According to The Society of Obstetricians and Gynecologists of Canada, nearly every woman will experience spotting at some point in her life. But how do you know if your spotting is cause for concern—and how to stop it?
Many things can cause spotting, says Dr. Dustin Costescu, an obstetrician and gynecologist at Hamilton Health Sciences and assistant professor in family planning at McMaster University in Hamilton, Ont. In medical terms, he says, spotting is defined as “bleeding that does not require sanitary protection.” But spotting can take on different forms. “The first and obvious one is spots of blood with wiping or noticed on sanitary protection or underwear,” says Costescu. “Sometimes spotting results in brown discharge (think old blood plus normal mucus production), which can be confused for infection, but is usually not associated with any odour or other symptoms.”
Below, Costescu shares the possible reasons you’re spotting, and what’s so “normal” about it.
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The gynecologist says: “Hormonal IUDs, like Mirena, Jaydess, or the newest product in Canada called Kyleena (a low-dose hormonal IUD that can be used for five years) control bleeding in part by thinning the lining of the uterus. Progestins keep the lining of the uterus from growing out of control — but it can do too good a job, so the lining is a bit unstable and sheds. This can translate to a period that is so light it is perceived as spotting. Tracking your cycle will help. For some women, particularly those who have heavy flow prior to an IUD, they will experience irregular spotting instead of the heavy period, or spotting with lighter flow. Women should weigh the pros and cons of spotting against what periods were like before – especially if they were heavy or painful.”
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The gynecologist says: “Women who spot after intercourse or intense exercise may do so simply because the friction of the cervix is causing some irritation. Women who are taking up new rigorous exercise routines and who lose weight rapidly may also experience spotting owing to changes in hormones. Burning fat cells and weight loss can release estrogens into the body. And, because fat cells help produce some sex hormones, sustained weight loss can cause a lower level of estrogen in the body. If a woman loses too much weight, her periods may stop and spotting may result. If that’s the case, you should visit your doctor.”
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The gynecologist says: “Stress plays a complex role in spotting and cycle changes. Likely the increase in cortisol affects the body’s signaling system and the change in hormones causes spotting to occur.”
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The gynecologist says: “If you have significant or bothersome spotting, a trip to the doctor is warranted. Polyps are small growths on the cervix that can bleed on contact. They are benign but can be removed if bothersome. Ectropion is a normal condition where the glandular cells – the ones that look like the lining of the uterus – are prominent on the cervix. This can bleed easily if poked. In some [medical] centres, liquid nitrogen can be used to freeze the ectropion to prevent further bleeding.”
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The gynecologist says: “Spotting can be a sign that hormone levels are off, but in most cases. It is normal for a small amount of spotting around ovulation – two weeks before a period is due – related to hormone changes. Women who find spotting to be a nuisance can talk to their doctor about options. The most common option is to try a birth control pill, which is progestin-dominant and will help stabilize the lining. Numerous studies have looked at supplements that can help control [hormone-related] spotting. Unfortunately, while small studies show promise, most large scale studies do not show benefit for vitamin B supplementation, vitamin C or iron.”
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The gynecologist says: “In any case where a woman experiences spotting on the pill, an IUD, either copper or hormonal, such as a Mirena, Kyleena of Jaydess, is a reasonable next option.”
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The gynecologist says: “Some women may experience an ‘implantation bleed’ once a pregnancy has taken hold. Any irregular period or bleeding warrants a pregnancy test. Implantation bleeds are also a common culprit when a woman finds out she is further along in her pregnancy than expected—that bleed can be confused for a period.”
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The gynecologist says: “Menopause is a time of transition, which can start five to 10 years prior to periods stopping. Some women experience spotting because they aren’t releasing an egg each month, and so the body isn’t going to have a normal period. Other women, as their hormone levels drop, may experience very light flow or spotting, as the lining of the uterus becomes dormant. In a healthy young woman, spotting is not a warning sign of menopause.”
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“If spotting is rare, and there are no red flags, then a visit to the doctor is probably not necessary,” says Costescu. “The occasional irregular period or episode of spotting is normal — nut there are a few conditions associated with spotting that your doctor will want to rule out if you go.”
His advice? Look for patterns — when it happens and at what point in the cycle it occurs. Make note if you changed sexual partners, are taking new medication, or anything else in your lifestyle that is different and might affect what’s going on down there.
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