Bleeding Between Periods? How To Tell if It’s a Problem

Have you ever experienced spotting or bleeding between periods? It’s not only inconvenient — but it can make you worry, too.

So, what is spotting? Known to happen in between your periods, this kind of bleeding can range from a heavy flow that feels like a normal period or may contain light blood in your discharge that isn’t a period either.

Often, a healthcare provider will consider your age when evaluating the possible reasons for bleeding. Many young women and people assigned female at birth (AFAB) have irregular bleeding for normal reasons, and breakthrough bleeding during the middle of a menstrual cycle isn’t uncommon.

But no matter your age, it’s important not to ignore this symptom. If you notice spotting between your normal cycle times, contact your doctor for an evaluation. While bleeding between periods generally doesn’t signal a problem, there are times that it does.

Physician assistant-certified Danielle Wehn, PA-C, explains what may cause spotting between periods, when you should see a doctor and what to expect during your visit.

Why you might be bleeding or spotting between periods

It can be frustrating — and even scary — to experience bleeding or spotting after your periods.

In most cases, you’ll have spotting but no period. And you may ask yourself: Why am I spotting two weeks after my last period?

Here are some common reasons why you may be spotting.

Perimenopause

When spotting occurs at the end of your reproductive years during perimenopause, it may be related to hormones. As you age, your hormone levels start to change, which can result in a thickening of the lining of your uterus.

“Ovulatory dysfunction or shifts are common in the years preceding menopause, as the ovaries start to plan for their retirement,” says Wehn. “Sometimes, this can result in prolonged absence of bleeding or more frequent episodes of irregular bleeding.”

Menopause

When you’re in menopause, you don’t stop getting your period automatically. It takes time. This can result in irregular bleeding or spotting.

And if you’re taking hormone replacement therapy (HRT) to manage your symptoms, this can also lead to spotting.

“It’s important to discuss any changes in bleeding on hormone therapy or during the time surrounding menopause or after with your healthcare provider,” stresses Wehn.

Uterine fibroids or polyps

Uterine fibroids and uterine polyps are noncancerous tumors that grow in the lining or muscle of your uterus and can lead to spotting and bleeding after your period.

Polycystic ovary syndrome (PCOS)

When you have PCOS, the eggs in your ovaries become surrounded by fluid-filled sacs, making it hard for eggs to be released like they normally would.

“Ovulatory dysfunction or alteration is a common result of PCOS, which can cause irregular bleeding patterns among other symptoms and issues,” explains Wehn.

Sexually transmitted infections (STIs)

STIs like chlamydia can cause bleeding in between periods.

“Some individuals diagnosed with sexually transmitted infections, including chlamydia or gonorrhea, have no signs or symptoms,” says Wehn. “Others present with irregular bleeding. It’s important to consider discussing screening for sexually transmitted infections with your healthcare provider.”

Hormonal contraceptives

If you just started a hormonal contraceptive (birth control pills, contraceptive implant, patch or injection or intrauterine device), there’s a chance you may experience spotting — known as breakthrough bleeding — during the first three months of using.

“The body takes a couple of months to adjust to the hormonal changes as a result of starting or changing hormonal contraception,” says Wehn.

Certain health conditions

Wehn says the following health conditions may also cause irregular bleeding:

• Blood clotting disorders like von Willebrand disease.
• Hypothyroidism.
• Liver disease.
• Chronic kidney disease.

Pregnancy complications

While in your first trimester, it’s common to have some minor bleeding — and may happen after sex, a pelvic exam or a Pap smear.

But if you’re bleeding more than expected, it’s important that you discuss it with your healthcare provider.

“Don’t hesitate to call your healthcare provider if you have concerns during your pregnancy,” says Wehn.

Cancer

Wehn says gynecologic cancers — cervical, ovarian, uterine, vaginal and vulvar — are rare causes of bleeding between periods.

“Ensure you’re keeping regular preventive visits with your Ob/Gyn provider,” encourages Wehn.

When to see a doctor

It’s important to track when spotting is happening and any other symptoms to share with your clinician.

You can make a few notes in a calendar on your phone or in a planner. Write down if you notice any major changes in the bleeding pattern or if the spotting is associated with symptoms that affect your daily life.

See your Ob/Gyn or healthcare provider if the irregular bleeding persists, gets worse, recurs or if you experience any postmenopausal bleeding or bleeding after sex.

Also, if this irregular bleeding is associated with other symptoms, like easy bruising, dizziness, fever, abnormal vaginal discharge or abdominal/pelvic pain, let your healthcare provider know.

What to expect

During your visit, your clinician may perform a pelvic exam, obtain cultures or order blood tests or imaging to take a closer look. They may also change your medication.

Treatment options vary depending on the cause of your spotting so it’s always best to talk or see a healthcare provider if you’re concerned about bleeding or spotting between your periods.