Menses, the bleeding seen as part of menstruation, is a normal occurrence for girls who have reached puberty and women within their reproductive years. However, there are times when vaginal bleeding occurs and it is not related to menstruation. Naturally it is a case for concern but this does not always mean that it is due to any serious medical problem. Nevertheless, it is always advisable to be cautious.
What is spotting?
Spotting is a common term used to describe small amounts of vaginal bleeding between periods. This is also known as intermenstrual bleeding. It can also occur in pregnancy when periods are not expected to occur, any bleeding after menopause, before reaching puberty as well as bleeding after intercourse. Spotting can sometimes be mistaken for urinary tract and even rectal bleeding.
Although spotting refers to an abnormal or unexpected vaginal bleed, the quantity of the blood is also a factor. Usually spotting denotes a few drops of blood or small amounts that does not correlate with a regular menstrual bleed. Sometimes spotting may not be a cause for any concern. It occurs one time and may not recur thereafter. However, at other times spotting can be a symptom of a more serious condition.
Spotting is a sign and not a condition on its own. It may be accompanied by various other signs and symptoms such as:
- Pain and cramping
- Vaginal discharge
- Offensive vaginal odor
- Nausea and sometimes vomiting
There are a host of other signs and symptoms that may occur depending on the underlying cause of spotting. It is important to note that the cause of spotting may not always be a disease. For example, pregnancy is a physiological state and not a disease where spotting may occur along with nausea and vomiting. Generally any girl or women within the fertile years of life needs to first conduct a pregnancy test before other causes are investigated.
Causes of Spotting
The age of the person, time in the menstrual cycle, medication currently being used and preceding events all play a role in determining the possible cause of the spotting. Further diagnostic investigations may be required to confirm or exclude suspected causes.
If pregnant, spotting may be caused by:
- Miscarriage (spontaneous abortion) in the early stages of pregnancy. Spotting may be a sign of an impending miscarriage (threatened abortion) and prompt medical treatment may save the pregnancy.
- Ectopic pregnancy where the fetus starts to develop in the fallopian tube. It is a very serious condition and can be life-threatening for the mother without immediate medical care.
- Implantation bleed occurs when the embryo implants on the inner surface of the uterus. It is a normal sign of pregnancy and is sometimes missed.
Injury to the vulva, vagina, cervix or uterus can lead to abnormal vaginal bleeding. This may be seen as a result of intercourse, medical or surgical procedures, scratching the areas vigorously or with foreign bodies. Spotting due to trauma is usually accompanied by other symptoms like pain.
- Polycystic ovarian syndrome is a condition where there is elevated testosterone levels in girls and women along with menstrual irregularities and cysts in the ovaries.
- Uterine fibroids are benign (non-cancerous) growths that occur in the smooth muscle of the uterus. It is more common in women during the reproductive years of life.
- Uterine polyps are growths that protrude from the inner layer of the uterus known as the endometrium. It may be a single growth or multiple. Most cases are benign (non-cancerous).
- Endometrial hyperplasia is abnormal thickening of the endometrium (inner lining) of the uterus. It occurs with high levels of estrogen. Sometimes it can progress to cancer.
- Vaginitis is inflammation of the vagina, usually due to an infection or overgrowth of naturally-occurring bacteria in the vagina. The infection may be due to bacteria, yeasts and parasites.
- Sexually-transmitted diseases (STDs) like gonorrhea and chlamydia can cause a host of symptoms, including abnormal vaginal bleeding.
- Pelvic inflammatory disease (PID) is a more serious infection when microbes infect the areas beyond the cervix, including the uterus, fallopian tubes and/or ovaries.
- Hyperprolactinemia where the levels of the hormone prolactin is abnormally high. It is often associated with pituitary gland problems.
- Thyroid problems including hyperthyroidism (overactivity of the thyroid gland) and hypothyroidism (underactive thyroid) can cause spotting in girls and women.
- Diabetes mellitus where there is either a deficiency of insulin (type 1) or non-responsiveness of the cells to insulin (type 2).
A number of different cancers can lead to spotting. Most of these cancers are related to the female reproductive system and includes:
- Vaginal cancer
- Cervical cancer
- Uterine cancer
- Ovarian cancer
It is important to note that cancers which may cause urinary tract bleeding or rectal bleeding may sometimes also be mistaken for spotting.
Any medication that causes a change in hormone levels may also cause spotting. This is usually seen with drugs like oral contraceptives (the pill), emergency contraceptives (the “morning after” pill) and hormone replacement therapy (HRT). It also includes hormone-medication for the treatment of certain types of cancers as well as fertility treatments. Abnormal vaginal bleeding may also occur with anticoagulants like warfarin.
When to Seek Help?
Many girls and women are unsure as to when spotting requires medical attention. It is always advisable to see a doctor even if the spotting was very slight and does not occur apart from a single episode. However, there are cases where emergency medical attention. Severe pain with spotting, for example, should warrant a trip to the emergency room. It may be due to conditions like ectopic pregnancy which can be life-threatening.
In the absence of such acute symptoms, it is still nevertheless advisable to consult with a medical professional durig regular hours. Never try to self-diagnose or treat spotting without a doctor. Similarly, drugs that are suspected of being the cause of the spotting should not be discontinued unless advised by a doctor or pharmacist. Take note of factors that may exacerbate or relive the spotting as this can help the doctor with a final diagnosis.