Table of ContentsView AllTable of ContentsCausesPatternsManagementComplicationsTreatment

Table of ContentsView All

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Table of Contents

Causes

Patterns

Management

Complications

Treatment

Irregular bleeding and spotting describe vaginal or uterine bleeding that occurs outside of your menstrual period. It can happen at any age, even before or after the reproductive years. While most cases are not a cause for concern, the problem can sometimes result from serious issues.

Irregular bleeding and spotting can range from light bloody discharge to heavier, constant bleeding. It can result from conditions such as hormone therapy, pregnancy, infections, or other health concerns.

Living with irregular bleeding and spotting can be frustrating and may pose some health dangers. Finding out the reasons for spotting can help you get the right treatment and reduce the bleeding.

Alihan Usullu / Getty Images

A person holds a sanitary pad to use for vaginal bleeding

Causes of Bleeding Outside of Period

Uterine fibroids(leiomyomas): Fibroids are muscular tumors that grow in the wall of theuterus. These growths are usually benign (not cancerous) and may be asymptomatic or cause symptoms such as bleeding betweenmenstrual periods.

Uterine polyps: Polyps are overgrowths of the inner lining of the uterus. They are usuallybenign, though some can be malignant (cancerous). Uterine polyps are rare in people younger than 20 and become more common with age. They peak in the 40s and decline inmenopause(the end of menstrual periods).

Adenomyosis: This occurs whenendometrial tissue(tissue similar to that which lines the uterus) grows into the myometrium (the muscle wall of your uterus). It can cause the uterus to double or triple in size. People age 35 to 50 who have had at least one pregnancy are most often affected.

Endometrial hyperplasia: In this condition, the endometrium becomes too thick. It is often linked to excessestrogenand/or inadequate levels ofprogesterone, resulting in too many endometrial cells. It is more likely to occur after age 35.

Gynecologic cancers: Gynecologic cancers begin in the reproductive organs. Abnormal vaginal bleeding and discharge can occur with any type of gynecologic cancer. The risk of these cancers increases with age. These cancers include:

Polycystic ovary syndrome(PCOS):This condition causes issues withovulationand the function of the ovaries. It typically affects 1 in 10 women of childbearing age. Most people find out they have it when they have problems getting pregnant.

A Note on Gender and Sex TerminologyVerywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.

A Note on Gender and Sex Terminology

Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.

Other Medical Conditions

Bleeding disorders: Inherited bleeding disorders such ashemophiliaorvon Willebrand disease, alow platelet count (thrombocytopenia), or a deficiency ofVitamin K(which helps produce blood-clotting factors) can cause vaginal bleeding.

Cervicitis:Cervicitis is an inflammation of the cervix, the canal that connects your uterus and vagina allowing fluids to pass from youruterusto yourvagina. Cervicitis can often be traced to asexually transmitted infection (STI). It can also cause bleeding or spotting between periods or after menopause.

Thyroid conditions: Different thyroid conditions can affect or interfere with your normal menstrual cycle, causing long periods, absent periods, and spotting.Thethyroidis a gland that produces hormones that regulate metabolism and influence the menstrual cycle.

Hormone-based birth control:Combined hormonal contraceptivemethods such as pills,implants,patches,shots, orringsuse synthetic hormones to help regulate your menstrual cycle. Spotting and bleeding, calledbreakthrough bleeding, can occur as your body adjusts to these hormones when you start them or switch products. It is most likely to happen with low-dose and ultra-low-dose birth control pills, the implant, and hormonal intrauterine device (IUD) in the first months after use or after stopping them. This problem usually improves within two to six months.

Hormone replacement therapy (HRT):HRT is a treatment that can helpsymptoms associated with menopause. During this time, the body gradually decreases production of estrogen and progesterone. HRT can help relieve symptoms such ashot flashes,night sweats, andvaginal drynessthat occur during menopause.

Perimenopause: Spotting is normal during perimenopause, the stage that occurs before menopause. Perimenopause can last five to 10 years as your ovaries become smaller and produce less estrogen, causing irregular periods and varying amounts of bleeding until your periods stop.

