IF you menstruate, chances are you’ve experienced some light bleeding between your periods at some point or other. This is often referred to as ‘spotting’ — but what does it really mean and should you be concerned about it?
Spotting, also called ‘inter-menstrual bleeding’ (IMB), is basically light vaginal bleeding that happens outside of your regular periods. As gynaecologist Dr Anne Henderson (gynae-expert.co.uk) explains: “Inter-menstrual bleeding or spotting is a common phenomenon and most women will experience this at some point during their reproductive lives.”
It can appear as spots of blood by itself, of may present within your discharge. This might be reddish, or tinged with shades of brown.
“The presence of blood in vaginal discharge often produces a metallic odour, which is sometimes described as coppery. This can occur around the time of a period or due to bleeding at other times, for example IMB around ovulation.”
A number of things can play a part. For instance, if you’re on the pill or regularly miss your pill, you might notice it more. It may also be a sign of an infection.
“The causes will depend on whether a woman is taking a hormonal contraceptive, such as the combined or progesterone-only pill, as hormonal contraceptives are more likely to be associated with IMB due to the effect they have on the endometrium (womb lining),” says Henderson.
“Certain types of infection, particularly STIs and thrush, can also be associated with spotting due to the localised inflammation they cause in the genital tract, including the vagina,” she adds.
Spotting can occur any time in the menstrual cycle, however it can be more common mid-cycle and just before your period.
“Women who are not using hormonal contraceptives tend to experience IMB around mid-cycle, as some of the endometrium can be shed spontaneously at this stage in the cycle,” Henderson says.
“Another common time for women to experience IMB is just before a period starts, when the endometrium can be released earlier than expected.”
Henderson says avoid over-washing right before your period however, as this can increase the risk of thrush and BV. “Before you period, your vaginal pH tends to rise slightly, reducing the acidity,” she explains.
“It is usually this, combined with other behaviours, which raise your risk [of infections]. For example, if you use aggressive washing agents and perfumed vaginal washes, this will alter the pH balance within your vagina, and this affect combined with your menstrual cycle can cause thrush and BV.
“Treating BV is extremely easy, and is all about rebalancing the pH within your vagina.”
In most cases, spotting is harmless and there’s no cause for concern. However, it can also be associated with a range of underlying conditions, some of which can be serious – so it’s always advisable to see a doctor as soon as possible if you experience any new or worsening changes.
Other possible underlying causes can include uterine fibroids, polyps, endometriosis and polycystic ovary syndrome (PCOS) – although it’s unlikely spotting would be the only symptom. Your doctor can put your mind at rest, and arrange any further tests and investigations if necessary.
“If brown discharge occurs regularly throughout the cycle, it could be a sign of uterine or cervical cancer and should be checked out by a health specialist immediately,” says Henderson.
When spotting is a sign of something more serious, often there will be other symptoms too, such as pain and bloating.
“Spotting just before your period can be an indication of endometriosis, but this is usually associated with pelvic pain too. You might have a polyp, a small cell lump, on the womb or on the cervix – both of which are treatable,” says Tania Adib, consultant gynaecologist for Callaly (calla.ly).
It can sometimes be associated with PCOS too.
“Vaginal signs of PCOS can include either increased or reduced vaginal discharge, a change to the colour of vaginal discharge – e.g. bloodstaining – as well as discomfort,” says Henderson.
Every person has a different ‘normal’, so it’s a good idea to be in tune with your own body and cycle, so you know what’s normal for you and can notice any patterns and changes.
Henderson also advises women to check their vulva on a regular basis, in the same way they’re advised to self-examine their breasts to check for any lumps, bumps or unusual changes: “You need to check for change in skin colour, anatomy and shape,” she says, reminding everyone to “seek specialist help from your GP” if you notice anything of concern.
In most cases, spotting is harmless... however it can also be associated with a range of underlying conditions.