Causes of spotting before period – the most common causes.

What causes a woman to spot before her period arrives?

This is a question I asked myself when I came off the contraceptive pill to try for a baby in 2013. I found that after I ovulated I would spot on random days during the run up to the day my period was due. Sometimes it was brown and sometimes it was pink and even red. Many times I was convinced it was my period arriving early but then when the spotting would stop for a few days I found it quite confusing and frustrating.  I never had cramps with the spotting and sometimes it was as soon as 2-3 days after ovulation. I did lots of research on this and I will share with you my findings.

 

Ovulation spotting

Spotting after you have ovulated or ‘Mid cycle spotting’ is very common and I have experienced this several times, especially when my ovulation pain has been particularly bad. It occurs within a few days of ovulation so spotting at this time in your cycle can be quite surprising for many woman. Ovulation spotting is nothing to worry about and up to 10% of women experience this at some point during their fertile years. Spotting occurs because of a brief drop in estrogen levels following the release of an egg from the ovaries.

The spotting usually happens around 10-14 days before your period is due. I have read on many trying to conceive forums that ovulation spotting corresponds with a ‘strong ovulation’ but what this means I’m not sure. Many woman seem to think it is a positive occurrence and can be linked with a good ‘strong’ egg being released.

 

Implantation bleeding

If your menstrual cycles and luteal phase length is normal and you never usually have spotting between ovulation and your period, then you could be experiencing implantation bleeding. Light spotting of brown or pink (and sometimes even red) discharge around 6-12 days after ovulation could indicate implantation of a fertilised egg into the walls of the uterus. This could be a very early sign of pregnancy. Implantation bleeding is usually very light and occurs when the egg attaches to the lining of uterus i.e. implantation. When the egg attaches, a small amount of blood may be shed. This blood may then pass through the cervix and out of the vagina.

You may notice this small amount of blood after you wipe. Implantation bleeding usually stops as quickly as it starts but if you carry on spotting and you find out that you are pregnant then speak to your GP.  Likewise if you have unusual bleeding at any point during your cycle and you are not pregnant, then you should consult your doctors advice. There are many photos of implantation bleeding on google images and you can look up some images to get an idea of what it may look like.

 

Vascular cervix

This reason is not so well known and I haven’t found much about a vascular cervix online but when I went to see my doctor about my spotting she examined my cervix and told me it was very vascular. I had ovulated a few days prior to my doctors visit and I had light spotting so went in for some tests. She said that the blood vessels are often more visible, prominent, swollen and more dense during the luteal phase of a woman’s menstrual cycle. This is due to the effects of progesterone levels being higher during this phase. Pregnant women may also have a vascular cervix for the same reason i.e. they have high progesterone levels and their cervix becomes engorged with blood. If you have a vascular cervix during your luteal phase then any light trauma e.g. through sex, could cause you to have some spotting.

If you experience spotting after sex during the luteal phase then this could be your problem. You should however have yourself checked out by your doctor if you ever experience any abnormal spotting throughout your cycle or after intercourse just to be safe. When I was on the contraceptive pill called ‘Cilest’, which is a progesterone only pill, I would spot now and then after sex which makes sense to me now. I was young and so I didn’t go to my GP although I did have several smears over the years which were all normal. It is usually nothing to worry about but it is better to get checked anyway.

 

A Luteal Phase Defect

This issue is very common and is a problem I have suffered from since coming off the contraceptive pill in 2013. My cycles have always been on the longer side and I would spot for up to 5-7 days before my period was due every cycle. After much research and a few cycles charting my temperatures I discovered my luteal phase was short at 10-11 days, meaning I had a ‘luteal phase defect’. What this means is that your progesterone level peaks as it should around 5 days after ovulation but then levels starts do drop sooner than they should. With a slight drop in progesterone your lining may begin to shed early and you may see spotting for several days before your period arrives.  The day your period arrives is when levels of progesterone plummet.

If you have a luteal phase defect and you are trying for a baby you may have some issues conceiving. Your lining may start to shed before the fertilised egg has time to attach. There are several ways you can help with this issue naturally or you can try progesterone after ovulation. You may only be able to obtain progesterone suppositories from a gynaecologist as your GP usually will not prescribe it. I have a separate post titled ‘What is a luteal phase defect‘ and ‘Progesterone and Fertility‘ if you would like to know more and I also described how I overcome my issue to conceive successfully.

 

Cervical erosion (cervical ectropion)

Cervical erosion is now more commonly referred to as cervical ectropion or cervical eversion. It is quite a common condition and is harmless.  There is no evidence to suggest it is associated with cervical cancer or other cancer causing conditions. The condition occurs when cells from the inside of the cervix appear on the outside of the cervix.  Cervical ectropion may be diagnosed during an examination of the inside of the vagina e.g. during a smear test, as the cervix will appear redder than normal. The condition is often caused by hormonal changes and is more commonly seen in young girls going through adolescence, pregnant woman or woman on the contraceptive pill . Many woman can be born with the condition also. Cervical ectropion often causes no issues and may disappear without any treatment. The cells on the outside of the cervix may however cause spotting and pain during or after intercourse. If you are taking the contraceptive pill then switching to a different pill may help or if you are not on the pill and are not trying for a baby, then taking the contraceptive pill may also help. Speak to your GP if you are experiencing any symptoms and they can examine you and confirm if this is your issue. If you are suffering considerably from the condition then the cells may be cauterised to prevent any further bleeding.

 

Polycystic Ovary Syndrome (PCOS)

If you have PCOS then you will probably experience irregular bleeding from time to time. PCOS is caused by a hormonal imbalance which may prevent ovulation. If a woman is not ovulating then the lining of the uterus is not shed on a regular basis and may become thickened.

