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Spotting Before Periods- Causes, Risk Factors, and Treatment

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Light vaginal bleeding that happens outside of the usual period is known as spotting. Read this article to learn the underlying causes and management.

Medically reviewed by

Dr. Sunita Kothari

Published At August 18, 2022
Reviewed AtMarch 2, 2023

What Is Spotting and How Does It Differ From Periods?

A woman undergoes a complex set of hormonal changes every month during a menstrual cycle, lasting from three to seven days. Any light atypical vaginal bleeding other than a period is known as spotting. Spotting can occasionally mimic an extremely light period and vice versa. The duration and volume of bleeding can help a person decide whether it is menstruation or spotting. A period usually lasts four days or longer, whereas spotting lasts only one or two days. Spotting blood is generally dark red or brown, while menstrual blood is usually red.

What Are the Causes for Spotting Before Periods?

Depending on the severity and involved risk, spotting before periods can be classified as follows-

1. Low-Risk Factors-

  • First Menstruation- Many girls can experience off-schedule menstrual periods or spotting. This is completely natural and is usually caused by a hormonal miscalculation that causes the uterine lining to shed at the incorrect time of the month. This essentially means that the body is attempting to comprehend this new "feature" and work out all of the complexities of the reproductive system and "becoming a woman."

  • Contraceptive Pills- Spotting is a frequent and expected adverse effect of discontinuing or switching birth control pills. Spotting is a common adverse effect of hormonal birth control or progesterone treatments. The decline in hormone levels is frequently the cause of spotting. Spotting can also occur due to birth control devices like an intrauterine device (IUD).

  • Emergency Contraception- Light spotting can be caused by emergency contraception, also known as the morning-after pill. The hormones in the drug (either progestin or progestin coupled with estrogen) can cause women to bleed other than their menstrual cycle.

  • Implantation Spotting- When a fertilized egg attaches itself to the interior wall of the uterus, it causes implantation spotting or implantation bleeding. Tiny blood vessels can erupt when the embryo implants in the uterus, causing the pregnant mother to notice a pink or brown discharge.

  • Ovulation Spotting- Ovulation spotting is common in some women and should not be taken seriously. Spotting between periods can appear a day or two after ovulation.

  • Perimenopausal- During this transition period, the periods may become more irregular and heavier, and the woman may experience spotting a week before her period.

  • Vaginal Dryness- Spotting is commonly caused by vaginal dryness or vaginal atrophy. It happens when the vaginal tissue becomes inflamed and no longer moist and elastic, owing to a shift in estrogen levels. Vaginal dryness can be caused by childbirth, friction during sexual intercourse, hormone treatments, contraception, medications like antidepressants, and reactions to substances like alcohol.

  • Stress- During stress, the body produces more cortisol, which leads the body to produce less estrogen and progesterone. This hormonal imbalance might disrupt the menstrual cycle, causing irregular or late periods and spotting in between.

  • Low Estrogen Level- Spotting can also be caused by a drop in estrogen levels, which normally occurs before ovulation. This sort of spotting is usually brownish vaginal discharge, and it develops when the amount of estrogen stimulating the endometrium decreases.

  • Delayed Ovulation- One-sided lower abdomen pain associated with late ovulation in the middle of the menstrual cycle is known as Mittelschmerz. Mittelschmerz can induce spotting or minor vaginal bleeding.

  • Delayed or Partial Periods- During a delayed or partial period, the monthly flushing does not complete, and a small quantity of lining is left behind. The uterine lining can stay in the uterus for up to a month. This residual tissue eventually expels out as a brownish or reddish spotting.

  • Vaginal Injury- Spotting can occur when something is inserted into the vaginal canal, causing a vaginal injury. If the vagina is not lubricated adequately during sexual intercourse, deep penetration during sex or inserting a tampon too quickly or too violently can cause spotting. Sexual assault can be a reason too.

  • Urethral Prolapse- Urethral prolapse can irritate the vaginal area, resulting in spotting or small quantities of blood.

2. Medium-Risk Factors-

  • Pregnancy- Due to the various hormonal changes, spotting is common throughout the first few months of pregnancy.

