How To Manage Breakthrough Bleeding During Your Menstrual Cycle

If you've experienced breakthrough bleeding, or spotting, in between periods, you're in good company. In fact, most women experience at least one bout of between-cycle spotting, and for some women, spotting happens quite often.

"Spotting happens for a variety of reasons," says Homa Wenah, CNM, a certified nurse midwife at Henry Ford Health. "While most women associate spotting with pregnancy, it can happen even when you're not expecting."

Spotting Defined

Spotting is any bleeding that happens outside your regular menstruation window. Sometimes called "breakthrough bleeding," spotting usually involves small amounts of blood.

"You might see blood on toilet paper after using the bathroom, or light bloodstains on your underwear," Wenah says. Spotting is lighter in flow than your period, it tends to be pink or light brown in color, and it usually doesn't last longer than a day or two.

If you're soaking a pad or tampon, that's not spotting. It's intermenstrual bleeding and you should see a doctor to determine the cause. Spotting, on the other hand, is usually benign and typically resolves on its own or with minor interventions.

What Causes Spotting?

Since spotting is a common experience for many women, it makes sense to drill down on the reasons why it's happening — and seek appropriate treatment, if necessary. Here are several common, mostly benign, triggers:

1. Birth control. Many birth control methods can trigger breakthrough bleeding. Whether you use a pill, patch, injection or IUD, spotting between periods isn't unusual. "When you start a new birth control method, you're likely to have irregular periods until your body adjusts," Wenah says.
2. Endometriosis. Endometriosis is a condition that happens when endometrial tissue (which lines the uterus) grows outside of the uterus, in places like the ovaries, belly and bowel. Like fibroids, endometriosis can cause spotting, heavy bleeding, or intermittent episodes of both.
3. Fibroids. Uterine fibroids are growths that develop on the uterus. They may cause spotting or even heavy bleeding. They can even happen without producing any symptoms. Fibroids may come and go, but if they don't, doctors can remove them with a minimally invasive procedure.
4. Injury. Vaginal tissue is fragile, and spotting can happen as a result of injury to the area, rough sex or even a medical procedure, such as a pelvic exam.
5. Ovulation. Some women experience spotting when they ovulate. "When your ovary releases an egg, it triggers a sort of light bleeding that can last for one to two days," Wenah says. Ovulation spotting is usually light pink or red and it happens in the middle of your cycle when your cervical mucus is stringy (like an egg white).
6. Pelvic Infections. Spotting can happen as a result of infections, including sexually transmitted infections (STIs), such as chlamydia and gonorrhea, as well as pelvic inflammatory disease, or PID. With PID, bacteria spread from your vagina to the uterus, fallopian tubes and ovaries.
7. Polycystic ovarian syndrome (PCOS). PCOS happens when one or more cysts develop on your ovaries. Many women with PCOS experience irregular periods and breakthrough bleeding as a result of higher circulating male hormones in their bodies.
8. Polyps. Polyps are small tissue growths that are usually benign. They can occur in a number of places, including the cervix and uterus. If you have uterine or cervical polyps, you may experience light bleeding after sex and in between periods.

When Is Spotting Cause For Concern?

Your menstrual cycle can serve as a litmus test for your overall health and well-being. So almost any change in your health can impact your menstrual cycle and cause spotting between periods.

"If you're under an enormous amount of stress, lose or gain a lot of weight, or start taking a new medication, you might experience changes in your period that include spotting," Wenah says.

Medications that are commonly linked with spotting include:

• Birth control pills
• Blood thinners
• Hormonal drugs
• Thyroid medication

Most episodes of spotting, particularly if they're temporary, aren't cause for concern. But spotting can also be a sign of serious health issues, such as cancer, diabetes, liver disease and bleeding disorders. In every case, it's a good idea to get checked out by your health care provider if you're experiencing breakthrough bleeding between periods.

"Your doctor will do a physical exam and may order a variety of tests including lab tests and pelvic ultrasound to rule out serious issues and pinpoint the source of spotting," Wenah says.

To find a doctor or certified nurse midwife at Henry Ford, visit henryford.com or call 1-800-436-7936.

Homa Wenah is a certified nurse midwife who sees patients at Henry Ford Medical Center - New Center One.