Spotting

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What is spotting?

Spotting refers to any uterine or vaginal bleeding that occurs outside the menstrual period. Most women have a normal menstrual period approximately every 28 days. Spotting can include bleeding between normal menstrual periods, bleeding after sexual intercourse, bleeding before puberty, and bleeding after menopause. Women who are pregnant may also experience spotting.

The causes of spotting vary depending on a woman's age and her stage in life. For instance, young women in the first few years of their menstrual periods may experience some spotting. Women of childbearing age may have gynecologic disorders, such as fibroids or polyps, or complications from hormonal contraceptives or hormone-replacement therapy, any of which may result in spotting.

Women who are nearing menopause may have spotting, irregular periods, or skip periods entirely. A condition called endometrial hyperplasia, which involves excessive or abnormal thickening of the uterine lining, can also cause spotting. In some cases, endometrial hyperplasia can lead to cancer of the uterus. Spotting may also be caused by medications, untreated infections, or a blood-clotting disorder. Suspected vaginal bleeding does not always originate from the reproductive organs. The blood may be from the urinary tract or something as simple as hemorrhoids.

The menstrual period is controlled by two hormones: estrogen and progesterone. Spotting may occur if these hormones are out of balance or not available. Women with thyroid disorders may have hormonal imbalances that result in spotting.

Seek immediate medical care (call 911) if you, or someone you are with, are pregnant and experience spotting.If you are not pregnant, your health care provider will determine the cause of your spotting through a pelvic exam and other tests. If you experience heavy or prolonged bleeding, or if your spotting is persistent or causes you concern, seek prompt medical care.

What other symptoms might occur with spotting?

Spotting may accompany other symptoms, which vary depending on the underlying disease, disorder or condition.

Common symptoms that may occur along with spotting

Spotting may accompany other symptoms including:

  • Abdominal pain or cramping
  • Abdominal, pelvic, or lower back pain that may be severe
  • Fatigue
  • Frequent infections, especially yeast or fungal infections
  • Heavy bleeding during menstrual period (menorrhagia)
  • Irregular menstrual periods
  • Irritability and mood changes
  • Missed menstrual periods
  • Pain during sexual intercourse

Other symptoms that may occur along with spotting

Spotting may accompany symptoms related to other body systems including:

Symptoms that might indicate a serious condition

In some cases, spotting may occur with other symptoms that might indicate a serious condition which should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, are pregnant and have spotting or other bleeding.

What causes spotting?

The causes of spotting can vary depending on a woman's age and her stage in life. Spotting can be normal in young women in the first few years of their menstrual periods and in women approaching menopause. Hormonal contraceptives or hormone therapy are also common causes of spotting.

In other cases, spotting is caused by abnormalities in hormone balance.

Gynecologic causes of spotting

Spotting may be caused by gynecologic disorders including:

Hormonal causes of spotting

Spotting can also be caused by hormonal imbalances including:

  • Changes in levels of estrogen or progesterone

  • Hormonal contraceptives (birth-control pills, patch or injection; intrauterine devices)

  • Hormone therapy

  • Hyperthyroidism (overactive thyroid)

  • Hypothyroidism (underactive thyroid)

Serious or life-threatening causes of spotting

In some cases, spotting may be a symptom of a serious or life-threatening condition that should be immediately evaluated. These conditions include:

Questions for diagnosing the cause of spotting

To diagnose your condition, your doctor or licensed health care provider will ask you several questions related to your spotting including:

  • Are you pregnant?

  • When did you first notice the spotting?

  • Have you noticed any changes in your menstrual periods?

  • Is your menstrual period heavy or prolonged?

  • Have you missed any menstrual periods?

  • Do you have any other symptoms, such as fatigue or rapid heart rate?

  • What medications are you taking?

What are the potential complications of spotting?

Because spotting can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Adverse effects of treatment
  • Anemia (low red blood cell count)
  • Cancer of the uterus
  • Frequent serious or opportunistic infections
  • Inability to participate normally in activities
  • Spread of cancer
  • Spread of infection
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 8
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Abnormal menstrual periods. UCSF Medical Center. http://www.ucsfhealth.org/conditions/abnormal_menstrual_periods/index.html.
  2. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.
  3. Lockwood CJ. Mechanisms of normal and abnormal endometrial bleeding. Menopause 2011; 18:408.