  • Low Thyroid Levels- One of the most common causes of vaginal spotting before the period is hormonal abnormalities. Hypothyroidism can cause changes and abnormalities in the metabolism, body temperature perception, and menstruation, but it is rarely life-threatening.

  • Postpartum Spotting- For the first few weeks after childbirth, pregnancy loss, or induced abortion, light spotting to heavy bleeding might occur. This occurs because the uterus has not collapsed back to its pre-pregnancy size or because of the residual fetal tissue present in the uterus.

  • Medication- Drugs like anticoagulants, Phenothiazides, corticosteroids, or Tricyclic antidepressants can cause spotting.

  • Cervical Erosion- Cervical erosion occurs when glandular cells from inside the cervical canal appear on the outer surface of your cervix. Cervical erosion causes no difficulties for the majority of women. However, it may cause spotting in a few women.

  • Miscarriage or Abortion- Women who miscarry frequently have spotting right before their miscarriage. A miscarriage or abortion occurs when a pregnancy is terminated before the mother has been pregnant for 20 weeks.

  • Polycystic Ovary Syndrome (PCOS)- PCOS is a hormonal imbalance that prevents normal ovulation and results in irregular bleeding or spotting between cycles.

  • Cervicitis- Cervicitis is an irritation or inflammation of the cervix. Symptoms include vaginal discharge, itching, pain during sexual intercourse, and spotting.

  • Sexually Transmitted Disease (STD)- Chlamydia and gonorrhea are the most common types of STDs that cause spotting. Symptoms include yellow or smelly vaginal discharge, a burning sensation while urinating, pain during sex, and spotting between periods.

  • Ovarian Cyst- Ovarian cysts are tiny sacs filled with fluid that develop in the ovaries. Lower pelvic pain, spotting, and extreme discomfort might occur if an ovarian cyst ruptures.

  • Uterine Fibroids- Fibroids, also known as leiomyomas or myomas, are noncancerous uterine growths that can develop during the childbearing years. Heavy menstrual bleeding, spotting between periods, pelvic pressure or pain, frequent urination, and constipation indicate uterine fibroids in some women.

3. High-Risk Factors-

  • Polyps- Endometrial polyps, also known as uterine polyps, are noncancerous growths that extend into the uterine cavity and are attached to the inner wall of the uterus. Polyps can cause irregular menstrual flow, spotting before periods, vaginal bleeding after menopause, and infertility, among other symptoms.

  • Adenomyosis- In adenomyosis, endometrial tissue exists within and grows into the muscular walls of the uterus. It is usually a noncancerous development. An enlarged uterus can be uncomfortable, leading to missed periods, heavy periods, or spotting in between periods.

  • Pelvic Inflammatory Disease (PID)- Infections such as chlamydia and gonorrhea, use of intrauterine devices (IUDs), and douches are common causes of pelvic inflammatory disease (PID). Symptoms include lower abdominal pain, fever, vaginal discharge and odor, spotting between periods, bleeding during sex, and a burning sensation during urination.

  • Ectopic Pregnancy- Ectopic pregnancy is a condition in which the embryo develops and attaches outside the uterus. The initial indicators of an ectopic pregnancy include spotting and light vaginal bleeding, and pain in the pelvis and abdomen.

  • Malignant Cancer- Spotting can indicate the presence of malignancies such as endometrial, ovarian, and cervical cancers. Endometrial cancer is the most frequent and treatable of all gynecological cancers.

What Is the Treatment for Spotting Before Periods?

The treatment depends on the underlying cause. However, if the accompanying symptoms are severe, it is recommended to visit a doctor.

Conclusion

The cause of spotting before a period is not always evident. It can, however, be an early symptom of pregnancy in some cases. In addition, hormonal shifts, beginning a birth control pill, or perimenopause can cause spotting. Although spotting is rarely a cause for concern, it should be discussed with a doctor if it persists or happens in conjunction with other symptoms such as pain, irritation, or unusual discharge.

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Dr. Sunita Kothari
Dr. Sunita Kothari

Obstetrics and Gynecology

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