Spotting Between Periods: Causes & When to See a Doctor

13 min read
Spotting Between Periods: Causes & When to See a Doctor

Spotting between periods is light vaginal bleeding that happens outside your usual period. It might appear as a few drops of pink, red or brown blood in your underwear or when you wipe.

It can happen for many reasons, from hormonal contraception and changes in your cycle to infections or other health conditions. Many causes aren't serious, but some need treatment, so unexpected bleeding is worth discussing with a doctor.

Key points

  • Spotting has many possible causes and many aren't serious. Its colour, timing and amount can't reliably tell you which one applies.
  • See your GP about bleeding between periods, bleeding after sex or any bleeding after menopause, even if it's light.
  • If you're pregnant and have vaginal bleeding, contact your doctor, midwife or hospital promptly.
  • Seek urgent medical help for very heavy bleeding, fainting or sudden severe abdominal or pelvic pain.

On this page

What is spotting?

Spotting is a small amount of vaginal bleeding outside your expected period. Doctors may also describe bleeding between periods as intermenstrual bleeding.

You might notice a few drops on toilet paper, a small mark in your underwear or enough bleeding to use a liner or light pad.

The blood can look pink, red or brown. Brown blood may simply be blood that has taken longer to leave the body.

Colour, timing and amount can't reliably tell you why you're bleeding. Our guide to period blood colour explains more about why blood can appear in different shades.

Spotting can happen:

  • a few days before or after your period
  • around the middle of your cycle
  • after vaginal sex
  • when you start or change hormonal contraception
  • during pregnancy
  • during perimenopause

These patterns can provide useful clues, but none of them identifies the cause by itself.

Spotting vs a period: what's the difference?

The main difference is usually the amount of bleeding and how it fits with your normal menstrual pattern.

Feature Spotting Menstrual period
Amount Usually a few drops or small marks Typically a more sustained flow
Timing Outside your expected period Around the time you expect your period
Duration May be brief or intermittent Commonly lasts several days
Colour Can be pink, red or brown Can also be pink, red, dark red or brown
Period products May only need a liner or light protection Depends on your flow and preferences

These are general differences, not diagnostic rules.

A light period can look like spotting, particularly if your cycles are irregular. Spotting can also happen with cramps or other symptoms, so having or not having period symptoms isn't a reliable way to tell the difference.

For more about menstrual flow, read how much you bleed during your period.

What causes spotting between periods?

There are many possible causes. Some relate to hormonal or menstrual changes while others need medical assessment.

Hormonal contraception

Breakthrough bleeding is bleeding outside your expected period while using hormonal contraception.

It can happen with methods including:

  • the combined pill
  • the progestogen-only pill
  • hormonal IUDs
  • the contraceptive implant
  • contraceptive injections
  • the vaginal ring
  • the contraceptive patch

It's particularly common after starting or changing a hormonal method. Missing contraceptive pills can also contribute to breakthrough bleeding.

If the bleeding continues, is bothersome or starts after you've been using a method without bleeding for some time, speak with your GP or contraception provider.

Don't stop or change prescribed contraception without discussing it with your healthcare professional.

Our guide to contraception options in Australia explains the different methods.

Ovulation

Some people experience light spotting around the middle of their cycle.

Hormonal changes around ovulation are one possible explanation. However, the timing of bleeding by itself can't confirm that ovulation is the cause.

If mid-cycle bleeding is new, keeps happening or worries you, mention it to your GP rather than assuming it's simply ovulation.

You can read more in our guide to the menstrual cycle.

Pregnancy-related bleeding

Spotting and bleeding can occur during pregnancy, particularly during the first trimester.

Almost 1 in 4 people experience some vaginal bleeding during pregnancy, and many go on to have a healthy pregnancy. However, bleeding can also occur with miscarriage, ectopic pregnancy and other pregnancy complications, so it still needs medical advice.

You may hear the term implantation bleeding used for light bleeding around the time a pregnancy implants in the uterine lining. Bleeding alone can't confirm that implantation is the cause because it can look the same as spotting from other reasons.

If pregnancy is possible, a home pregnancy test may be useful.

If you are pregnant and have any vaginal bleeding, contact your doctor, midwife or hospital promptly.

Perimenopause

Periods often become less predictable during perimenopause as hormone levels and ovulation patterns change.

You might experience longer or shorter cycles, skipped periods, changes in flow or bleeding that appears irregular.

Bleeding between periods or after sex is still worth discussing with your doctor rather than automatically attributing it to perimenopause.