Other symptoms of PCOS is high testosterone levels, obesity, excess hair (hirsutism) on the face, back, arms and legs and chest and balding of hair on the head. Your doctor can undertake a simple blood test and even an ultra sound examination to confirm if you have PCOS and can prescribe you treatment and give advice which should help.

 

Cervicitis – Inflammation or infection of the cervix 

Cervicitis is a condition where the cervix becomes inflamed and a woman may suffer from bleeding at unusual times during her menstrual cycle as a result. The condition is also linked to painful sex and abnormal vaginal mucus. Cervicitis is most commonly caused through a sexually transmitted infection such as gonorrhea or chlamydia. Many woman see no signs or suffer no symptoms of the condition and have no idea they have an STI for a long period of time. A woman with no symptoms may be diagnosed during a routine vaginal exam such as a smear test. If you are suffering from vaginal bleeding that is not associated with your period or if you experience painful sex or abnormal vaginal discharge then see your GP straightaway. Cervicitis may also be caused by an allergic reaction to latex condoms or spermicides or woman who regularly perform douching can suffer (cleaning of the inside of the vagina).

The cervix may also become inflamed if there is an overgrowth of the normal, natural occurring bacteria inside the vagina. This condition is called bacterial vaginosis. If is important to treat the underlying cause of cervicitis as the cervix is key in preventing bacteria and viruses from entering the uterus. If the cervix is infected and inflamed then this barrier is compromised and may lead to an infection of the reproductive organs which may lead to fertility issues later on.

 

Sexually Transmitted Infections/Diseases (STIs, STDs)

I have mentioned this briefly above as STIs such as gonorrhea or chlamydia may lead to cervicitis and abnormal vaginal bleeding.

 

Pelvic Inflammatory Disease (PID) 

Pelvic inflammatory disease (PID) is when the uterus, ovaries and/or fallopian tubes become inflamed. PID is commonly caused by sexually transmitted infections  such as chlamydia or gonorrhoea. Treatment is usually successful and involves one or two courses of antibiotics. If a woman has a severe infection or if a  she has had PID for a long time and has not been treated, she could develop fertility issues e.g. blocked fallopian tubes and risk of an ectopic pregnancy. Symptoms include bleeding between periods, pain in the abdomen, pain during sex, unusual discharge and often heavy periods.

An ovarian cyst

An ovarian cyst is a fluid-filled sac which grows on a woman’s ovary. They are extremely common, usually do not cause any symptoms and often disappear in a few months without treatment. If the cyst ruptures however it may cause a woman to experience pain in the pelvis area, pain during sex and abnormal periods (irregular, heavy or lighter than normal).

Uterine Fibroids

Uterine Fibroids  are abnormal growths of muscle tissue that develop within or around the uterus. They are non cancerous  growths (often referred to as uterine myomas or leiomyomas) and often do not cause a woman any symptoms. When symptoms occur they can include abnormal vaginal bleeding bleeding between periods, lower back and abdomen pain and pain during intercourse.

Uterine Polyps

Uterine polyps are growths which appear within the inner lining of the uterus. They are often attached by a thin stalk and extend into the uterus. They are usually noncancerous.

Stress

Stress can cause changes in to a woman menstrual cycle and some women may suffer from vaginal spotting due to fluctuations in stress hormones, Stress may also delay ovulation or even prevent it altogether.

An Early Miscarriage – Chemical Pregnancy

Early miscarriages or chemical pregnancies are extremely common accounting for 50 to 75 % of all miscarriages experienced. They usually occurs shortly after a fertilised egg has implanted and often following a very faint positive pregnancy test. I experienced a chemical pregnancy myself and it was shocking to get a positive pregnancy test only to have spotting and then my period arrive a few days later. Often woman find they have spotting and the pregnancy tests from one day to the next do not get any stronger. If you think you are pregnant and experience any spotting then it is always better to contact your GP for advise. If you do have an early miscarriage then inform your GP also as they need to put it on your medical records. Some woman experience several chemical pregnancies one after the other and as you only get help after 3 miscarriages it is best to keep your GP informed. Often it is nothing to worry about but there are tests your GP can perform to see for what reason the implantation process is unsuccessful.

Approaching menopause

When a woman is approaching the menopause she can begin to experience pink or brown spotting and even light bleeding before her period is due.

 

Low thyroid levels.

A woman might start to produce too much estrogen if she has a thyroid problem. An underactive thyroid may lead to over production of estrogen and spotting between periods.

 

Adenomyosis

Adenomyosis occurs when cells lining the inside of the uterus are found within the uterine wall. This can cause the uterus to become enlarged which may be very painful and cause spotting between periods and also heavier periods. This condition usually occurs after the menopause has begun.

 

Ectopic pregnancy 

An ectopic pregnancy is when a fertilised egg has implanted outside of the uterus, usually in one of the fallopian tubes. If you know you are pregnant and experience the following symptoms then contact your GP immediately – Abdomen pain which is low down and focused on one side, bleeding or spotting pr brown watery discharge , shoulder pain and discomfort when weeing or pooing.

 

Malignant cancer

If you have been experiencing any unusual spotting or bleeding in between your periods it is extremely important to see your GP. It is usually something that can be treated but if the worst case scenario occurs it is better to get a diagnosis sooner rather than later.  Your doctor will have heard and seen it all before and it is always best to get peace of mind or to get treatment as soon as possible. Don’t put it off and always make sure you  have a smear test performed when advised to and when they are due.

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