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Why Am I Spotting?

Spotting can be scary. And often when you go to a doctor, they might tell you it’s “normal.” But we found out why this happens to some women.

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Is spotting “normal?”

Spotting is very unnerving. And inconvenient. Sometimes for me it happens months at a time – it’s like having a really light period for 90 days. I kept going to the doctor and she’d just keep telling me to relax. My Pap, ultrasound and blood work results came back “normal.” “It just happens to some women,” she told me. I don’t know about you, but spotting didn’t feel very “normal” to me.

Dr. Dustin Costescu, an obstetrician and gynecologist at Hamilton Health Sciences and assistant professor in family planning at McMaster University in Hamilton, Ont., tells me that many things can cause spotting. We were originally talking about how to use an IUS (the hormone version of an IUD), when he mentioned that this form of birth control might cause spotting in place of a regular a period. I quickly high-jacked the phone call and followed up about other reasons spotting might happen.

He tells me that spotting is defined, in medical terms, “as bleeding that does not require sanitary protection.” But he adds: “Now, in practical terms, spotting can take on a few forms. The first and obvious one is spots of blood with wiping or noticed on sanitary protection or underwear. Sometimes spotting results in brown discharge (think old blood plus normal mucus production), which can be confused for infection, but is usually not associated with any odour or other symptoms.”

Yup. I recognize those things, especially after running or stress.

Again, like my doctor, Costescu, says: “There are lots of causes of spotting, and most of them are a normal part of life.”

So, let’s find out what’s so “normal” about it by investigating the reasons we spot.

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“Why am I spotting” reason: It’s your IUS

The gynecologist says: “Hormonal IUDs, like Mirena, Jaydess, or the newest product in Canada called Kyleena, a low-dose hormonal IUD that can be used for five years, control bleeding in part by thinning the lining of the uterus,” says Costescu. “Progestins keep the lining of the uterus from growing out of control. And sometimes it does too good a job, so the lining is a bit unstable and sheds. Sometimes, this translates to a period that is so light it is perceived as spotting. Tracking your cycle will help. For some women, particularly those who have heavy flow prior to an IUD, they will experience irregular spotting instead of the heavy period, or spotting with lighter flow. Women should weigh the pros and cons of spotting against what periods were like before – especially if they were heavy or painful.”

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“Why am I spotting” reason: It’s all the exercise you’re doing.

The gynecologist says: “Women who spot after intercourse or intense exercise may do so simply because the friction of the cervix is causing some irritation,” says Costescu. “Women who are taking up new rigorous exercise routines and who lose weight rapidly may also experience spotting owing to changes in hormones. Burning fat cells and weight loss can release estrogens into the body. And, because fat cells help produce some sex hormones, sustained weight loss can cause a lower level of estrogen in the body. If a woman loses too much weight, her periods may stop and spotting may result.” Costescu says that the absence of periods is concerning and is reason to visit your doctor.

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“Why am I spotting” reason: You’re stressed.


The gynecologist says: “Stress plays a complex role in spotting and cycle changes,” says Costescu. “Likely the increase in cortisol affects the body’s signaling system and the change in hormones causes spotting to occur.”

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“Why am I spotting” reason: You have ectropion or polyps.

The gynecologist says: Now as much as I’m told spotting can be considered “normal,” it can also be a cause for concern. That’s why my doctor had me do a Pap, an ultrasound and blood tests. “If you have significant or bothersome spotting, a trip to the doctor is warranted,” says Costescu. “Polyps are small growths on the cervix that can bleed on contact. They are benign but can be removed if bothersome,” he says. “Ectropion is a normal condition where the glandular cells – the ones that look like the lining of the uterus – are prominent on the cervix. This can bleed easily if poked. […] In some [medical] centres, liquid nitrogen can be used to freeze the ectropion to prevent further bleeding.”

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“Why am I spotting” reason: Your levels of progesterone and estrogen are off balance.

 

The gynecologist says: “Spotting can be a sign that hormone levels are off, but in most cases,” says Costescu. “It is normal for a small amount of spotting around ovulation – two weeks before a period is due – related to hormone changes. Women who find spotting to be a nuisance can talk to their doctor about options. The most common option is to try a birth control pill, which is progestin-dominant and will help stabilize the lining.” He also adds: “Numerous studies have looked at supplements that can help control [hormone-related] spotting. Unfortunately, while small studies show promise, most large scale studies do not show benefit for Vitamin B supplementation, Vitamin C or Iron.

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“Why am I spotting” reason: It’s your birth control pills.

The gynecologist says: Some women who take The Pill might notice spotting, because of the dosage of estrogen. “In any case where a woman experiences spotting on the pill,” says Costescu, “an IUD, either copper or hormonal, such as a Mirena, Kyleena of Jaydess, is a reasonable next option.”

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“Why am I spotting” reason: You’re pregnant.

The gynecologist says: “Some women may experience an ‘implantation bleed’ once a pregnancy has taken hold,” says Costescu. “Any irregular period or bleeding warrants a pregnancy test. Implantation bleeds are also a common culprit when a woman finds out she is further along in her pregnancy than expected – that bleed can be confused for a period.”

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“Why am I spotting” reason: You might be close to menopause.

The gynecologist says:Menopause is a time of transition, which can start five to 10 years prior to periods stopping,” says Costescu. “Some women experience spotting because they aren’t releasing an egg each month, and so the body isn’t going to have a normal period. Other women, as their hormone levels drop, may experience very light flow or spotting, as the lining of the uterus becomes dormant.” But if you’re thinking it might be a very early menopause, don’t worry about that. “In a healthy young woman, spotting is not a warning sign of menopause,” says Costescu.

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So you’re spotting, now what?

The gynecologist says: Instead of being frustrated, talk to your doctor. “If spotting is rare, and there are no red flags, then a visit to the doctor is probably not necessary, says Costescu. “The occasional irregular period or episode of spotting is normal. But there are a few conditions associated with spotting that your doctor will want to rule out if you go.” And he adds that we need look for patterns, like when it happens and at what point in the cycle it occurs. And make note if you changed sexual partners, are taking new medication, or anything else in your lifestyle that is different and might affect what’s going on down there. At the office, our favourite cycle trackers include: Clue, P Tracker and Pink Pad.

Costescu sent me these top five things to make note of if you’re spotting.

  1. In most cases, the occasional episode of spotting is nothing to worry about.
  2. It is normal for some women to experience spotting at the beginning or tail end of a period.
  3. Spotting is very common in the first few months of use of any birth control, including pills and IUDs. Spotting when on birth control does not mean it’s not working. You can be reassured that you will still get protection from your contraception.
  4. Beware of  spotting that can be a warning sign for the following: An STD (you notice spotting around the start of a new sexual relationship), cervical cancer (spotting comes with pain, particularly with intercourse or if you have not had a Pap test), an infection (accompanied with fever or discharge), or pregnancy, miscarriage or ectopic pregnancy (around when your period should come).
  5. Smoking increases the rate of spotting, so if the thousands of other reasons to not smoke are not enough, add this one to the list.