Here's How To Tell If Spotting Before Your Period Is No Biggie Or A More Serious Issue
When your Uber Eats delivery or those shoes you ordered show up early, it’s a welcome surprise. But when your period makes a preemptive appearance in the form of unexpected spotting, not so much.
Spotting before your period can understandably put you a little on edge if you're not sure what's going on with your body. But, there are several reasons why your period is getting ahead of itself that are usually no big deal.
Meet the experts: Suzy Lipinski, MD, is a board-certified ob-gyn at Pediatrix Medical Group in Denver, Colorado.
Mary Jane Minkin, MD, is a clinical professor in the department of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine.
Jill Krapf, MD, is a board-certified ob-gyn, vulvar and vaginal health specialist, and medical advisor to Evvy.
Spotting before your period is most likely related to your body's ovulation patterns.
The biggest factor at play typically is...hormones (surprise!). “[Spotting before your period] means you're not ovulating perfectly and not making as much progesterone as you should,” says Mary Jane Minkin, MD, a clinical professor in the department of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine.
Progesterone is one of the hormones involved with making menstruation happen, and Dr. Minkin says it plays an important role in stabilizing the lining of your uterus. If you don’t make enough of it during your cycle, some of your uterine lining may be discharged in the five to seven days before your period, which is that spotting you notice.
Talk to your ob-gyn about having your hormone levels tested (especially if you're planning a pregnancy). They may suggest solutions, such as birth control pills with progesterone.
Now, what if imperfect ovulation isn’t the cause of your pre-period spotting?
Bigger health problems that can cause spotting (we'll get into some of those in a sec) would most likely also cause symptoms throughout your *whole* cycle, not just the week before your period, Dr. Minkin stresses.
Here are 12 other reasons why you might be spotting prior to your period's big arrival—and what you can do about 'em.
1. You’re on a new birth control.
You’re more likely to see spotting throughout your entire cycle if you started a new type of BC, but this could also cause spotting right before your period specifically, Dr. Minkin says.
This "breakthrough bleeding" should resolve on its own in a few months after you start your new BC. If it goes on longer than that, Dr. Minkin suggests talking to your doc, who may recommend a birth-control method with a lower amount of estrogen.
2. You’re pregnant.
Surprise: You thought your period was arriving a week early, but it turns out it won’t be back for another nine months! Spotting ahead of your normal period week might actually be an early sign of pregnancy, says Dr. Minkin. The spotting you're noticing might be implantation bleeding (a.k.a. when the fertilized egg attaches to the uterine lining) or even just the early stages of pregnancy itself.
“About one-third of women will bleed in the first three months of pregnancy,” explains Dr. Minkin, who notes that this (obviously) makes some people nervous but does not necessarily signal that anything is wrong with the pregnancy. However, you should definitely talk to your doctor about your symptoms to rule out a more serious condition.
If you see spotting the week before your period typically comes but then don’t get a full-fledged period soon after, you should consider taking a pregnancy test.
3. You have a hormone imbalance.
Just like how progesterone can mess with your period, abnormal levels of estrogen may also be to blame for your spotting. Yes, this could mean estrogen changes related to a new BC, as mentioned above, or those associated with perimenopause or menopause.
A thyroid issue may also be at play here. If you have hypothyroidism (meaning your thyroid produces less thyroid hormone than it should) you might miss periods, according to Dr. Minkin. And if you deal with hyperthyroidism (when you have an excess of thyroid hormone), you might have heavier periods. Both of these may cause spotting between periods.
If you're dealing with thyroid dysfunction, you would likely have other symptoms in addition to period issues, such as weight loss/gain or fatigue. It's likely that your doc would rule out other possible underlying reasons for your pre-period spotting but possibly test your thyroid hormone levels if they suspect a thyroid problem.
4. You’re under the weather.
Almost any kind of illness or infection, from influenza to pneumonia to pelvic inflammatory disease (PID), can throw your whole cycle out of whack and give you any kind of irregular bleeding, including spotting, Dr. Minkin says. So if you’re spotting before your period but also battling some kind of sickness, it could be that your immune system is doing what it does best: prioritizing where it needs to direct more of its energy to get you healthy.
That said, if your spotting comes with pain, fever, or a vaginal odor, you should check in with your doc—it could point to the kind of infection that requires medical treatment (like an STD or the aforementioned PID).
5. You just had sex.
On another note, early spotting could be (coincidentally) linked to something else you just happened to do the week before your period—like getting busy with a sexual partner.
This doesn't actually have anything to do with your period. Medically referred to as “post-coital bleeding,” spotting a bit of blood after recently having sex may happen as a result of friction during intercourse, like if the vaginal lining gets damaged or if you don't have proper lubrication, according to the Mayo Clinic.
Bleeding in the days after having intercourse doesn’t necessitate a call to your provider unless it’s happening all the time, Dr. Minkin says. “If it happens once and goes away, it’s unlikely to be anything bad...but if it’s repetitive, we get concerned about precancerous changes on the cervix,” she explains—in which case your doctor may want to perform a test such as a Pap smear.
6. You're dealing with fibroids.
Uterine fibroids are benign growths that appear in or close to the uterus. When women visit their gyno and end up discovering they have fibroids, it often has to do with the fact that they were experiencing abnormal bleeding (which could mean before their period, but more likely is happening periodically throughout the entire cycle) and heavy periods that last longer than a week.
Fibroids tend to bring on other symptoms in addition to abnormal bleeding. Those may include pelvic pain or pressure, constipation, the need to pee frequently, and more, according to the Mayo Clinic. So if you have bleeding (especially if it's heavy) when your period should not be happening, and/or any of these other symptoms, see your MD. You can get diagnosed via an ultrasound.