Pregnancy

Ectopic pregnancy: An ectopic pregnancy is when a fertilized egg attaches itself to the wall of afallopian tubeor somewhere else outside the uterus. Bleeding is a sign of an ectopic pregnancy.

Miscarriage: The loss of pregnancy, known as miscarriage, can cause bleeding. Typically, bleeding in the first 20 weeks of pregnancy can be a sign that you have miscarried. About 10% to 20% of pregnancies end in miscarriage.

Implantation bleeding: Implantation occurs when a fertilized egg attaches itself to the endometrium. Implantation bleeding occurs in about 25% of pregnancies in the first trimester. It usually does not indicate a problem.

Vasa previa: With this condition, blood vessels from theplacenta(the organ that develops in the uterus in pregnancy to nourish the fetus) burst because they pass over or through cervical membranes and are at risk of rupture when the supporting membranes rupture.

Placental abruption: This serious but rare condition is when the placenta separates from the uterine wall before birth.

Low-lying placenta: When the placenta attaches itself lower than it should within the uterus. It often improves as the pregnancy progresses and the uterus grows.

Premature labor: Premature labor is uterine contractions before the 37th week of pregnancy. These contractions cause the cervix to open earlier than normal, resulting in premature birth.

Other Possible Causes

Stress: Psychological stress can trigger a physiological response that can cause irregular menstrual patterns, including irregular vaginal bleeding.

Medical procedures: Medical procedures such as a cervical orendometrial biopsy(removal of a tissue sample for examination in the laboratory),pelvic exam, or other medical procedures can cause spotting.

Trauma:Genital injuries such as cuts or tears in the vaginal area from rough sex, sexual abuse, rape, or a straddle injury (groin injury from falling on an object that is being straddled) can cause bleeding.

Obesity: Research indicates that obesity plays a role in the prevalence of infrequent periods and abnormal uterine bleeding.

Medications: Many medications can cause spotting or bleeding. They include:

Verifying a Hormonal ImbalanceThe process used to verify a hormonal imbalance can vary based on your symptoms and the suspected problem. Verifying a hormonal imbalance can include:Physical exam and review of health history to determine your risk of underlying conditionsEvaluation of medications and supplementsLaboratory tests to measure hormones in your blood, urine, or saliva samplesPelvic exam to identify tumors or cysts that can interfere with hormone productionUltrasoundto examine your ovaries, uterus, pituitary, or thyroid gland

Verifying a Hormonal Imbalance

The process used to verify a hormonal imbalance can vary based on your symptoms and the suspected problem. Verifying a hormonal imbalance can include:Physical exam and review of health history to determine your risk of underlying conditionsEvaluation of medications and supplementsLaboratory tests to measure hormones in your blood, urine, or saliva samplesPelvic exam to identify tumors or cysts that can interfere with hormone productionUltrasoundto examine your ovaries, uterus, pituitary, or thyroid gland

The process used to verify a hormonal imbalance can vary based on your symptoms and the suspected problem. Verifying a hormonal imbalance can include:

Patterns of Irregular Bleeding and Spotting

“Normal” vaginal bleeding occurs during a menstrual cycle. Most menstrual cycles are between 24 and 34 days apart. The cycle begins on the first day of menstruation, with menstrual bleeding usually lasting about five to seven days. Younger people may have cycles between 21 and 45 days apart, while people in their 40s may have a longer time between periods.

Patterns of irregular bleeding and spotting can occur at any time in the lifespan. Spotting is light vaginal bleeding that usually doesn’t require a pad or tampon. It can appear as red, light brown, or dark brown blood. Brown blood is usually older blood that is exiting the uterus slowly.

