Spotting between periods: the causes and when to worry

Are you worried about spotting between periods? There are many reasons someone might bleed between periods and it’s often not a cause for concern, but it’s worth getting checked out to rule out any underlying causes. We know you might have questions about vaginal spotting, so read on to find out everything you need to know.

Vaginal bleeding in between a period, when it’s a light flow, is called “spotting” or “breakthrough bleeding”. 

There can be a number of possible causes of spotting: the type of hormonal contraception you’re on; a side effect of taking emergency contraception; bleeding after having sex; an increase in stress levels; and certain STIs can cause vaginal bleeding.

In extreme cases, bleeding after sex can also be a symptom of cancer. But before you start worrying and google your symptoms (which rarely helps keep us calm in these types of situations!), read on to learn more about the different causes of spotting.  

When you start a new hormonal contraception, it’s fairly normal to experience some breakthrough bleeding for the first three months while your body adjusts. 

Types of contraception that might cause this include the combined contraceptive pill, the progestogen-only pill (like Hana®), the contraceptive patch, implant, injection and intrauterine system (IUS).

Hana® is a progestogen-only pill and the most common side effect experienced is a change in your menstrual cycle. Between 20-30% of people using Hana® report having heavier or more frequent periods. Around 20% experience less bleeding or may have no periods at all; this is also known as “amenorrhea”. You may find that your period returns to normal a couple of months after your menstrual cycle has adjusted to Hana®.

Find out about some of the other potential side effects, see our article here.

If you experience menstrual changes that you find concerning – or frequent or more regular bleeding which doesn’t settle down – you should visit your doctor to discuss this. They’ll make sure that there is no other reason for the bleeding. It’s also important to note that if you experience bleeding after sex you should seek advise from your doctor, especially before going on the contraceptive pill.

If you have experienced repeated bleeding after sex or unusually heavy bleeding after sex once starting the hormonal birth control pill, you should see your doctor as soon as possible.

You can read a detailed guide to Hana®, how to use it and any side effects that might occur in the package leaflet that comes with your pill, or view an online version here. To find out more about how Hana® affects your period, see here.

You might also bleed between periods if you miss any contraceptive pills, are sick or have diarrhoea while on the pill, or have a problem with your patch.Emergency contraception – both the morning after pill and the intrauterine device (IUD) – may also cause breakthrough bleeding too.

A urinary tract infection is a very common infection that occurs when bacteria enters into the urethra. UTIs can make peeing painful, and you may feel a continual urge to use the bathroom even after just having gone. Your urine might appear cloudy and smell unusual. 

On top of this, UTIs can cause bloody urine which might be confused with vaginal spotting. However, once treated, this symptom should go away.

Sexually transmitted infections like chlamydia can sometimes cause inflammation that leads to bleeding between periods. Other symptoms include unusual vaginal discharge that’s different in colour, smell and texture.

As well as potentially causing spotting, chlamydia can also lead to bleeding after any type of sexual activity involving penetration. 

It’s important to note that chlamydia can usually be easily treated with a short course of antibiotics – but it can become serious if it’s not treated early on. So you should go for regular check-ups at your sexual health clinic to stay on top of potential STIs.

Sometimes sex can cause skin irritation and even bleeding in your vagina if it isn’t lubricated enough, or if it’s irritated because of an allergy or yeast infection. 

If you experience bleeding after sex from time to time, chances are everything is fine. But it can also be an indication of a STI like chlamydia or gonorrhoea, or – in extreme cases – it could be a symptom of cancer in the cervix, uterus or vagina.

In a normal pregnancy, the egg is fertilised in the fallopian tube and then travels to the uterus where it grows. But in an ectopic pregnancy, the fertilised egg doesn’t make it to the uterus and often grows outside in the fallopian tube, ovary, cervix or elsewhere in your abdomen.

Some of the first symptoms indicating an ectopic pregnancy include a missed period, light vaginal bleeding, and pelvic pain.

Ectopic pregnancies can be life-threatening and the pregnancy rarely survives, so do seek medical advice if you’re concerned.

Stress can be a real drag on your menstrual cycle. When cortisol levels get too high in the body, your hormone levels can get out of whack and cause a delay in your period, disruption to your flow, or abnormal vaginal bleeding.

It’s important to keep an eye on our stress levels, especially as the female menstrual cycle is very sensitive to any hormonal changes.

A uterine fibroid is a non-cancerous growth of the uterus, which can occur inside the uterus, within the muscle wall or on the outer surface of the uterus. Many people who experience uterine fibroids don’t have any symptoms. However, when symptoms are experienced, they can include spotting between periods or longer, heavy periods.

A 2015 study shows that lower levels of vitamin D in the body are associated with irregular menstrual cycles and found vitamin D may play a role in regulating ovulatory function. See also this 2018 study.

If your vitamin D levels are low, try stepping outside to get your daily dose of sunshine, eating fatty fish like salmon and tuna, or taking supplements.