7. You have endometrial or cervical cancer.
A little bit of spotting right before your period in particular most likely isn't cause for concern, as Dr. Minkin points out. However, gynecological cancers can present with abnormal bleeding so don't hold back from getting an expert opinion sooner rather than later—even if it turns out to be nothing serious. Other symptoms of endometrial or cervical cancers include pelvic pain and pain during sex.
8. You have endometriosis.
Endometriosis occurs when the tissue similar to the tissue that normally lines the inside of your uterus (AKA the endometrium) grows outside the uterus on the ovaries, bowel, bladder, and inside wall of the abdomen, says Jill Krapf, MD, a board-certified ob-gyn, vulvar and vaginal health specialist, and medical advisor to Evvy. “One of the symptoms can be bleeding or spotting between periods, which is usually red, pink, or brown,” she explains.
The other primary symptoms of endometriosis include pain in the pelvis during your period, during sex, and bloating or nausea, according to the WHO. Endometriosis can be pretty painful, so if you experience symptoms, talk to your doctor ASAP.
9. You have polycystic ovary syndrome (PCOS)
Irregular bleeding between your periods may be a sign of PCOS, a common hormone imbalance that causes anovulation, which happens when an egg (ovum) does not release from your ovary during your menstrual cycle, says Suzy Lipinski, MD, a board-certified ob-gyn at Pediatrix Medical Group in Denver, Colorado. “It is also associated with other hormone imbalance symptoms such as acne, facial hair growth, and pre-diabetic or diabetic issues,” she explains. With PCOS, some women may also go months without their period or have very frequent or heavy bleeding before or during their period, she adds.
If you’re worried about your irregular periods or you experience excess facial hair or acne, visit your doctor for an official diagnosis.
10. You have a sexually transmitted infection (STI).
STIs such as chlamydia or gonorrhea can cause inflammation of the cervix which creates increased mucus and can lead to spotting or heavier bleeding than usual during menstruation, says Dr. Krapf. These infections are typically accompanied by yellow, green, or foul colored discharge, adds Dr. Lipinski. You may also experience pelvic pain, itching of the vagina or anus, and/or a burning sensation during sex or when using the bathroom, per the Cleveland Clinic.
STIs are contagious, so if you suspect your irregular bleeding is caused by an infection, experience other associated symptoms, or have been with a partner who is infected, visit your doctor or a clinic for an exam and testing, says Dr. Lipinski.
11. You have cervical polyps.
Dr. Krapf says that cervical polyps happen when a growth forms in or on the cervix and causes irregular, light bleeding. They are mostly noncancerous and occur when gland cells overgrow, adds Dr. Lipinski.
Other symptoms of cervical polyps include unusual discharge and light bleeding after sex, so talk with your doctor if you present symptoms. Cervical polyps can also be reoccurring and turn cancerous, so a doctor will likely perform a simple outpatient procedure to remove the small growth, says Dr. Krapf.
12. You’re in perimenopause.
Perimenopause occurs when you’re transitioning to menopause and aren’t ovulating as regularly, so your periods become irregular, says Dr. Krapf. As a result, perimenopause can cause you to skip periods altogether, or have light bleeding, she adds.
Women typically start perimenopause in their 40s, and can also experience hot flashes, vaginal dryness, sleep disturbances, mood symptoms, and more, according to Harvard Health. If your symptoms become worrisome or begin to interfere with daily activities, it warrants a chat with your doctor.
How can you tell the difference between spotting and your period?
It can be tricky to tell the difference between spotting and your actual period, but the main difference is the quantity of blood, says Dr. Krapf. “Most women typically have an idea of how long a period lasts, when it will occur, and how heavy the flow is for them, so when there is light bleeding outside of the typical period time window, this is considered spotting,” she explains.
When spotting, the color of the blood is typically pink, red, or brown, whereas period blood may be a deeper red, adds Dr. Krapf. Another difference? Additional symptoms are common during a period so you may experience things like bloating, cramps, fatigue, and mood swings, adds Dr. Krapf.
Should you take a pregnancy test?
“You can take a pregnancy test when there is light bleeding but to avoid a false negative, I’d recommend waiting until the spotting stops or five days after your missed period,” Dr. Krapf explains. “This will allow your human chorionic gonadotropin levels to increase, the ‘pregnancy hormone’ which is only released once your fertilized egg has been successfully implanted in the uterus, and ensure reliable and precise results.”
When should you see a doctor?
One more time for those in the back: You are your own best health advocate so never hesitate to call your doc if you're concerned about any symptom. In particular, though, if the irregular bleeding continues for more than a few days or recurs for several months, see a doctor, says Dr. Lipinski. “Additionally, if the bleeding is heavy enough to saturate a pad in less than one hour or is associated with pain or other serious symptoms, see a doctor,” she adds.
You should also see a physician if you are pregnant or suspect you’re pregnant, adds Dr. Krapf. “Although it may be nothing to worry about, it’s always best if you’re experiencing unexplained symptoms to be proactive about your health and get a better understanding of what may be causing it.”
What is the treatment for irregular spotting?
Treatment will completely depend on the cause of the bleeding but can be as simple as a change or addition in birth control pills or an antibiotic medication to clear up a bacterial infection, explains Dr. Krapf.
If you experience spotting before your period, make note of when the spotting occurs and talk with your doctor. From there, they can give a proper diagnosis and discuss possible treatment plans.
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