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Bleeding or spotting between your regular monthly periods is not uncommon, but it can be alarming. You may see just a spot or two of blood on your underwear or toilet tissue, or you may be bleeding as if you have started your period.

Most of the time, there is no reason to worry. In some cases, though, bleeding or spotting between periods can signal a more serious problem.

This article explains common causes of bleeding or spotting between periods and when to call your healthcare provider.

Types of Bleeding Between Periods

Here are the different types of bleeding that can occur between your periods.

• Spotting: This is when there's just a red tinge on the toilet paper or a drop or two of blood in your underwear. Medically, it's only considered spotting if it's not during your period and doesn't require you to use a pad or tampon.
• Light bleeding: This type of bleeding occurs just before or after your period and isn't technically spottingit's considered part of your period.
• Breakthrough bleeding: Breakthrough bleeding is when bleeding occurs between your periods if you are taking oral contraceptives. It's usually caused by low estrogen levels.
• Abnormal bleeding: This describes any heavy bleeding [requiring the use of a tampon or pad] outside of your cycle that isn't due to hormonal birth control pills. It is often called abnormal uterine bleeding or abnormal vaginal bleeding.

Normal Menstrual Bleeding

Normal menstrual bleeding lasts for about five to seven days.The average cycle occurs every 28 days, but anywhere between 21 to 35 days between periods is considered normal.

Most women get to know their own cycles after a few years of menstruating. Although it may seem like you are losing a lot of blood, it usually only adds up to between 2 and 8 tablespoons.

About 14 days after the start of your period, your ovaries release an egg. This is called ovulation. Some people notice spotting during ovulation, which can be normal but should be discussed with your healthcare provider. If the egg is not fertilized, a period starts approximately two weeks after ovulation, and the uterine lining is shed.

Causes of Spotting and Light Bleeding

Some of the more common causes of spotting or bleeding between periods include:

Pregnancy

There are several reasons bleeding or spotting might occur during pregnancy:

• Implantation bleeding: Spotting may occur at the time the fertilized egg implants in the uterus and begins to grow.
• Miscarriage: Bleeding in early pregnancy, especially if it's heavy, may mean that you've had a miscarriage.
• Ectopic pregnancy: This occurs when a fertilized egg implants outside of the uterus. One of the signs is vaginal bleeding. An ectopic pregnancy can be an emergency.
• Abortion: Bleeding can occur after terminating a pregnancy using medication or having an abortion procedure.

Birth Control

Spotting and bleeding can occur in women who use these types of birth control:

• Oral contraceptives: Starting, stopping, or missing oral contraceptives [birth control pills] can lead to spotting or bleeding.
• Other hormonal birth control methods: Irregular vaginal bleeding might be seen when using the contraceptive patch, implant, or injection.
• Intrauterine devices [IUDs]: Intrauterine devices are known to cause occasional spotting.

Hormonal Conditions

Bleeding may be seen in conditions that affect your hormones, such as:

• Thyroid disease that results in either low or high thyroid hormone levels
• Polycystic ovary syndrome [PCOS], a hormone imbalance that affects ovulation
• Perimenopause, leading to vaginal dryness or atrophy

Common Infections

The following infectious diseases that may cause bleeding include:

• Vaginal, cervical, and uterine infections and inflammatory conditions
• Sexually transmitted infections including chlamydia, gonorrhea, and genital warts
• Pelvic inflammatory disease

Other Causes

Other possible causes of spotting and bleeding include:

• Endometriosis [abnormal growth of uterine tissue outside the uterus]
• Injury to the vagina from the insertion of foreign objects or sexual trauma
• Uterine fibroids [noncancerous growths in the uterus]
• Malignant cancers, including cervical cancer, uterine cancer, uterine sarcoma, ovarian cancer, and vaginal cancer
• Certain drugs, particularly anticoagulants [blood thinners] and tamoxifen
• Certain gynecological procedures [including a Pap smear]
• Urethral prolapse or polyps

When to See a Healthcare Provider

It can be useful to keep track of your menstrual cycle using a calendar or app. This information can help your healthcare provider figure out whether or not any spotting or bleeding outside your cycle is a concern. If you think you might be bleeding too heavily, also make a note of how many pads or tampons you go through in a day.

Any unexplained vaginal bleeding between periods is a reason to call your healthcare provider. It is especially important to call if you haven't yet gone through puberty or if you are past menopause.

Diagnosis

When you see your medical provider about bleeding or spotting, they will ask about your medical history. If you've been tracking your menstrual cycle on a calendar, you should show them that.

Some questions your provider may ask:

• How long have you experienced bleeding between periods?
• Does it happen every month or is this the first time?
• At what point during your menstrual cycle did the bleeding begin and how long did it last?
• Do you experience menstrual cramps with the bleeding?
• Does anything make the bleeding worse or better?
• Is the bleeding worse with increased physical activity?

If you are pregnant or recently had a miscarriage or abortion, it is important to let your healthcare provider know. The same applies if you have been injuredor undergone any gynecological or surgical procedure.

If youre visiting a healthcare provider for the first time, theyll want to know how old you were when you first started having periods. If you are sexually active, they need to know that, along with the birth control method you may be using.

Remember to tell your healthcare provider about any prescription or over-the-counter medications [including herbal supplements] that you are taking.

Your provider might give you a pelvic exam including a Pap smear if you haven't had one recently. Additional tests, such as blood tests or imaging tests, might be needed as well.

Treatment

The treatment for your vaginal or uterine bleeding will depend on the underlying condition that is causing it. For example, if you have a sexually transmitted infection, you will be treated for that. If the cause of your bleeding is PCOS, treatment for that may help.

Summary

Many women experience spotting or bleeding between their periods. There are many possible reasons for why this happens. Most are not anything to worry about, but sometimes this type of bleeding can be a sign of something serious.

Taking hormonal birth control is one cause of spotting. Others include pregnancy, sexually transmitted infections, and PCOS. The most serious causes include cancer and ectopic pregnancy.

A Word From Verywell

If you experience any vaginal bleeding, light or heavy, you should discuss it with your healthcare provider. The cause may turn out to be something minor that is easy to fix. If the bleeding is a sign of something serious, you may need further treatment.