You’ve started spotting on day 10 of your cycle and you have no idea why. Ack!
It’s a week before your period and suddenly you find blood in your underwear. What?!
Your period was two weeks ago and it’s come again. Nooo!
Spotting or irregular bleeding (known as Abnormal Uterine Bleeding -AUB) causes a lot of distress for women because they feel this isn’t normal and they worry about what it means for the current state of their hormonal health and future fertility.
Plus, it can be downright inconvenient. As if your period isn’t bad enough on it’s own, you’re then saddled with a whole lot of extra hassle each month. This creates a ton of stress that just compounds the underlying problem.
Here are the most common irregular bleeding scenarios:
1. I spot during or around ovulation time.
2. I start spotting sometime after ovulation and it lasts until I get my period.
3. I spot anywhere from 1-7 days before my period.
4. I spot for a couple days after my period.
5. I basically bleed all the darn time!
Why are you spotting?
There are quite a few reasons you might be experiencing bleeding between your periods. You also have to keep in mind that sometimes it’s a totally normal occurrence—sometimes during pregnancy and ovulation spotting are two of those instances.
However, infection, endometriosis, ovarian cysts, uterine polyps, fibroids, thyroid disease, anovulatory cycles (such as is the case with PCOS), and progesterone deficiency are not considered “normal” reasons for irregular bleeding.
Important note: For many of us, our periods begin with spotting. (Please note that spotting is not considered your period, and if you’re tracking your cycle, spotting should not be counted as the beginning of menstruation.)
Here are the main reasons for spotting between your periods:
1. Spotting after ovulation
In most cases, this is considered normal. In fact, this kind of spotting is a sign of fertility when it happens only at ovulation and you’re not spotting at other times in your cycle as well.
True ovulation spotting occurs only with ovulation, and usually lasts for around 1-3 days. It looks like fertile cervical fluid streaked with bright red, light red or pink. Estrogen rises significantly and then drops right before ovulation. This causes a mini estrogen-withdrawal and slight partial shedding of the uterine lining in some cases, because progesterone hasn’t had a chance to kick in (to keep the uterine lining in place).
It’s considered to be perfectly normal and doesn’t need treatment. Interestingly, there is a study that suggests it occurs in women who have a higher estrogen and LH spike at ovulation time, and higher progesterone rise in the second half of the cycle.
Another scenario is that ovulation spotting is caused by the follicle rupturing as the egg is released into the fallopian tube. This would typically happen on the day of ovulation.
If you notice the blood is brown in color, you should get your estradiol tested (the type of estrogen most prevalent in cycling women), and consider getting a full thyroid panel done as well (TSH, free T3, free T4, TPO and TGAB, along with reverse T3). Higher estrogen and low thyroid function (which often is a cause of low progesterone) is typically associated with brown blood spotting.
According to Dr. Lara Briden, author of the Period Repair Manual, “The spotting caused by any of those conditions (listed previously) can occur mid-cycle, so it could masquerade as normal ovulation spotting. However, it would usually be seen at other times as well.”
2. Low progesterone spotting
By far this is the most common cause of spotting or irregular bleeding that happens anytime after ovulation right up to the day before your period. Progesterone keeps your uterine lining intact until your period comes. If your progesterone levels aren’t high enough, you might start spotting after ovulation. Or it might drop prematurely before your period and cause pre-period spotting.
Lots of women ask me if ovulation is the only time that spotting is normal? Or can someone spot the day of or the day before her period and be okay?
Premenstrual spotting for 1 to 2 days before your period begins is no big deal; this blood is often darker red or brown because it’s slow mov- ing or is leftover blood from the previous cycle, which is common with a flexed or tipped uterus.
However, spotting for more than 3 days leading up to your period is not considered normal. In fact, it is often a sign that your progesterone is dropping too quickly and could also indicate a condition such as endometriosis, uterine fibroids, or hypothyroidism.
You can take this at home Progesterone Test to find out if your levels are normal. Use coupon code Hormones20 to get 20% off all tests at Lets Get Checked.
3. Spotting due to bacterial, yeast infections, or sexually transmitted infections
The other reason I’ve seen (and experienced myself!) for spotting before a period is when there is some kind of bacterial infection or bacterial imbalance in the vagina.
Bacterial vaginosis (BV), the most common vaginal infection in women between 15 and 44, can cause white or grayish vaginal discharge, pain, itching and burning, a fish-like odor, and burning when you pee, but it can also cause spotting. Likewise, sexually transmitted infections (STIs) like trichomoniasis causes many of the same symptoms.
