What Can Spotting Before Your Period Mean?

Spotting or light vaginal bleeding can take occur at any time during your cycle. Some benign and not benign conditions may lead to spotting before your period.

The story goes that menstrual cycles come and go like clockwork on a fixed 28-day cycle. Your period will last about three to five days — maybe seven if you’re unlucky — and that will be that. 

But it’s not that simple. 

Spotting, or light vaginal bleeding, can actually take place at almost any time during your cycle. Some of its reasons for doing so are benign, and some are not. Normal bleeding is understood to take place anywhere from 21 to 35 days into your cycle. 

Spotting between periods is always a cause of at least some concern. Spotting between periods is itself considered a symptom. But if it accompanies other menstrual symptoms, this could be a sign of a larger issue. Even if the underlying cause turns out to be normal, you’ll want to have it tested and diagnosed. Symptoms that may accompany spotting include:

• Very heavy or frequent bleeding 
• Pelvic pain
• Shortness of breath
• Fatigue
• Dizziness

Whether you’ve gone through menopause is also an important factor to consider. Postmenopausal women see an increase of 10% in their overall cancer risk, and bleeding is one of the signs that doctors look for. Cancer seldom causes spotting between periods in premenopausal women.  

Spotting is mostly characterized by light to medium blood flow from the uterus, known as menorrhea. It can happen naturally at various times in the menstrual cycle, usually caused by normal changes in the hormonal balance of the body. 

This could be due to:

Birth control

A common culprit of spotting is birth control changes. Using hormonal birth control, or changing from one type of birth control to another, alters your progesterone levels and increases your risk of spotting between periods. This is true for all major forms of hormonal birth control, including: 

• Birth control pills
• Injections like Depo-Provera
• Intrauterine devices 

Ovulation

Ovulation happens when your body releases an egg as part of the natural menstrual cycle. It happens about halfway through the cycle and involves an alteration of estrogen levels in the body, which can cause spotting. Spotting during ovulation usually only lasts for a few days and is not cause for concern.

Anovulatory cycle

An anovulatory cycle is a menstrual cycle in which ovulation does not take place. Many factors play a role in this, such as stress, weight gain or loss, and others. It involves an alteration of the body’s estrogen levels, so abnormal bleeding is a common side effect. 

Infections

Some sexually transmitted diseases (STDs) are known to cause vaginal bleeding. If this is the case, your bleeding will often be accompanied by at least a few other symptoms, especially  itching, burning, and painful urination. 

Endometriosis

If you begin spotting regularly before your scheduled periods, it may be a sign you have endometriosis, a condition that affects as many as 5.5 million women. Endometriosis is a condition caused by the growth of uterine lining outside the uterus. In addition to abnormal bleeding, endometriosis is also associated with severe pelvic pain and possible fertility issues.

Other potential causes of spotting before your period may include: 

• Uterine polyps
• Inflammation
• Blood thinners
• Injury

Bleeding at an unusual time in your cycle can also be a sign of an underlying condition like: 

• Pelvic Inflammatory Disease (PID)
• Ectopic Pregnancy
• Hyperthyroidism
• Cancer

The wide variety of causes for spotting between periods, both benign and serious, is all the more reason to seek an accurate and prompt diagnosis.

Doctors often begin diagnosis by asking you a few questions about your medical history and lifestyle and doing a physical exam. This can help them rule out any immediately obvious causes for your spotting. 

After that, there are a number of different tests that can be used to find the problem. These may include: 

• Transvaginal ultrasound: A small device is carefully inserted into the vagina to take detailed pictures of the uterus and ovaries and look for any abnormalities.  
• Sonohysterography: A saline solution is injected into the uterus to create an image of the endometrium, the lining of the uterus, and look for any polyps or other objects that might be causing the spotting. 
• Endometrial biopsy: A tissue sample is removed from the endometrium to test it for cancer or other potential issues. 

Your doctor may also test your blood and hormone levels to narrow down the source of your spotting. 

In cases where the spotting is at least partially caused by birth control methods, your doctor may adjust, switch, or even remove your birth control. This may balance your hormone levels and improve your symptoms. 

If the problem is more than a hormonal imbalance, various other therapies can help. In addition to prescribing medication, your doctor may consider surgical interventions to treat the issue. Serious cases may result in hysterectomy, the removal of the uterus entirely. 

However, most instances of spotting before your period are normal and benign, and they do not require drastic intervention.