Ask Your Ob/Gyn: Spotting Between Periods—Should You Be Concerned?

woman checking periods on menstrual calendarSpotting or bleeding between periods does happen occasionally. Most of the time, it does not signal a health problem. Still, it is inconvenient, and most women want to know what is going on.

There are definitely situations where spotting or irregular bleeding should not be ignored. You should consult your ob-gyn if:

  • There is any chance you may be pregnant.
  • You have reached or are approaching menopause.
  • You also have pain.
  • You have had several episodes of irregular spotting or bleeding.

A pregnancy that develops in the fallopian tube instead of the uterus will cause bleeding. This is a very serious problem and needs immediate medical care. Also, spotting or bleeding after menopause should always be evaluated by your doctor. Although the menopause transition usually occurs around age 50, the age varies. So, women in their forties should probably not ignore the symptom. A woman who has spotting along with discomfort, or repeated spotting, should consult her doctor regardless of her age. Fibroids (benign tumors) can develop within the uterus. They are very common and may cause pain and bleeding as they enlarge. Women can develop fibroids even in their thirties or before. We recommend treatment for fibroids when they are getting larger and causing symptoms.

Women using hormonal birth control methods can occasionally have an episode of spotting or bleeding not related to a menstrual period. It can range from barely noticeable to heavier bleeding. This type of breakthrough bleeding is usually not a sign that something is wrong. But neither is it something you just need to put up with. Your ob-gyn can offer solutions.

Birth control methods that prevent pregnancy by delivering hormones include birth control pills, the vaginal ring, birth control shots, implants, patches, and hormonal IUDs (intrauterine devices). Your birth control is still effective in preventing pregnancy even if you have breakthrough bleeding.

Smoking increases the likelihood of breakthrough bleeding. So do certain STDs like chlamydia or gonorrhea.

Women who take birth control pills continuously, hoping to have no periods, will likely eventually have some breakthrough bleeding. This is not a problem unless it is bothersome to you. After a hormonal IUD is placed, a woman may have some irregular bleeding at first. It usually gets better within a few months. Women using the ultra-low dose birth control pill are a bit more likely to have breakthrough bleeding.

We suggest you schedule an office visit if you are having irregular spotting or bleeding. We will ask you to describe your experience, and we will usually do an exam. If hormonal birth control is the most likely cause, we can offer you some options. Some women do better by taking their birth control pill at the same time every day. We might recommend a different birth control pill, for example, a slightly higher dose pill in place of the ultra-low dose. We can vary the number of placebo pills (non-hormonal pills) that you take during each cycle. If you are using continuous pills to avoid having any periods, we may recommend you schedule a period now and then. Follow your physician’s directions to assure than your birth control remains effective. Sometimes ibuprofen (Advil and other brands) will help. We may prescribe a short treatment with supplemental estrogen. We can also discuss other birth control options. So do schedule a time to talk to your ob-gyn about any type of irregular spotting or bleeding. In most cases there is no health problem. But we want you to be satisfied with your birth control choice.