Spotting Between Periods Should You Worry Everyday Health MenuNewslettersSearch Women's Health Spotting Between Periods Should You Worry What it means if you’re bleeding between periods or spotting on birth control — and what you should do about it. By Anne HardingMedically Reviewed by Justin Laube, MDReviewed: September 5, 2017Medically ReviewedSpotting means different things depending on your stage of life.Getty ImagesBleeding between periods, or “spotting,” can occur for many reasons. The cause is usually benign. Hormonal fluctuations that occur at the very beginning of your reproductive life cycle (menarche, the onset of periods) or toward the end (menopause, when periods stop) are often likely culprits. Still, spotting between periods is never normal, says Joyce Gottesfeld, MD, an ob/gyn at Kaiser Permanente Colorado in Denver. That means if you do find yourself bleeding between periods, you should get it checked out by your doctor, she says. "It doesn't necessarily mean that something bad is going on, but it's not normal.” When investigating abnormal bleeding, healthcare providers consider your age and whether you’re pregnant, have been having unprotected sex, or recently started using a hormonal contraceptive. If you’ve started taking the birth control pill or gotten a progesterone implant, it’s not unusual to experience irregular bleeding. If spotting doesn't taper off, talk to your doctor. “You're probably going to want to change birth control pills, because nobody wants to deal with that all the time,” Dr. Gottesfeld says. Skipping a pill or two may also bring on spotting. “If you're on birth control pills and you missed a pill, that can also make you have bleeding between your cycles, and I wouldn't be so worried,” says Anne C. Ford, MD, associate professor of obstetrics and gynecology at the Duke University School of Medicine in Durham, North Carolina. Spotting in the Early Years Spotting between periods can mean different things at early versus later stages of your reproductive cycle. When you first start having your period, it may be quite irregular for months or even years. This is because your brain, ovaries, and uterus are still working on getting in sync hormonally. Unless your bleeding is excessively heavy or prolonged, it's usually not a problem, according to Dr. Ford. Once you become sexually active, spotting after intercourse raises a red flag. This is especially true if you’re having unprotected sex or have just started having sex with a new partner. Bleeding can signal a sexually transmitted infection (STI), such as chlamydia or gonorrhea, that should be treated promptly, Ford says. “Often, the cervix can be very friable [eroded] or just bleed very easily from the infection,” she explains. Another condition that can lead to bleeding after intercourse is cervical entropion, in which the fragile glandular cells lining the cervical opening grow on the surface of the uterus. Much more rarely, post-sex spotting can be a sign of cervical cancer. Your doctor can take a Pap smear, a sample of cells from your cervix (the opening of the uterus at the top of the vagina) to test for STIs and abnormal precancerous or cancerous cells. Mid-cycle bleeding could also mean that you’re pregnant and could be miscarrying, although spotting during pregnancy doesn't always mean the pregnancy will be lost. Ectopic pregnancy, in which a fertilized egg grows outside of the uterus (usually within the fallopian tubes), can also cause bleeding, according to the American Congress of Obstetricians and Gynecologists (ACOG). Spotting may also be due to vaginal trauma. “The vagina and the cervix are very vascular [they have a lot blood vessels], so they bleed very easily,” says Lisa Dabney, MD, an ob/gyn in the division of urogynecology at Mount Sinai West in New York City. “A scratch in the vagina will always bleed more than a scratch in your regular skin would.” Bleeding Between Periods in the Middle Years Once you reach your thirties, the chance that spotting could indicate endometrial cancer, a type of cancer of the uterus, increases. Obesity also boosts your risk of endometrial cancer, even if you’re a younger woman. “We're seeing more and more endometrial pathology like that because of the obesity epidemic. We have to worry about that in very obese women, even if they're younger,” Ford says. Spotting between periods “definitely becomes more worrisome after the age of 35, because it could be an early sign of endometrial cancer,” Dr. Dabney says. “Hormonal changes, fibroids, and polyps are far more common than endometrial cancer. It's probably one of those things, but unless you have it evaluated, you don't know if you're that one in 1,000 people who has the cancer.” Fibroids, benign growths that can form in your uterus, are more likely to cause irregular bleeding if they grow into the uterine lining. Polyps, another type of benign growth, can also grow in the uterus or on the cervix and may cause bleeding. Both fibroids and polyps can be removed surgically. Endometrial hyperplasia, in which the lining of the uterus grows too thick, can also cause abnormal bleeding. While this condition is benign, it can be a precursor to cancer in some cases, according to ACOG. If your doctor suspects you may have endometrial cancer, he or she will take a sample of tissue from the endometrium so that the cells can be examined under a microscope. Other tests, such as an ultrasound, may be used to determine if bleeding is related to polyps or fibroids. The long march toward menopause — which officially occurs when a woman has not menstruated for a full year — begins for most women during their fourth decade. As your ovaries begin winding down egg production, your period is likely to become irregular. You may skip a cycle here or there, have your periods unusually close together, or experience heavy bleeding. “As people's ovaries start to age, you can see mid-cycle spotting,” Ford says. “That's very normal and it comes from fluctuating hormone levels.” It can be hard to tell what's normal and what's not during this tricky time of life, according to Ford. “If your normal period was three to five days and now you're bleeding seven to 10 days and it's heavy, then it's probably not a normal period.” Taking hormones to cope with menopausal symptoms like hot flashes can also contribute to irregular bleeding. After menopause, any vaginal bleeding is cause for concern. “If somebody's having spotting when they're postmenopausal, that's definitely abnormal and needs to be looked into,” Gottesfeld says. NEWSLETTERS Sign up for our Women' s Health Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. 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