Dr. Briden says, “Spotting is a common symptom of bacterial vaginosis, but it doesn’t seem to correlate with hormones. It relates to inflammation of the cervix, so women see red-tinged mucus after the cervix has been bumped, say after sex or a PAP smear.”
If anything seems “off,” no matter how minor you think it is, make your way to the doctor ASAP. If you have an STD, you have an increased risk for getting HIV and other STDs—and your sexual partner should be tested and treated, too.
I’ve personally experienced spotting because of an infection so it is super important that you see a doctor to get diagnosed and treated. Additionally, you might want to try Purefem suppositories or FloraFemme suppositories, Vitanica Yeast Arrest Suppositories and Yeastgard Advanced Suppositories for a more natural treatment. I’ve tried them all and they are very effective.
Important note: Please go see your doctor and get tested to determine what could be going on with you.
4. Spotting due to fibroids, endometriosis or adenomyosis
More serious conditions like these also contribute to spotting and irregular bleeding. I noticed women with these conditions tend to spot for days after their period in the lead up to ovulation. They are often linked to an imbalance in estrogen and progesterone, where estrogen becomes dominant over progesterone and over-stimulates the endometrial lining.
There are other factors that play a role in their development as well, like genetics, inflammation, blood sugar and insulin imbalances, obesity and immune system problems.
5. Spotting caused by hormonal birth control or the Copper IUD
There are a number of hormonal birth control methods that can cause spotting and irregular bleeding. The pill, the shot (depo provera), and the implant (implanon or nexplanon) have all been linked to spotting in between periods. If this is an ongoing problem for you, definitely see your doctor.
The copper IUD known as Paragard commonly causes irregular bleeding. Clients who have had the copper IUD implanted have complained of spotting for up to 10 days before they get their periods, blood clots, and long periods. One study found that women who had the copper IUD inserted continued to have spotting 39 weeks after having it inserted!
On the flip side, many women are super happy with their copper IUD, so as always, you need to make the best—and an informed—decision for yourself.
If you need help coming off hormonal birth control, I’ve created the ultimate step by step protocol to help you transition off hormonal birth control (the pill, patch, IUD, implant, etc.) and take back control of your hormones, your body and your life. Check out my Fix Your Birth Control Protocol here!
6. Spotting due to stress
This ties in with low progesterone. When we’re stressed, we produce stress hormones like cortisol and epinephrine. During long periods of stress, our bodies make the executive decision to delay or stop ovulation due to the higher levels of these stress hormones indicating that this is not a safe time to ovulate or get pregnant.
Remember, we need cortisol but we don’t need normal reproductive function to survive, hence the reason our ovaries take a big hit when we experience ongoing psychological stress. If we don’t ovulate consistently, estrogen will continue its job of stimulating the uterine lining and without enough progesterone to slow uterine lining growth, it can get too thick and cause ongoing spotting issues.
7. Spotting can happen during pregnancy
Although missing a period is always a hallmark sign of being pregnant, you could actually have spotting while you’re pregnant. In fact, about 20 percent of women experience spotting during the first trimester.
Spotting can occur during pregnancy because there’s an increase in the amount of blood to the cervix and its surrounding tissue, or because of an “implantation bleed,” when the embryo is implanted into the uterus about 6 to 12 days after the egg was fertilized.
Spotting may also happen simply because you had a hard workout at the gym or an intense romp with your partner.
Of course, you should always take a pregnancy test to confirm. If you are pregnant, light pink or brown spotting are both normal. While bright red or heavy bleeding are not normal, it doesn’t necessarily mean you had a miscarriage—your best bet is to always consult your doctor right away.
What can you do to stop spotting between periods?
There is a lot you can do to address irregular bleeding in between cycles, especially from a root cause perspective. Progesterone should remain high during the luteal phase and if it is prematurely dropping that needs to be addressed.
If you are spotting anytime after ovulation and/or leading up to your period here’s what you should do:
1. Make sure you are actually ovulating.
If you are not ovulating consistently, you are going to be progesterone deficient.
This requires tracking your cycle using an app (see my top 3 fertility trackers here) and even taking your basal body temperature to see if there is a mid-month rise in temps.
Progesterone raises your body temperature so you will see a distinct thermal shift 1-2 days after ovulation occurs. I teach you how to track your temperatures in my Fix Your Birth Control Protocol.
