What You Need to Know About Bleeding Between Periods

Know when to seek medical care

Bleeding or spotting between regular monthly periods can alarm you. When this happens, you may see just a spot or two of blood on your underwear or toilet tissue, or you may be bleeding as if you have started your period. While there are harmless reasons for this to happen, it can also point to more serious problems that need medical treatment.

What Is and Isn't Spotting

It's common for people to refer to any bleeding outside of a period as spotting. However, spotting, breakthrough bleeding, and other issues differ in the timing and amount of bleeding.

  • Spotting: This includes just a red tinge on the toilet paper or a drop or two in your underwear. Medically, it's considered spotting if it's outside of your period and doesn't generally require you to use a pad or tampon.
  • Light bleeding: This type of bleeding occurs just before or after your period and isn't technically spotting—it's considered part of your period.
  • Breakthrough bleeding: Mid-cycle bleeding is heavier than spotting.

Breakthrough Bleeding

Bleeding separate from your period that's heavy enough to require feminine products is called breakthrough bleeding.

  • Breakthrough bleeding is defined as mid-cycle bleeding if you are taking oral contraceptives, and it's usually caused by estrogen levels too low to suppress the natural menstrual cycle.
  • If heavy bleeding outside of your cycle isn't tied to oral birth control pills, it is defined as abnormal uterine bleeding or abnormal vaginal bleeding.

Normal Menstrual Bleeding

Normal menstrual bleeding lasts for about five to seven days. While menstruation usually occurs an average of every 28 days, between 21 to 35 days between periods is considered normal.

Most females get to know their own cycles after a few years of menstruating. Although it may seem like you are losing a lot of blood, it usually only measures between two and eight tablespoons.

About 14 days after the start of your period, you ovulate and release an egg from the ovary.

  • Some people notice spotting during ovulation, which can be normal, but should be discussed with your healthcare provider.
  • If no fertilized egg implants, the uterine lining is shed during menstrual bleeding approximately two weeks after ovulation. 

Causes of Spotting

Although the reasons for irregular bleeding can vary according to individual health situations, pregnancy, birth control, and infection are some of the more common causes.

Causes of irregular menstrual bleeding

Verywell / Jessica Olah

Pregnancy

Several possible causes are related to pregnancy:

  • Implantation bleeding: Spotting may occur at the time the fertilized egg implants in the uterus and begins to grow.
  • Miscarriage: You may or may not have known you were pregnant, and the bleeding may be a sign that the pregnancy has ended.
  • Ectopic pregnancy: This occurs when a fertilized egg implants outside of the uterus.
  • Abortion: Bleeding can occur after terminating a pregnancy using medication or a procedure.

Birth Control

You may see bleeding related to your birth control method:

  • Oral contraceptives: Starting, stopping, or missing oral contraceptives (birth control pills) can lead to spotting or bleeding.
  • Other hormonal birth control methods: Irregular vaginal bleeding might be seen when using the contraceptive patch, implant, or injection.
  • Intrauterine devices (IUDs): Intrauterine devices are known to cause occasional spotting.

Hormonal Conditions

Bleeding may be seen in conditions that affect your hormones:

Common Infections

There are several infectious diseases that may cause bleeding:

Bleeding Around Your Period

Light bleeding right before or after your period is not considered spotting but is just a normal part of your period.

Other Causes

Various possible causes include:

  • Endometriosis (abnormal growth of uterine tissue outside the uterus)
  • Injury to the vagina from the insertion of foreign objects or sexual trauma
  • Uterine fibroids (noncancerous growths in the uterus)
  • Malignant cancers, including cervical cancer, uterine cancer, uterine sarcoma, ovarian cancer, and vaginal cancer
  • Certain drugs, particularly anticoagulants and tamoxifen
  • Certain gynecological procedures
  • Urethral prolapse or polyps

When to See a Healthcare Provider

Use your menstrual cycle calendar to record the number of tampons or pads you use. This information can help your healthcare provider determine whether or not you are bleeding excessively.

Any unexplained vaginal bleeding between periods is a reason to call your healthcare provider. While it needs to be reported at any age, it is especially a concern for people who haven't yet gone through puberty and for females who are past menopause. 

If you are pregnant and you have spotting or bleeding, you need to see your healthcare provider.

You should seek immediate medical care if the bleeding is heavy, or if it is accompanied by pain, fever, dizziness, chills, nausea, or vomiting.

Diagnosis

You should expect to give your full medical history when you visit your healthcare provider for a diagnosis of bleeding or spotting between periods. If you've kept a menstrual cycle calendar, it will help.

Your provider may ask:

  • How long have you experienced bleeding between periods?
  • Does it happen every month or is this the first time?
  • At what point during your menstrual cycle did the bleeding begin and how long did it last?
  • Do you experience menstrual cramps when bleeding between periods occurs?
  • Does anything make the bleeding worse or better?
  • Is the bleeding worse with increased physical activity?

If you are pregnant or recently had a miscarriage or abortion, it is important to let your healthcare provider know. The same applies if you have experienced any injury or undergone any intrauterine medical or surgical procedure.

If you’re visiting a healthcare provider for the first time, they’ll want to know how old you were when you first started having periods, whether you’re sexually active, and what birth control method you may be using.

Remember to inform your healthcare provider about any prescription or over-the-counter medications (including herbal supplements) that you are taking.

You might have a pelvic exam, including a Pap smear if you haven't had one recently. Additional tests, such as blood tests or imaging tests might be needed as well.

Treatment

The treatment for your vaginal or uterine bleeding will depend on your diagnosis.

Frequently Asked Questions

What is the most common cause of bleeding between periods?

The most common cause of bleeding between periods is hormonal and can include the use of hormonal contraceptives or the process of going through menopause.

Who is most likely to experience breakthrough bleeding on hormonal contraceptives?

Women who smoke or skip birth control pill doses are more likely to experience breakthrough bleeding than non-smokers or those who adhere to the prescribed hormonal contraceptive schedule.

Should I be concerned if bleeding between periods is accompanied by other symptoms?

If you experience fever, dizziness, bruising, or pain while bleeding between periods, you should contact your healthcare provider.

A Word From Verywell

You are right to be concerned about abnormal vaginal bleeding, and you should discuss it with your healthcare provider. While it may have a cause that is only a minor concern, it can also be a sign of a condition that needs attention, including pregnancy or miscarriage.

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Article Sources
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