Spotting vs. Period: How to Tell the Difference

Is it spotting or your period?

• Spotting refers to very light vaginal bleeding or brown discharge that occurs mid-cycle between menstrual periods.
• Menstrual periods are the monthly bleeding that occurs in women of reproductive age.
• Spotting may be due to a number of causes. You should call your doctor or other health care professional if you are pregnant and experience spotting or bleeding of any kind.
• Implantation bleeding in early pregnancy is a common cause of spotting and is not abnormal.

Menstruation or the menstrual period refers to the monthly vaginal bleeding that is experienced by women of reproductive age. Most women recognize their menstrual period. The typical menstrual cycle lasts 28 days. The menstrual bleeding is heavy enough to require the use of a pad or tampon and lasts for 3-5 days on average. Menstruation stops during pregnancy.

Symptoms of a period (menstruation)

• Cramps in the abdomen, pelvis, or lower back
• Bloating or slight weight gain
• Tender, sore breasts
• Mood swings
• Headache
• Fatigue

Symptoms of spotting

Spotting usually is much lighter bleeding than normal menstrual bleeding. Unlike a normal period, it usually is so light that a pad or tampon is not required. Spotting may be red or brown in color and occurs when you are not having your regular period. Spotting may not have any symptoms associated with it, but if it happens as a result of a medical condition, you may have other symptoms like:

• Heavy bleeding during the menstrual period
• Irregular periods
• Abdominal pain
• Burning or pain during urination
• Pain or burning during sexual intercourse
• Vaginal discharge, redness, or itching

Talk to your doctor or other health care professional if you are not sure if it is your period, or if you are spotting.

Remember, spotting is light bleeding that does not get heavier like a typical menstrual period. The normal menstrual period usually is associated with some other symptoms like breast tenderness or cramps as described previously, and often is accompanied by the heavy flow. During the first day of your period bleeding may be light, but it typically becomes heavier over the next few days.

Light bleeding that does not worsen and is not associated with the symptoms of your period is likely to be spotting.

A home pregnancy test can be helpful if you believe you are spotting due to early pregnancy, or you may experience early signs and symptoms of pregnancy.

You should always contact your doctor or other health care professional if you experience any vaginal bleeding, spotting if you are pregnant or if you have reached menopause or any time you have unusual bleeding that concerns you.

• Implantation bleeding: Many women experience spotting in the early weeks (first trimester) of pregnancy. Implantation bleeding is a common cause of spotting. This occurs early in pregnancy when a fertilized egg attaches to the wall of the uterus (known as implantation). A woman may mistake this light implantation bleeding for a menstrual period and therefore not realize she is pregnant.
• Birth control: Certain birth control methods can cause spotting, including birth control pills, especially when they are first used. Switching birth control pills or using continuous birth control pills can also cause spotting. Some women with an IUD (intrauterine device) for birth control also report spotting.
• Polycystic ovary syndrome (PCOS) is a common condition in which multiple cysts form in the ovaries. It can make it difficult to get pregnant and can cause irregular periods and bleeding.
• Benign growths in the uterus or cervix, like fibroids or cervical polyps, can cause irregular bleeding and spotting.
• Infections, including sexually transmitted diseases (STDs), are another possible cause of spotting or breakthrough bleeding in between periods.
• The menopausal transition is a time when women’s hormone levels can vary widely, sometimes causing spotting or irregular periods.
• The trauma of any kind, including assault or rough sex, can injure the vagina and lead to bleeding or spotting.
• While the vast majority of spotting in pregnant women is not due to serious causes, spotting and bleeding in early pregnancy are sometimes related to miscarriage or ectopic pregnancy (a pregnancy that has been implanted outside the womb or uterus, most commonly in the Fallopian tube).

If you have continuous spotting or abnormal vaginal bleeding or spotting postmenopausal you need to be evaluated by a doctor or other health care professional.

Spotting is more likely to occur in certain women who:

• Are approaching menopause
• Are pregnant
• Have switched birth control methods, including having a new IUD in place or having recently started taking birth control pills
• Have infections of the sex organs including STDs and pelvic inflammatory disease (PID)
• Have fibroid tumors of the uterus or cervical polyps
• Have polycystic ovary syndrome

The cause of vaginal bleeding or spotting requires a thorough history of the symptoms (when the bleeding or spotting is occurring and any associated symptoms, birth control methods, and history of any medical conditions or infections).

• A pelvic examination is usually the first step to diagnosis.
• A pregnancy test is performed for women of reproductive age.
• Special tests like a Pap smear or cultures may be ordered.
• In some cases, blood or urine tests are ordered.
• Imaging studies such as vaginal or abdominal ultrasounds may be useful in diagnosing the cause of spotting or bleeding.

Treatments for spotting depend on the underlying cause of the spotting.

• Many causes of spotting are not serious, and there is no treatment required.
• For infections, antibiotic therapy is indicated.
• Women with PCOS who desire to become pregnant can be treated with fertility-enhancing drugs or assisted reproductive technologies.
• Surgery can be required in some cases to remove cervical polyps or uterine fibroids that are causing bleeding.
• For women who desire a more regular menstrual cycle, sometimes birth control pills or hormonal treatments can be helpful.