Spotting During Menstruation: Causes, Symptoms & When to See a Doctor

Spotting—light bleeding between periods—is common and often harmless. However, heavy or prolonged spotting warrants medical evaluation to rule out underlying conditions.

Common Causes

• Hormonal imbalances: Fluctuations in estrogen and progesterone (during puberty, pregnancy, menopause, or with hormonal birth control) can cause spotting.
• Implantation bleeding: Light spotting 10–14 days after ovulation when a fertilized egg attaches to the uterine lining.
• Breakthrough bleeding: Caused by a sudden drop in estrogen, often linked to hormonal contraceptives (pills, rings).
• Polycystic ovary syndrome (PCOS): A hormonal disorder causing irregular periods, heavy bleeding, and spotting.
• Uterine polyps: Benign growths on the uterine lining that may cause intermenstrual spotting or heavy periods.
• Fibroids: Non-cancerous uterine tumors that can lead to heavy bleeding, pelvic pain, and spotting.
• Cancer (rare): Cervical, uterine, or endometrial cancer may present with spotting, especially if accompanied by pelvic pain, unexplained weight loss, or fatigue.

When to See a Doctor

Consult a healthcare provider if you experience:

• Heavy or prolonged spotting
• Spotting with pelvic pain, unexplained weight loss, or fatigue
• Spotting after menopause

Diagnosis & Treatment

Your doctor may order blood tests, ultrasound, or biopsy to determine the cause. Treatment depends on the diagnosis and may include hormonal therapy, surgery (for polyps/fibroids), or radiation/chemotherapy for cancer.

Outlook

Most spotting is benign and resolves on its own. Persistent or heavy spotting should always be evaluated.