Premenstrual spotting: what are the causes and how to distinguish them?

Premenstrual spotting is usually light, irregular, usually brown or dark red vaginal bleeding that lasts no more than 1-2 days.

Premenstrual spotting is often not related to particular problems, and there is not always a cause that can explain it. Sometimes it can be an early sign of pregnancy (in this case spotting becomes synonymous with implant losses ), in other cases it can be the result of hormonal imbalances, perhaps due to cessation of the pill, stress, or a perimenopause condition.

But let’s look at the various situations and how to distinguish them.

Spotting in pregnancy

A light bleeding can be an indication of pregnancy, in this case, as we said, we speak of implantation losses, and are a consequence of the blastocyst implantation in the uterus. They do not always occur, indeed in most pregnancies no initial bleeding is observed.

Implantation bleeding, when it occurs, occurs 1-2 weeks after conception, around which time a woman would expect to see her period. Although implantation bleeding is usually lighter than menstrual bleeding, some women may mistake it for very light menstrual bleeding and realize they are pregnant late.

When in doubt, it is always advisable to take a pregnancy test .

Birth control pill spotting

The birth control pill is a form of hormonal contraception that works by preventing ovulation and making the cervix and uterus less conducive to pregnancy. The pills contain synthetic hormones that are also often prescribed to help regulate a woman’s menstrual cycle.

When starting to take the pill, the woman for the first few months of taking it may experience spotting just before the menstrual flow. This spotting is a sign that the body is adjusting to the hormones and doesn’t mean the pill isn’t working. In any case, it is always good to notify the doctor who prescribed the pill if abnormal losses occur.

Spotting can also occur if you miss taking a pill or take the pill later than usual.

In some cases, your doctor may prescribe another type of pill.

Ovulation spotting

Ovulation occurs when the ovaries release an egg. This process usually occurs in the middle of the menstrual cycle (or in any case 11-16 days before menstruation) and can sometimes cause a slight spotting.

Spotting from hormonal imbalances

Hormonal imbalances, temporary or chronic, can affect a person’s menstrual cycle and cause small losses before the actual period.

For example, progesterone deficiencies can manifest themselves with prolonged spotting in the post-ovulatory phase. Difficulty ovulating can cause frequent bouts of spotting during a menstrual cycle. All these situations should be reported to the doctor.

Spotting following sexual intercourse

Sexual intercourse can irritate the delicate tissues of the vagina, and may cause a small amount of bleeding. If this bleeding occurs regularly, the couple might consider using a vaginal lubricant to reduce the risk of tissue trauma during intercourse.

In any case, frequent bleeding must be reported to the doctor as it can be caused by infections or other.

Spotting perimenopausale

Menopause is the time in a woman’s life when her fertility ends. It is said that a woman has entered menopause when at least 12 months have passed without menstruation (the average age at which it occurs is around 50). However, menopause is preceded by a more or less long period called perimenopause.

Perimenopause is the transitional period to menopause and can last up to 10 years. During perimenopause, hormone levels can fluctuate randomly, which can lead to symptoms such as menstrual irregularities and changes in the length and amount of menstrual bleeding.

Cervical cancer spotting

In rare cases, premenstrual spotting can be a symptom of cervical cancer, which develops in the cervix, the area between the vagina and uterus.

Other symptoms of this tumor include:

  • menstrual flows heavier and longer than usual
  • bleeding after intercourse
  • vaginal bleeding after menopause
  • pain or discomfort during sexual intercourse
  • abnormal vaginal discharge

To rule out cervical cancer, it is important to undergo a Pap smear, which checks for the presence of cancer cells in the cervix.

Differences between spotting and menstrual flow

A scanty period can sometimes resemble spotting and vice versa. The two factors that can help a woman understand whether the bleeding is a real period or not are the duration and amount of the bleeding.

A period typically lasts about at least 4 days, while spotting only lasts 1 or 2 days. During a period, enough blood is lost to fill a pad. Menstrual blood is usually red while spotting is often dark red or brown.

When should you see your doctor?

Premenstrual spotting isn’t usually a cause for concern, but contact your doctor if you notice your luteal phase is shorter, if the spotting lasts for many days, and if you suspect anything that’s causing you concern.

It is advisable to consult the gynecologist even if the following symptoms appear in addition to the spotting:

  • an unusual smell
  • vaginal irritation and discomfort
  • vaginal mucus that contains blood or has a cottage cheese-like appearance
  • unexplained fever or tiredness

Women who suspect pregnancy can simply take a home pregnancy test.

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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