Spotting Before Periods: Why And When To Seek Help

Spotting is a phenomenon that can get a woman puzzled but not always worried. It's the kind of light vaginal bleeding that occurs when you are not expecting your period—sometimes mid-cycle, at times just a few days before your periods. At first, it's easy to confuse that light pink or brown tinge staining your panties as a precursor to an 'early' period. It will not be enough to warrant a tampon, a menstrual cup, or a sanitary pad but still be substantial enough for you to put a panty liner in place. The bleeding continues to remain light throughout the day and doesn't get heavier—as menstrual bleeding does. Indeed, the spot seems like a false alarm that is more exasperating than painful.

Some women describe spotting as bleeding a week before periods; it could be a regular part of their menstrual cycle that may not take them by surprise. But when the spot seems like an abnormality in your usual menstrual cycle, it could be a red flag of an underlying problem in your reproductive system that needs attention.

How different is spotting from menstruation?

The amount of blood expelled during spotting and the frequency of it can vary from person to person. Let's first understand how exactly is spotting different from menstrual bleeding and some of the causes of spotting before periods:

• It's irregular and unpredictable - Unlike menstrual bleeding, spotting can be sporadic. You may start spotting, have a day with no bleeding, and then spot again. Periods have a predictable bleeding pattern; spotting does not.
• The colour is different - Some women find they spot brown blood, which is distinctly different from the standard deep red of menstrual bleeding.
• The length of time - A period typically lasts for around three days or more, whereas spotting only lasts for one or two days. You won't need more than one pad per day when you are spotting.
• Other symptoms - Menstruation is accompanied by other symptoms like cramps, fatigue, etc. Spotting isn't.

What causes spotting?

Spotting can occur as a symptom in a wide range of conditions. Very often, it tends to be a benign occurrence that can be overlooked, but sometimes the reasons for spotting before periods could be an indication of a potentially dangerous complication unfolding inside. Here are the most common causes that lead to spot:

• Use of hormonal birth control - If you have started a new contraceptive pill or other birth control measures such as an IUD, injection, or patch, your body may take a few months to adjust to it, and you may experience what doctors call 'breakthrough bleeding'. 
   

Any birth control device comes with a set of hormones that build a reproductive environment in your uterus that can prevent pregnancy. Sometimes, the progestin in a pill could be causing the endometrium (uterine lining) to become thinner (a thinner endometrium is not conducive for the fertilised egg to latch on), and this leads to a temporary spurt of bleeding. 
Your gynaecologist would warn you of these symptoms while putting you on the pill. The changing levels of hormones can cause spotting for a week or a few days.
Spotting can also happen if you have missed any combined or progestin-only contraceptive pills or used emergency contraception. Typically, the spotting caused by any contraceptive is expected to subside once your body gets adjusted to it (six months or so). In case it does not, it's best to seek a diagnosis and rule out underlying problems.

• Ovulation -  Just before ovulation, the levels of oestrogen in your body go up. Once the egg is released, the oestrogen ebbs and there is an increase in progesterone. This shift in the balance between the two hormones can cause ovulation spotting. Ovulation spotting can also occur because of endocrine abnormalities like thyroid problems.
• Fibroids - A uterine fibroid is a non-cancerous growth in or on the uterus. Fibroids contain blood vessels that can rupture and be discharged. Typically, spotting caused by fibroids tends to be coagulated clumps of blood that are dark maroon or brownish in appearance.
• Endometriosis - This is a condition in which, instead of on the inside the lining of the uterus grows on the outside. Sometimes a small shred of such endometrial tissue will bleed into your normal vaginal discharge. You may notice it as a fresh pink streak on your toilet paper or panty. If the blood expelled from the endometrial tissue has been lurking around in your uterus without being discharged, it could get oxidised and eventually surface as a brownish discharge.
• PCOS - Polycystic ovarian syndrome occurs when the body overproduces androgens, which leads to spotting, irregular and painful periods, acne, hair growth, and weight gain. If you have a range of these symptoms, chances are your spotting is caused by PCOS.
• Polyps - Polyps on the cervix or uterus can also cause spotting. These are usually non-cancerous growths that can suddenly start bleeding.
• Infections and vaginal discharge - Spotting can also be caused by a sexually transmitted disease or an infection such as vaginitis. Typically, such spotting will be foul-smelling and accompanied by a fever and pelvic pain.
• Perimenopause - The years preceding your menopause is defined by major hormonal fluctuations. During this time, the oestrogen in your body keeps shifting gears and brings about atypical changes in your menstrual cycle. Your period may become lighter or heavier, and it's normal to experience some measure of spotting between periods.
• Pregnancy: When a fertilised egg latches onto the uterus, it's normal for a woman to experience some light bleeding. This typically happens 10 to 14 days after conception.
• Endometrial or cervical cancer: As many as 90 per cent of women who have endometrial or cervical cancer report abnormal bleeding as one of their early struggles. Typically, such bleeding occurs frequently throughout the menstrual cycle and not just a day or two.
• Stress - If you are stressed due to a sudden trauma or suffer from chronic stress, your body becomes vulnerable to hormonal turbulence that can trigger spotting between periods.

When to seek help?

Spotting before the period is not always a sign of anything serious. You can wear a panty liner or pad to protect your clothes from staining. However, keep an eye on other symptoms that tag along when you are spotting. Do you tend to have a fever? Are there cramps? Is the blood foul-smelling? Is it a light fluid or slightly clotted? Is it spread over many days? If you are sexually active, always keep a pregnancy test kit handy and get yourself tested. 

Seek your doctor's help if:

• You are pregnant
• There's pain, nausea, and dizziness in addition to the spotting.
• There is a change in body temperature (sudden fever or chills)
• The spotting lasts longer than a day
• If you are spotting after menopause

Treatment for spotting

When the spotting is caused by birth control methods, your doctor may adjust, switch, or even take you off birth control to restore your hormonal balance and ease your symptoms.

If the problem is more than a hormonal imbalance, in addition to medication, your doctor may consider surgical intervention. However, most instances of spotting before your period are normal and don't need drastic intervention.

Tests that your doctor could recommend

• Your doctor may advise one or more of the following tests:
• Pregnancy test
• Blood tests to check thyroid and ovarian function
• Cervical cultures to check for a sexually transmitted infection
• Colposcopy and cervical biopsy
• Uterine biopsy
• Pap smear
• Pelvic ultrasound
• Saline infusion sonohysterogram
• Hysterosonogram
• Hysteroscopy.

Conclusion

While it is not necessary to be paranoid about abnormal bleeding, don't ignore it if it persists and becomes a pattern. Your body usually sends out alarms and signals well in advance if any of its parts are going through a phase of discontent. Your uterus is one of the most delicate and amazing body parts. Listen to what it is trying to tell you through the signs of abnormal bleeding.