Read our guide to menopause and the transition for more.

Polyendocrine metabolic ovarian syndrome (PMOS)

Polyendocrine metabolic ovarian syndrome, or PMOS, is the condition previously known as polycystic ovary syndrome or PCOS.

PMOS can affect ovulation and lead to infrequent periods or unpredictable bleeding. Bleeding that seems like spotting may sometimes be part of an irregular menstrual cycle.

Spotting by itself doesn't mean you have PMOS, and a healthcare professional can assess whether other symptoms or tests suggest it.

Infections

Infections affecting the vagina, cervix or uterus can cause bleeding between periods or after sex.

Sexually transmitted infections such as chlamydia and gonorrhoea can sometimes cause abnormal bleeding and may cause few or no other symptoms.

If an infection spreads to the uterus or fallopian tubes it can cause pelvic inflammatory disease, or PID. Symptoms may include pelvic pain, unusual vaginal discharge, fever or pain during sex.

Learn more about pelvic inflammatory disease (PID) symptoms and when to seek medical help.

See a doctor if you experience bleeding after sex, unusual discharge, pelvic discomfort, pain when urinating or possible exposure to an STI.

Fibroids and polyps

Fibroids and polyps are usually non-cancerous growths that can affect menstrual bleeding.

Polyps can occur inside the uterus or on the cervix, while fibroids grow from the muscular tissue of the uterus.

Either may contribute to irregular bleeding, heavier periods or bleeding between periods.Β 

Learn more about uterine polyps and irregular bleeding.

Endometriosis and other conditions

Endometriosis can sometimes occur with irregular bleeding or spotting, although bleeding alone can't diagnose it.

Other possible causes include:

  • blood-clotting conditions
  • injury or irritation of the vagina or cervix
  • some medicines, including blood thinners
  • menopausal hormone therapy

Less common causes

Less commonly, unexplained bleeding between periods can be associated with cervical or endometrial cancer or precancerous changes.

Most people with spotting do not have cancer. The reason unexpected or persistent bleeding is investigated is that you can't tell which cause applies simply from the amount, colour or timing of the bleeding.

When should you see a doctor about spotting?

Australian health guidance recommends speaking with a doctor if you have bleeding between periods.

It's particularly important to arrange an appointment if:

  • the spotting is new, persistent or keeps coming back
  • you bleed during or after sex
  • you have pelvic or abdominal pain
  • you have unusual vaginal discharge or a fever
  • your periods have become considerably heavier or longer
  • pregnancy is possible
  • you develop unexpected bleeding while using contraception

If your concerns aren't being addressed or symptoms continue despite reassurance, it's reasonable to ask for another review or a second opinion.

Our guide to talking to a doctor about vaginal concerns can help you prepare for an appointment.

Bleeding after sex

Bleeding during or after sex is called postcoital bleeding.

There are many possible causes, including irritation, infection, cervical polyps and other changes to the cervix.

It's worth discussing postcoital bleeding with your doctor whatever your age.

Persistent or recurrent bleeding after sex needs further assessment even if previous cervical screening results have been reassuring.

Bleeding after menopause

Menopause is reached when you haven't had a menstrual period for 12 consecutive months and there isn't another explanation.

Any vaginal bleeding or spotting after menopause should be checked by a doctor, even if it's only a small amount or only happens once.

If you use menopausal hormone therapy, unscheduled bleeding can occur, particularly in the first few months. Tell your doctor about the bleeding rather than assuming the hormone therapy is the cause.

When is spotting urgent?

Most spotting isn't a medical emergency, but some combinations of bleeding and other symptoms need urgent care.

If bleeding is very heavy

Call triple zero (000) for an ambulance if you're bleeding very heavily and feel faint, think you may pass out or are seriously unwell.

Seek urgent medical care if bleeding suddenly becomes much heavier than usual or occurs with significant dizziness or weakness.

If pregnancy is possible

If you know you're pregnant and have vaginal bleeding, contact your doctor, midwife or hospital promptly.

Seek urgent assessment if pregnancy is possible and bleeding occurs with severe lower abdominal or pelvic pain, shoulder-tip pain, dizziness or fainting. These can occur with an ectopic pregnancy.

Sudden severe abdominal or pelvic pain requires urgent medical assessment even if you haven't yet had a positive pregnancy test.

If you collapse, have uncontrollable bleeding, are in severe pain or feel seriously unwell, call triple zero (000).

If you're unsure how urgently you need care, call healthdirect on 1800 022 222 for advice from a registered nurse.

