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 Dysfunctional Uterine Bleeding) 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 – pregnancy and ovulation spotting are two of those instances.
However, infection, endometriosis, ovarian cysts, uterine polyps, fibroids, thyroid disease, anovulatory cycles (such as PCOS), and progesterone deficiency are not considered “normal” reasons for irregular bleeding.
Dr. Lara Briden, author of the Period Repair Manual says “The spotting caused by any of those conditions can occur mid-cycle, so it could masquerade as normal ovulation spotting. However, it would usually be seen at other times as well.”
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, because progesterone hasn’t had a chance to kick in (to keep the uterine lining in place).
Dr. Lara finds it’s more likely to occur in slender women with lower baseline estrogen, but I’ve also seen it in women with estrogen dominance. 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. See figure 3 on the study page.
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.
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?
Dr. Briden says, “Officially, it’s “okay” or normal to see a few days of premenstrual spotting. But it probably means lower-than-optimal progesterone levels.”
3. Spotting due to bacterial, yeast infections or sexually transmitted infections
The other reason I’ve seen (and experienced!) for spotting before a period is when there is some kind of bacterial infection or bacterial imbalance in the vagina.
Dr. Briden says, “Spotting is a common symptom of bacteria 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.”
I’ve personally experienced spotting because of an infection so I highly recommend seeing a doctor to get diagnosed. Additionally, you might want to try Purefem suppositories, VH Essentials suppositories or FloraFemme 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. 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, blood sugar and insulin imbalances, obesity and immune system problems.
5. Spotting caused by hormonal birth control
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 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 steal pregnenolone and progesterone to make more cortisol so we can survive.
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.
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 (I wrote a post about the best apps 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 do this 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 15-33ng/mL and your saliva progesterone level should be 75-270 pg/mL.
If it is lower, don’t freak out. Hormone levels fluctuate a lot during the course of a day. It’s important to pay attention to the symptoms first and foremost.
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 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 8oz of bone broth daily (you can now buy bone broth online!) and fermented foods like sauerkraut with each meal.
3. Treat it effectively
I don’t love the prescription meds for bacterial or yeast infections and don’t find them particularly useful! 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:
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.
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, inflammation and lighter periods! 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.
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Information in this post and on this web site is provided for informational purposes only. The information is a result of practice experience and research by the author. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional or any information contained on or in any product label or packaging. Do not use the information on this web site for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem.
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Check out my friend Dr. Lara Briden’s excellent book The Period Repair Manual.