10 Reasons Why You’re Spotting Before Your Period Even Starts, and When to See an OB/GYN

Spotting here and there is typically no big deal, and happens to most people who menstruate at one point. But if it keeps happening, it could be a sign something more is going on, says Tamara Guichard, MD, an OB/GYN in Forest Hills, New York. Learn more about the top causes of spotting between periods here, and when it's time to talk to your doctor.

10 causes of spotting before your period

1. Hormonal birth control

Hormonal birth control methods (like pills, rings, patches, and IUDS) are one of the most common culprits of spotting between periods, per Dr. Guichard. "Especially when you're starting a new method or switching types," she adds. When it comes to the pill in particular, you may get spotting if you miss a dose, take antibiotics while on birth control, or throw up or have diarrhea—which may prevent the pill from getting absorbed, per the Mayo Clinic.

2. Stress

Turns out, stress can affect your period. Chronic stress, in particular, can contribute to spotting, because it can cause hormonal shifts that lead to changes in your cycle, says Dr. Guichard. "Many times the uterine lining may be out of sync and cause bleeding one to two weeks before the expected period," she adds. This type of spotting should clear up within a couple of months or once your stressor has eased up. But if it continues, that's a sign to see your doctor and maybe reach out to a mental health professional to reduce unchecked stress.

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3. Early pregnancy

Sometimes spotting can be one of the first clues that you're pregnant, especially if it's accompanied by other tell-tale pregnancy signs, like headaches, breast tenderness, bloating, nausea, or fatigue, per the Cleveland Clinic. This spotting is from implantation bleeding, which happens when a fertilized egg attaches to the side of the uterine wall and starts to grow. The easiest way to tell if that's what's causing your spotting? Take a home pregnancy test, recommends Kelly Culwell, MD, a board-certified OB/GYN in San Diego, California.

4. Ovulation

Spotting midway through your cycle (or even spotting a week before your period) could be a sign that you're ovulating—i.e., when your ovary releases an egg, Dr. Guichard says. It can be accompanied by some lower abdominal pain or one-sided pelvic pain (called mittelschmerz) and typically lasts less than a day, per the Cleveland Clinic.

5. Perimenopause

It's normal for your periods to become irregular in your 40s, as your levels of the hormone estrogen decline and your body moves towards menopause, says Dr. Culwell. That might mean your periods are closer together, further apart, or happen with some spotting in between. The shift is often followed by other perimenopause symptoms like hot flashes, sleep problems, vaginal dryness, mood changes, and changes in your sex drive, notes the American College of Obstetricians and Gynecologists (ACOG).

6. Polyps or fibroids

Uterine growths like fibroids and polyps can potentially cause spotting or pre-period bleeding, says Dr. Guichard. (Fibroids are always benign; polyps can also be benign, but have the potential to turn cancerous.) If you have one, you might also deal with heavier periods, pain or fullness in your lower abdomen, painful sex, or frequent urination, per the Cleveland Clinic.

You should let your doctor know if you think you have a fibroid or polyp. Small ones may just need to be monitored, and sometimes they go away on their own. But if a larger one is causing symptoms, your doctor might recommend meds to shrink the growth or surgery to remove it.

7. Infections

Spotting that happens alongside vaginal pain, itching, burning, or unusual discharge is likely coming from an infection. It's often cervicitis—a cervical infection marked by inflammation, Dr. Culwell says. But occasionally other infections like bacterial vaginosis (BV), trichomoniasis (an STI), or even yeast infections could be to blame, according to the Cleveland Clinic. The best way to determine what you're dealing with, and figure out how to treat it? Get in to see your doctor.

8. Hormonal imbalances

Any condition that involves abnormal levels of reproductive hormones (like estrogen, progesterone, or androgens) can lead to period changes, including spotting, Dr. Guichard says. One of the most common is polycystic ovary syndrome, or PCOS.

Marked by higher-than-normal levels of hormones like androgens and insulin, PCOS can make your cycle irregular and cause acne, weight gain, and facial hair growth, per the Office on Women's Health. Maintaining a healthy weight for your body size and taking hormone medications (like birth control, anti-androgen meds, or Metformin) can help manage symptoms.

9. Thyroid condition

Your thyroid—the small, butterfly-shaped gland in your neck—plays a key role in regulating your periods. Meaning any condition that causes the gland to make too much or too little thyroid hormone (like hyper- or hypothyroidism) can mess with your cycle. The result can be spotting or missed periods, Dr. Guichard says.

Symptoms of thyroid conditions can vary depending on whether you're making too much or too little of the hormone. But they're often marked by changes in weight, energy levels, and sleeping patterns, per the Office on Women's Health.

10. Pelvic inflammatory disease

Any condition that leads to uterine inflammation can cause excess blood to build up in the lining of your uterus, which could lead to spotting, says Dr. Guichard. This includes pelvic inflammatory disease (PID), which can happen when a sexually transmitted infection moves into your uterus, fallopian tubes, or ovaries. PID usually comes with other symptoms including the following, per the Mayo Clinic:

• Severe pelvic pain
• Unusual vaginal discharge
• Pain during sex
• Painful urination
• Fever or chills

PID is a serious infection, so you should seek prompt medical care if you think you have it. Your doctor can prescribe antibiotics to get the infection under control.

How to tell the difference between spotting and your period

It's not always easy to tell the difference between spotting and a very light period. But taking a closer look at your "period facts," like the color and length of your flow, might be able to clue you in. "Spotting is usually light pink or brown and lasts a short time, while a very light period may be a lighter shade of red and last one to three days," Dr. Guichard says. Spotting also tends to be lighter—think a few literal spots in your underwear—that don't require a pad or tampon, she adds.

How to treat spotting before your period

Managing spotting before your period really depends on what's causing it. If it's related to birth control, for instance, making sure to take your pill at the same time every day can make a difference, Dr. Guichard says. That'll ensure your hormone levels stay relatively stable, which will help prevent breakthrough bleeding.

Healthy lifestyle habits can help, too, especially if you think stress is a contributing factor, Dr. Guichard says. You'd be surprised by how much basic self-care strategies like eating well, exercising, getting enough sleep, and making time for any chill, feel-good activity can help with feeling better overall.

When to see a doctor

If you're having frequent or regular spotting before your period, or any other persistent changes to your typical cycle, let your doctor know, recommends Dr. Guichard. While occasional random spotting isn't usually a big deal, spotting that happens often or with other symptoms could be a sign of an underlying problem that needs to be addressed.

FAQ

What does pregnancy spotting look like?

Implantation bleeding—i.e., the spotting that can happen when a fertilized egg sticks to the lining of the uterine wall—can look like a very light period. Not everyone gets it, but when it happens, it's usually within a week or two of an egg being fertilized, says the ACOG. If you think that's what's causing your spotting, a home pregnancy test can help confirm.

Why do I feel like I have a period but no blood?

Early pregnancy can cause a lot of the same symptoms that you might feel right before your period, minus the actual period. Think tender or swollen breasts, nausea, fatigue, cravings, and constipation, gas, or bloating, notes the Mayo Clinic. Again, a home pregnancy test can give you a quick "yes" or "no!" If you're not pregnant, it's possible you're dealing with PMS cramping before your actual period begins.

When to worry about spotting?

Occasional random spotting isn't usually a big deal. But spotting that happens frequently or regularly, or that's accompanied by symptoms like pain, itching, burning, or unusual discharge, could be a sign of an underlying problem. Reach out to your OB/GYN if you're unsure. They can help get to the root cause of your spotting.

—reviewed by Andrea Braden, MD, OB/GYN