Spotting between periods: causes and when to get help

Spotting between periods should always be checked by a GP or sexual health clinic, even if the bleeding has stopped. It is not usually serious. Still, even a few spots on the toilet paper are worth mentioning.

Describing the bleeding

Spotting means small spots of blood, not a flow that soaks a period pad. In its pregnancy guidance, the NHS describes it as pink, red or brown spots on underwear or toilet paper. That description doesn’t mean pregnancy is the cause.

A period is when blood and tissue leave the womb. Bleeding between periods is a separate pattern, so mention it at your appointment. Not sure if what you saw was spotting or an early period? Just describe the bleeding.

If you notice spotting before a period, log the spotting and any fuller flow separately. For example: “Spots on Tuesday. Usual flow began Thursday.” If you can’t tell where one episode ends and the next starts, say so in the note. You don’t need to know the cause before you ask for advice.

Book a check, even if the bleeding stops

For bleeding between periods or after sex, book a GP or sexual health appointment. Your assessment may include a pregnancy test, blood tests, STI tests and an examination of the vagina and cervix. Any further tests depend on what they find.

You don’t have to wait for the bleeding to stop. An examination can be done while you are bleeding. If you’re unsure, ask about this when you book.

The NHS cervical screening guidance says to see a GP about symptoms such as bleeding between periods, during or after sex, or after menopause. Don’t wait for your next screening appointment to raise them.

After menopause, see a GP even if the bleeding happens only once or is very light. Postmenopausal bleeding is usually not serious, but can be a sign of cancer. It needs a GP check, but it isn’t automatically an emergency. The heavy bleeding and emergency signs below still need faster help.

What could be causing it?

Several causes can lead to similar bleeding. These are things a clinician may look at. A calendar alone can’t tell you which one applies to you.

Contraception. Hormonal contraception can change your bleeding pattern. Irregular use, including stopping and starting or missing pills, patches or rings, can play a part. MedlinePlus also lists intrauterine devices (IUDs) as a possible cause of spotting.

Tell the clinician which method you use and what has changed. If you missed contraception, ask a pharmacist or sexual health service what to do for your method. The bleeding pattern can’t tell you what to take next. To learn how returning fertility differs from returning periods, read about periods after stopping hormonal contraception.

Ovulation. A little vaginal bleeding or discharge can happen at ovulation, when an ovary releases an egg. Some people also feel a short ache or twinge on one side of the lower tummy. The NHS page on ovulation pain describes these symptoms. It also lists other conditions that can cause similar pain.

A date near the middle of your cycle isn’t enough to call it ovulation spotting. Get urgent help if the pain is severe and painkillers haven’t helped, if it keeps coming back, or if you might be pregnant.

Pregnancy. Possible causes of bleeding in pregnancy include implantation in very early pregnancy and changes in the blood vessels of the cervix. They also include miscarriage and ectopic pregnancy. Calling a spot “implantation bleeding” at home can’t tell you which one it is.

If you know you’re pregnant, get urgent advice for spotting or light bleeding, even without pain. Contact your maternity service. In the UK, use NHS 111 if you can’t reach a maternity or early pregnancy service. Elsewhere, contact your local urgent medical service.

Infections and changes in the cervix or womb. Sexually transmitted infections (STIs), including chlamydia, can cause bleeding between periods or after sex. You may be offered STI testing. A sexual health clinic is a good place to ask for help.

Polyps and fibroids can cause bleeding between periods. Bleeding after sex can be caused by cervical polyps, cervical ectropion and vaginal dryness. Ectropion is a change to the surface of the cervix. Unusual bleeding can sometimes be a sign of cancer. That is one more reason to get it checked.

Medicines and other conditions. MedlinePlus also lists blood-thinning medicines and an underactive thyroid as possible causes. Bring the names of your medicines to the appointment. Mention any link you suspect. The bleeding alone can’t show whether a medicine is the cause.

Pain or heavy bleeding needs faster help

Get urgent medical advice if you could be pregnant and you have unusual bleeding with tummy or pelvic pain. NHS ectopic pregnancy guidance says to get help even without a positive pregnancy test. In the UK, contact your GP urgently or call NHS 111. Elsewhere, use your local urgent medical service.

Sudden, intense tummy pain with strong dizziness or fainting can be a sign of a ruptured ectopic pregnancy. Call 999 in the UK, or your local emergency number. If you’re pregnant and bleeding, these also need emergency help: severe tummy pain, shoulder pain, faintness or bleeding that soaks a pad soon after putting it on.

Contact a healthcare professional straight away if bleeding becomes very heavy. ACOG calls it an emergency when you need to change a pad or tampon every hour for more than two hours and you also have chest pain, breathlessness and lightheadedness or dizziness. Get emergency care. Don’t wait for an appointment. For the practical signs, see recognising heavy periods and knowing when to get help.

Take these details to your appointment

MedlinePlus suggests noting the timing, flow and other symptoms. Keep the note short:

• When the bleeding happened, and how it relates to your period or to sex.
• Spots or a fuller flow, and how often pads or tampons got soaked.
• Any pain, dizziness or other symptoms, and whether you could be pregnant.
• Your contraception, other medicines and any recent changes.

For help putting the details together, see preparing notes for a healthcare appointment. If a date is a guess, mark it as a guess.