Vaginal bleeding and spotting is considered irregular with it occurs in the following circumstances:

Spotting vs. Period

How to Manage Constant Bleeding and Spotting

Constant bleeding and spotting can be a challenge to manage. The unpredictability of symptoms can make you anxious or cause you to limit your activities to compensate for the possibility of bleeding. As your healthcare provider works with you to determine the cause and potential treatments, follow these strategies to help manage your symptoms:

When to Contact A Healthcare ProviderContact a healthcare provider when you have a new episode of undiagnosed spotting or bleeding between periods and any of the following symptoms are present:Your bleeding between periods is an undiagnosed problem.Your bleeding soaks through a tampon or pad every hour for two to three hours.Your spotting and bleeding lasts longer than a week.You are pregnant or have the possibility of being pregnant.You have started a new medication or hormone therapy.You have severeabdominal pain, fatigue, or dizziness.Your spotting becomes more frequent or severe.You have severe abdominal pain, but you are not menstruating.You are postmenopausal (past menopause).

When to Contact A Healthcare Provider

Contact a healthcare provider when you have a new episode of undiagnosed spotting or bleeding between periods and any of the following symptoms are present:Your bleeding between periods is an undiagnosed problem.Your bleeding soaks through a tampon or pad every hour for two to three hours.Your spotting and bleeding lasts longer than a week.You are pregnant or have the possibility of being pregnant.You have started a new medication or hormone therapy.You have severeabdominal pain, fatigue, or dizziness.Your spotting becomes more frequent or severe.You have severe abdominal pain, but you are not menstruating.You are postmenopausal (past menopause).

Contact a healthcare provider when you have a new episode of undiagnosed spotting or bleeding between periods and any of the following symptoms are present:

Complications and Risk Factors

Some types of irregular bleeding or spotting are normal. However, some causes can cause one or more of the following complications if the source of the problem is not treated:

While spotting or abnormal bleeding can occur anytime during your lifespan, you have a higher chance of having irregular bleeding or spotting with the following risk factors:

Why Am I Spotting Before My Period?

Treatments to Regulate Bleeding

The treatments prescribed to regulate spotting and irregular bleeding depend on the cause of the problem. Considerations also include whether you have plans for pregnancy. In some cases, treatment may not be necessary. When needed, common treatments include the following.

Nonhormonal Medications

Nonhormonal medications: These drugs can help control bleeding with fewer risks and adverse effects than hormone therapy and can be administered as needed. They include:

Hormone Therapy

Hormone therapy can help suppress endometrial development and reestablish predictable bleeding patterns. Hormone therapy can often help the bleeding problems that occur in perimenopause while also helping reduce symptoms such as night sweats and hot flashes. These drugs include:

Other hormonal medications occasionally used depending on the cause of irregular bleeding include:

Surgical Management

Surgical management depends on the cause and severity of irregular bleeding. Procedures include:

What’s Considered Dysfunctional Uterine Bleeding?

Summary

Spotting and irregular bleeding can occur as a result of harmless causes. However, these issues can sometimes be a sign of a hormone imbalance, pregnancy complications, or an unknown health problem.

Since they can be linked to some severe health risks, spotting and irregular bleeding should not be ignored. Contact your healthcare provider if these symptoms persist for over a week or occur with other symptoms like cramping or a fever. Getting the right treatment can help relieve symptoms and protect your well-being.

34 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mount Sinai.Vaginal bleeding between periods.MedlinePlus.Uterine fibroids.MedlinePlus.Adenomyosis.American Academy of Family Physicians.Endometrial hyperplasia.Yale Medicine.Gynecologic cancers.Office on Women’s Health.Polycystic ovary syndrome.MedlinePlus.Abnormal uterine bleeding.Temple Health.Cervicitis.Joshi BR, Rizal S, Subedi S.Thyroid dysfunction in patient with abnormal uterine bleeding in a tertiary hospital of eastern Nepal: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021;59(239):635-639. doi:10.31729/jnma.6487The American College of Obstetricians and Gynecologists (ACOG).What you should know about breakthrough bleeding with birth control.MedlinePlus.Hormone replacement therapy.American College of Obstetricians and Gynecologists (ACOG).Perimenopausal bleeding and bleeding after menopause.The American College of Obstetricians and Gynecologists (ACOG).Ectopic pregnancy.March of Dimes.Miscarriage.Baptist Health.What does implantation bleeding look like?Boston Children’s Hospital.Vasa previa.March of Dimes.Placental abruption.Yale Medicine.Placenta previa.Kaiser Permanente.Low-lying placenta versus placenta previa.March of Dimes.Preterm labor and preterm birth: are you at risk?Rafique N, Al-Sheikh MH.Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences.Saudi Med J.2018;39(1):67-73. doi:10.15537/smj.2018.1.21438Mount Sinai.Endometrial biopsy.Seattle Children’s.Genital injury - female.Zhang CY, Li H, Zhang S, et al.Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study.American Journal of Obstetrics and Gynecology. 2023;228(2):213.e1-213.e22. doi:10.1016/j.ajog.2022.10.029Kaiser Permanente.Medicines that can cause changes in menstrual bleeding.UCLA Health.7 signs of a hormonal imbalance - and what to do about it.MedlinePlus.Vaginal or uterine bleeding.Cleveland Clinic Health Essentials.Vaginal discharge color: what’s normal and what isn’t.American Academy of Family Physicians.Abnormal uterine bleeding.Revere Health.Why am I spotting between periods?MedlinePlus.Vaginal bleeding between periods.Dignity Health.Abnormal uterine bleeding.Healthdirect.Bleeding between periods.MedlinePlus.Vaginal or uterine bleeding.

