43)
Painful defecation (43)
Weight changes (38)
Fatigue (38)
These symptoms may indicate an underlying condition that warrants medical intervention (43,38).
Now you know more about what spotting could mean
There are several different reasons you could be spotting. In some cases, spotting can indicate an underlying condition that warrants treatment. Sometimes, it may go away on its own (16).
The Clue app can help you track your spotting so that you can see it’s not in your head, it’s in your data. Data can empower you to learn more about your cycle and personal patterns. You can use this information at your next doctor’s appointment (40).
FAQ
Should I take a pregnancy test if I am spotting?
Spotting is a common symptom of early pregnancy (5), however, if you are spotting, this does not necessarily mean you are pregnant. There are several other reasons why you could be spotting (19,15). But if you had unprotected sex and you experience any of the following symptoms along with spotting, you should consider taking a test:
Nausea or vomiting (41)
Pelvic pain (41)
Back pain (41)
Weight gain (42)
Vaginal discharge (42)
Why am I spotting but have no period?
People with PCOS may have no periods, or their periods may be very unpredictable (11). Certain contraceptives, like the shot, can also cause spotting and halt periods (20). Lifestyle factors such as stress can also affect the heaviness and regularity of your bleeding.
Why have I had spotting?
Spotting can be caused by many things, from hormonal birth control (16) to thyroid conditions (37), cancer (34), endometriosis (27), perimenopause (39), or pregnancy (5). There are several different reasons for irregular bleeding. Your healthcare provider can help you determine the reason behind your spotting.
This article was originally published on October 5, 2017.
