Why am I Spotting?

If you’ve ever spotted before then you know it’s not like a regular menstrual flow. Spotting is very light vaginal bleeding, typically so light it doesn’t even require more than a pantyliner, if that. Sometimes it’s so light the only sign it’s even happening is a pink tinge when you wipe after peeing.

It can happen at the beginning or end of a regular period, or it may occur randomly during any other part of the cycle. For some it may even happen during pregnancy. Some spotting may be normal, while other types of spotting can be indicative of hormone imbalance or certain conditions. I’ll explain what’s going on and, if needed, how to manage your spotting.

What’s happening?

Spotting can be caused by bleeding from anywhere inside of the internal reproductive organs. It is commonly the shedding of the endometrium, or uterine lining, which normally happens each cycle during the period. Especially if spotting happens at the beginning or end of the period it may just be the lining shedding at a slower rate, though spotting can still come from the endometrium at any point in the cycle. This type for bleeding is common during shifts in hormones or due to certain hormone imbalances.

Bleeding, whether it’s spotting or something heavier, can also come from other parts of the uterus, the ovaries, or Fallopian tube(s), the cervix, or vagina. These types of bleeding can be caused by a number of different reasons, including trauma, events of pregnancy (such as implantation), or growths (such as cysts, polyps, or fibroids).

Spotting vs. a light period

In some cases bleeding may be very light during a normal menstrual flow, which can be confused for spotting. This is particularly common for those with hormonal IUDs, such as the Mirena, but it may also happen randomly for seemingly no reason.

If you are tracking your cycle with BBT charting, then that may help you identify if light bleeding is indeed your period. If this light bleeding happens just one cycle then it’s typically not cause for alarm, but if it becomes a pattern then it may be a good idea to have your hormone levels tested. Light periods also respond well to acupuncture and herbal medicine.

Imbalances of hormones

What usually happens during the menstrual cycle is an ebb and flow of estrogen and progesterone. Estrogen is produced throughout the cycle, but it dominates the first part of the cycle, from the start of the period until ovulation. Progesterone, on the other hand, is only produced after ovulation and before the next period starts. Estrogen works to build up the uterine lining and progesterone holds it in place (they both serve other functions too but we’re going for a simple explanation here.)

Estrogen and progesterone are both produced before the period starts, when levels drop that triggers bleeding to begin. If progesterone is deficient, however, then it may cause some of the uterine lining to shed early, causing spotting before the period starts. If this is the pattern you’re experiencing it’s possible it may also cause a short luteal phase or low bbt temperatures during this phase. If you are trying to conceive, this pattern may effect your ability to get pregnant since the uterine lining is not stable when implantation should be taking place.

Spotting that happens at the end of the period, while not ideal, is less likely to negatively effect fertility. This pattern is more commonly caused by low estrogen levels, since estrogen is produced early in the menstrual cycle (after the period has started) and the rising levels are part of what signals bleeding to stop. If estrogen levels are low, then the period may linger on much longer than usual, causing spotting for several days after the full flow.

Some people use progesterone supplementation if their levels are low, but estrogen isn’t usually used to just clear up spotting, and overall Western medicine doesn’t have many treatment methods to address spotting due to these hormonal imbalances. Luckily, however, I treat these patterns all the time and they respond quite quickly to acupuncture and herbal medicine.

Fibroids, polyps, and cysts

Fibroids can cause spotting, but it’s more common for them to cause heavy menstrual bleeding and cramping during the period. It’s much more likely for polyps or ovarian cysts to cause spotting, especially randomly during the cycle.

Polyps don’t typically cause many issues for the menstrual cycle itself besides spotting, but they may effect implantation if you’re trying to conceive. While polyps may resolve on their own, if you are actively trying to conceive and having difficulty, many doctors suggest a saline ultrasound to map the interior of the uterine cavity, and if needed, hysteroscopy may be used to look inside and remove any polyps.

Ovarian cysts are quite common and they come in many different types. Cysts may not cause any symptoms, or they may cause abdominal pain, pain at ovulation, spotting, or even irregular cycles. Luckily most simple cysts resolve after just one cycle. More substantial cysts, however, such as teratomas or blood-filled cysts caused by endometriosis may need to be removed surgically.

Implantation + early pregnancy spotting

Implantation typically occurs 7 to 10 days after ovulation (4-7 days before your expected period.) It involves an embryo, or at that point a blastocyst, rooting into the uterine wall. This can cause light spotting, usually just for 1 to 2 days, and it’s not a sign that anything is wrong so it does not require any treatment. Keep in mind, spotting doesn’t always happen during implantation and there are many other reasons why spotting may be happening during this point of the cycle.

For some, spotting may also happen during pregnancy, particularly the first trimester. If you have spotting or heavier bleeding during pregnancy, especially accompanied by uterine cramping and/or low back pain, it’s recommended you see your doctor asap or go to the ER/urgent care just to make sure everything is okay.

I commonly see my patients have spotting in the first trimester without any complications. It can be caused by the normal process of the placenta embedding into the uterus, old blood/tissue being passed from the uterus, bleeding from the cervix, over-exertion/heavy lifting, or sometimes bleeding may be from a bruise that forms under the placenta (known as a subchorionic hematoma.) Depending on the cause, acupuncture and moxibustion may be effective at stopping or reducing bleeding during pregnancy.

Physical trauma

One of the most common causes of spotting due to physical trauma is simply from penetrative vaginal sex causing the cervix or vagina to bleed. This can happen if the vagina is not properly lubricated, which can cause minor tearing and bleeding. If this is the case then using extra lubrication during sex may help.

Bleeding may also come from the cervix (the opening to the uterus that is at the top of the vagina) during the times of the cycle when it is soft and sensitive, such as during ovulation or before the period. It’s more likely for spotting to happen as a result of vigorous or aggressive penetration, but not always.

Other types of trauma may include sexual abuse or injury to the vulva, vagina, cervix, or low abdomen. If you have experienced physical trauma then it’s important to visit a doctor to assess your injuries, and I would also recommend speaking with a therapist and/or councilor to address the emotional aspects of the trauma you’ve experienced.