34 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mount Sinai.Vaginal bleeding between periods.MedlinePlus.Uterine fibroids.MedlinePlus.Adenomyosis.American Academy of Family Physicians.Endometrial hyperplasia.Yale Medicine.Gynecologic cancers.Office on Women’s Health.Polycystic ovary syndrome.MedlinePlus.Abnormal uterine bleeding.Temple Health.Cervicitis.Joshi BR, Rizal S, Subedi S.Thyroid dysfunction in patient with abnormal uterine bleeding in a tertiary hospital of eastern Nepal: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021;59(239):635-639. doi:10.31729/jnma.6487The American College of Obstetricians and Gynecologists (ACOG).What you should know about breakthrough bleeding with birth control.MedlinePlus.Hormone replacement therapy.American College of Obstetricians and Gynecologists (ACOG).Perimenopausal bleeding and bleeding after menopause.The American College of Obstetricians and Gynecologists (ACOG).Ectopic pregnancy.March of Dimes.Miscarriage.Baptist Health.What does implantation bleeding look like?Boston Children’s Hospital.Vasa previa.March of Dimes.Placental abruption.Yale Medicine.Placenta previa.Kaiser Permanente.Low-lying placenta versus placenta previa.March of Dimes.Preterm labor and preterm birth: are you at risk?Rafique N, Al-Sheikh MH.Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences.Saudi Med J.2018;39(1):67-73. doi:10.15537/smj.2018.1.21438Mount Sinai.Endometrial biopsy.Seattle Children’s.Genital injury - female.Zhang CY, Li H, Zhang S, et al.Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study.American Journal of Obstetrics and Gynecology. 2023;228(2):213.e1-213.e22. doi:10.1016/j.ajog.2022.10.029Kaiser Permanente.Medicines that can cause changes in menstrual bleeding.UCLA Health.7 signs of a hormonal imbalance - and what to do about it.MedlinePlus.Vaginal or uterine bleeding.Cleveland Clinic Health Essentials.Vaginal discharge color: what’s normal and what isn’t.American Academy of Family Physicians.Abnormal uterine bleeding.Revere Health.Why am I spotting between periods?MedlinePlus.Vaginal bleeding between periods.Dignity Health.Abnormal uterine bleeding.Healthdirect.Bleeding between periods.MedlinePlus.Vaginal or uterine bleeding.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Mount Sinai.Vaginal bleeding between periods.MedlinePlus.Uterine fibroids.MedlinePlus.Adenomyosis.American Academy of Family Physicians.Endometrial hyperplasia.Yale Medicine.Gynecologic cancers.Office on Women’s Health.Polycystic ovary syndrome.MedlinePlus.Abnormal uterine bleeding.Temple Health.Cervicitis.Joshi BR, Rizal S, Subedi S.Thyroid dysfunction in patient with abnormal uterine bleeding in a tertiary hospital of eastern Nepal: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021;59(239):635-639. doi:10.31729/jnma.6487The American College of Obstetricians and Gynecologists (ACOG).What you should know about breakthrough bleeding with birth control.MedlinePlus.Hormone replacement therapy.American College of Obstetricians and Gynecologists (ACOG).Perimenopausal bleeding and bleeding after menopause.The American College of Obstetricians and Gynecologists (ACOG).Ectopic pregnancy.March of Dimes.Miscarriage.Baptist Health.What does implantation bleeding look like?Boston Children’s Hospital.Vasa previa.March of Dimes.Placental abruption.Yale Medicine.Placenta previa.Kaiser Permanente.Low-lying placenta versus placenta previa.March of Dimes.Preterm labor and preterm birth: are you at risk?Rafique N, Al-Sheikh MH.Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences.Saudi Med J.2018;39(1):67-73. doi:10.15537/smj.2018.1.21438Mount Sinai.Endometrial biopsy.Seattle Children’s.Genital injury - female.Zhang CY, Li H, Zhang S, et al.Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study.American Journal of Obstetrics and Gynecology. 2023;228(2):213.e1-213.e22. doi:10.1016/j.ajog.2022.10.029Kaiser Permanente.Medicines that can cause changes in menstrual bleeding.UCLA Health.7 signs of a hormonal imbalance - and what to do about it.MedlinePlus.Vaginal or uterine bleeding.Cleveland Clinic Health Essentials.Vaginal discharge color: what’s normal and what isn’t.American Academy of Family Physicians.Abnormal uterine bleeding.Revere Health.Why am I spotting between periods?MedlinePlus.Vaginal bleeding between periods.Dignity Health.Abnormal uterine bleeding.Healthdirect.Bleeding between periods.MedlinePlus.Vaginal or uterine bleeding.

