Have you ever thought your period was over, only to see spots of blood in your underwear a few days later? If you didn’t pack a panty liner, you’re not alone.
Menstrual cycles usually last somewhere between 24 and 38 days, and a regular period can run anywhere from a few days to about a week. If you bleed between periods, however, it’s considered irregular, and referred to as either spotting or intermenstrual bleeding.
“Spotting can happen at any point in the cycle, but it’s not a steady flow,” says Ma Lourdes Mina, MD, an OBGYN from Coliseum Medical Centers in Macon, Georgia. Spotting can include pink blood on your toilet paper after sex or urination, or spots of blood in your underwear either before or after your period.
Although most reasons for spotting are benign, like switching birth control, others are more serious, and spotting along with certain other symptoms might point to an underlying condition. In general, if you notice spotting, it’s never a bad idea to go to the doctor. “Any bleeding that is concerning needs to be checked,” says Dr. Mina. Your OBGYN might point to one of these as the reason.
Birth control pills stop a woman’s egg from being released. If the egg is not released, the male sperm has nothing to fertilize, which prevents pregnancy. This happens because the pill contains hormones—usually estrogen and progestin—which stop you from producing the hormones that tell your body to ovulate.
“If you miss a pill, change birth controls in the middle of a pack or skip your placebo pills, you’re adjusting your body’s hormone levels,” says Mina. And that manipulation of hormones can cause spotting.
If you notice blood, and your menstrual cycle lasts longer than 38 days or is shorter than 24 days, it’s a good time to see your gynecologist. Always remember to tell your OBGYN if you take other medications, since certain drugs can interact with the pill to cause spotting.
Emergency contraception is a type of birth control that temporarily stops your ovary from releasing an egg, or prevents that egg from being fertilized. It is effective within five days of unprotected sex, and many pills work best when used within three days. If you choose to use it, be sure to check with a health professional about timing.
Mina says that it’s not uncommon to have spotting or bleeding like a period, or anything in between when using an emergency contraceptive. She says, “If your spotting lasts longer than a few days, or becomes heavier, you should speak with your gynecologist.”
When you do get your period afterward, it might come earlier or later than what you consider normal.
SEXUALLY TRANSMITTED DISEASES
Any sexually transmitted disease (STD) affecting the cervix can cause bleeding, especially after sex. Two common examples are chlamydia and gonorrhea. If you have painful urination or increased discharge along with your irregular bleeding, it’s important to see your gynecologist. Both STDs can be treated with antibiotics—so the sooner you see a doctor, the better off you’ll be.
If you’re sexually active, speak with your gynecologist about STD screening and a pap smear—especially because STDs can lead to infertility if left untreated.
One of the symptoms of both menopause and perimenopause is that a woman’s cycle becomes less predictable than it once was. In some cases, it could get shorter, going from 28 days to, say, 26 days. Some women might skip periods, or they may become heavier or lighter. Other symptoms can include night sweats and mood swings.
However, after menopause, it’s never normal for a woman to spot or bleed vaginally—so see a doctor if you start. Some common causes for bleeding after menopause include endometrial atrophy, which is when estrogen levels drop and cause the endometrium to thin, or endometrial hyperplasia, a condition causing the lining of the uterus to thicken. Treatment for post-menopausal bleeding will depend on the cause.
Fibroids are tumors that grow in the wall or inside the cavity of the uterus. They’re actually pretty common—especially amongst women in their 40s and early 50s. If the growth occurs within the innermost layer of the uterus (endometrium), then spotting between periods can result. Other symptoms might include heavy and painful periods, frequent urination and painful sex. Treatment will vary depending on where the fibroid is located, as well as symptoms and size, and might include over-the-counter medication for less severe symptoms.
Other uterine conditions like endometriosis and pelvic inflammatory disease may also cause spotting, though their most noticeable symptom is often pelvic pain. If you experience pain and spotting, talk to your gynecologist.
MISCARRIAGE OR PREGNANCY COMPLICATIONS
A miscarriage, or a loss of pregnancy, can happen at any time, but usually occurs in the first trimester, sometimes before a woman even realizes she’s pregnant. “When people who typically have regular, predictable periods miss a period or have less bleeding than normal, it can be a sign either of pregnancy or a miscarriage,” says Mina. Other symptoms of a miscarriage might include lightheadedness, pain in the abdomen, brown discharge or other irregular bleeding.
It’s important to note: if a woman knows she’s pregnant and experiences irregular bleeding, it doesn’t mean it’s a miscarriage. Spotting during pregnancy isn’t uncommon, and can happen at any time. However, if you’re pregnant and you’re spotting, call your doctor to discuss any symptoms.
Most cancers of the reproductive organs—including vaginal, cervical, uterine and ovarian cancer—can all have intermittent, abnormal bleeding as one of the symptoms. But Williams says that that irregular periods or a prolonged absence of a period can lead to cancer in a hyperestrogenic environment, so these situations should be evaluated regularly.
If you experience any symptoms lasting two weeks or longer, such as pelvic pain, bloating, frequent urination or itching/burning in the vulva, you should see your gynecologist. The symptoms for each gynecological cancer varies from person to person and depends on the type of cancer. (For a full list, check the CDC Gynecologic Cancers page.)
Pap smears can help detect cervical cancers. Other cancers, like ovarian cancer, are harder to detect because there is no formal screening. If the cancer is at a more advanced stage, surgery and chemotherapy might be used for treatment.
Sourcing: UpToDate, The American College of Obstetricians and Gynecologists, Office of Women’s Health, U.S. National Library of Medicine, Cleveland Clinic