What should you do if you notice spotting?

You don't need to work out the cause yourself.

A few simple notes can make your appointment more useful:

  1. Record when the bleeding happens and where you are in your menstrual cycle.
  2. Note whether it happens during or after sex.
  3. Describe the amount, such as only when wiping, a mark in your underwear or enough to need a liner or pad.
  4. Record any pelvic pain, unusual discharge, fever, dizziness or other symptoms.
  5. Note any recent changes to contraception or missed pills.
  6. Consider whether pregnancy is possible.

Period Shop's free downloadable period tracker can help you record bleeding, symptoms and other changes across your cycle.

What period products can you use for spotting?

For occasional light spotting, a liner or light pad may be enough.

If you'd prefer a washable option, you can browse our reusable cloth pads and liners.

Choose whatever feels comfortable for the amount of bleeding you're experiencing.

A menstrual cup or disc isn't necessary just to monitor spotting, and no period product can tell you why the bleeding is happening.

What might your GP check?

Your GP will usually ask about your menstrual cycle, contraception, medicines, possible pregnancy, sexual health and any other symptoms.

Depending on your circumstances, investigations may include:

  • a pregnancy test
  • STI tests or vaginal swabs
  • blood tests
  • an examination of the vagina and cervix
  • a pelvic ultrasound, which may include a transvaginal ultrasound
  • referral to a gynaecologist

What about cervical screening?

Routine cervical screening is designed for people who don't have symptoms.

Unexplained abnormal bleeding follows a diagnostic pathway rather than simply waiting until your next routine Cervical Screening Test is due.

Australian cervical screening guidelines recommend a clinician-collected co-test for persistent unexplained intermenstrual bleeding, postcoital bleeding and postmenopausal bleeding where appropriate. A co-test checks for HPV and examines cervical cells using liquid-based cytology.

A self-collected cervical screening sample can't be used for this co-test because self-collection tests for HPV only and doesn't provide the cervical cell sample needed for cytology.

Not every episode of irregular bleeding requires a co-test. For example, specific pathways apply when bleeding is clearly related to hormonal contraception or a diagnosed STI. Your doctor can decide which investigations are appropriate for your circumstances.

If you're due for routine cervical screening and don't have symptoms, our guide to self-collected cervical screening explains your options.

You can ask why any test or examination is being recommended and discuss your preferences before it begins.

Common questions about spotting

Can you have spotting without pain?

Yes. Spotting can occur without cramps or discomfort. Having no pain doesn't identify the cause or rule out something that needs assessment.

Is brown spotting different from red spotting?

Brown blood may simply be older blood that has taken longer to leave the body. Colour alone can't tell you whether spotting is harmless or whether it needs investigation.

Can stress cause spotting?

Stress and other changes such as significant weight changes or very high levels of exercise can affect menstrual cycles. However, unexplained spotting shouldn't automatically be attributed to stress because there are many other possible causes.

Can spotting happen while taking the pill?

Yes. Breakthrough bleeding can happen with hormonal contraception, particularly after starting a new method, changing methods or missing pills. Speak with your contraception provider if the bleeding persists, becomes troublesome or changes unexpectedly.

Can spotting happen around ovulation?

Yes, some people notice light mid-cycle bleeding around the time they may be ovulating. Timing alone can't prove ovulation is the cause, so recurring or unexplained mid-cycle bleeding is still worth mentioning to your GP.

Is bleeding after sex something to worry about?

There are several possible causes of bleeding after sex and many aren't serious. However, it should still be discussed with your doctor because infections, cervical changes and other conditions can cause it. Persistent or recurrent postcoital bleeding requires further investigation.

Can spotting mean pregnancy?

It can occur during early pregnancy, but spotting isn't a reliable way to tell whether you're pregnant. If pregnancy is possible, take a pregnancy test. If you're pregnant and have vaginal bleeding, contact your doctor, midwife or hospital for advice.

Understanding your cycle without guessing

Spotting between periods can happen for many different reasons.

Some causes are related to hormonal contraception or changes in the menstrual cycle, while others need investigation or treatment.

The most useful approach is to notice what has changed, keep a record of the timing and any other symptoms and seek medical advice rather than trying to diagnose the cause from blood colour or timing alone.

For a practical next step, download Period Shop's free period tracker and use it to record your symptoms before an appointment.

Related reading

Sources and further reading

This article provides general educational information and isn't a substitute for individual medical advice. If you have unexpected bleeding, a qualified healthcare professional can help work out the cause.