You can also use an OPK (Ovulation Predictor Kit) but keep in mind that it doesn’t tell you that you’ve actually ovulated, it only tells you that there has been a spike in luteinizing hormone which precedes ovulation by about 24-36 hours. So if you happen to have a stressful event during that time, your body might delay ovulation by a day or longer and you could miss your opportunity to get pregnant if that’s what you’re trying to do.
2. Get your progesterone tested.
Ideally you want your progesterone tested on days 19-21 of your cycle or about a week after you have ovulated (mid-luteal phase). If you ovulate later, just count 7 days after ovulation and get your test done then. Your blood serum progesterone level should be 15-25ng/mL.
If it is lower, don’t freak out. Anything over 7ng/mL is an indicator of ovulation.
Grab this at home Progesterone Test to find out if your levels are normal and be sure to use coupon code Hormones20 to get 20% off this test.
3. Increase your progesterone levels. Duh, right? 🙂
There are a number of things you can do to increase your progesterone:
- Start with increasing your intake of magnesium-rich foods like leafy green vegetables (kale, collards and spinach are my faves). I love this cookbook for leafy greens too! You should also incorporate pumpkin, chia and flax seeds to get a good dose of food-based magnesium. Add them to smoothies, salads, or on top of your favorite dishes. Additionally it’s a good idea to add in 200-400mg a day of magnesium glycinate.
- You can try seed-cycling, where you consume certain seeds throughout your monthly cycle that provide the nutrients to maintain proper hormone balance. Get my free guide here.
- Try rhodiola rosea. It’s commonly used for reigning in the bad boy hormone cortisol. This will help reduce the conversion of progesterone to cortisol which will indirectly raise your progesterone. Yay! I recommend 200mg twice a day for 8-12 weeks. Here is the brand I have used and love.
4. See an acupuncturist.
A qualified acupuncturist will look more deeply at your hormonal balance and help you address the specific cause of your spotting with regular acupuncture and herbs. If you can’t get to an acupuncturist or you don’t like needles, check out Aimee Raupp’s free Fertility Enhancing Acupressure Guide. Aimee is the fertility acupuncturist extraordinaire and this guide includes a worksheet and video discussing location, function and the emotional correlation of each acupressure point and is a great way to regulate your hormones and optimize your fertility from the comfort of your own home.
If you are spotting between periods due to a bacterial infection, here is what you should do:
1. See a doctor for a proper diagnosis.
And by doctor, I don’t mean “Dr. Google,” okay? 🙂 It’s best to get tested to see what’s going and make sure it’s nothing serious.
2. Address the root cause of the infection.
In most of the cases I’ve seen (including myself), healing the gut has helped reduce and eliminate any chronic bacterial or yeast infections. Start with something simple like fermented foods like sauerkraut with each meal or a probiotic. I use and highly recommend Megaspore Probiotics. Use code “NJC”.
3. Treat it effectively.
I don’t love the prescription meds for bacterial or yeast infections and don’t find them particularly useful for chronic infections. Just my humble opinion, but obviously you should do what feels best for you. Instead, I have found some other solutions to tackle this issue:
- FloraFemme suppositories – this was the best one I used.
- Ultimate Flora Vaginal Support – really good probiotics.
If you are spotting due to conditions like endometriosis, fibroids, or adenomyosis, here is what you should do:
1. Test your estrogen levels.
You need to make sure that your estrogen levels aren’t too high in relation to your progesterone. You can now test your hormone levels from home. I recommend taking this test from Let’s Get Checked (use coupon code Hormones20 to get 20% off).
If you are estrogen dominant, I recommend following these steps:
- Take a good B complex vitamin. You need sufficient B6, B9 and B12 in order for your liver to efficiently detox estrogen. Try Thorne Research Basic B Complex.
- Consider taking SGS. This is a broccoli extract that effectively supports phase 2 of liver detoxification which tends to get backlogged because there are more detox pathways than in phase 1. Try Thorne Research Crucera SGS. Take 2 capsules every other day for 4 weeks.
2. Include more turmeric in your diet.
I think everyone should include more turmeric in their diet, regardless of estrogen dominance. It is one seriously awesome spice that has many benefits like less pain and inflammation! The best way to consume it is with some form of healthy fat like coconut oil and black pepper. Check out my friend Michelle Lyons’ blog post on how to make this fabulous concoction.
Check out my friend Dr. Lara Briden’s excellent book The Period Repair Manual.