Mount Sinai.Vaginal bleeding between periods.

MedlinePlus.Uterine fibroids.

MedlinePlus.Adenomyosis.

American Academy of Family Physicians.Endometrial hyperplasia.

Yale Medicine.Gynecologic cancers.

Office on Women’s Health.Polycystic ovary syndrome.

MedlinePlus.Abnormal uterine bleeding.

Temple Health.Cervicitis.

Joshi BR, Rizal S, Subedi S.Thyroid dysfunction in patient with abnormal uterine bleeding in a tertiary hospital of eastern Nepal: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021;59(239):635-639. doi:10.31729/jnma.6487

The American College of Obstetricians and Gynecologists (ACOG).What you should know about breakthrough bleeding with birth control.

MedlinePlus.Hormone replacement therapy.

American College of Obstetricians and Gynecologists (ACOG).Perimenopausal bleeding and bleeding after menopause.

The American College of Obstetricians and Gynecologists (ACOG).Ectopic pregnancy.

March of Dimes.Miscarriage.

Baptist Health.What does implantation bleeding look like?

Boston Children’s Hospital.Vasa previa.

March of Dimes.Placental abruption.

Yale Medicine.Placenta previa.

Kaiser Permanente.Low-lying placenta versus placenta previa.

March of Dimes.Preterm labor and preterm birth: are you at risk?

Rafique N, Al-Sheikh MH.Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences.Saudi Med J.2018;39(1):67-73. doi:10.15537/smj.2018.1.21438

Mount Sinai.Endometrial biopsy.

Seattle Children’s.Genital injury - female.

Zhang CY, Li H, Zhang S, et al.Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study.American Journal of Obstetrics and Gynecology. 2023;228(2):213.e1-213.e22. doi:10.1016/j.ajog.2022.10.029

Kaiser Permanente.Medicines that can cause changes in menstrual bleeding.

UCLA Health.7 signs of a hormonal imbalance - and what to do about it.

MedlinePlus.Vaginal or uterine bleeding.

Cleveland Clinic Health Essentials.Vaginal discharge color: what’s normal and what isn’t.

American Academy of Family Physicians.Abnormal uterine bleeding.

Revere Health.Why am I spotting between periods?

MedlinePlus.Vaginal bleeding between periods.

Dignity Health.Abnormal uterine bleeding.

Healthdirect.Bleeding between periods.

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