Why am i spotting bright red blood

Vaginal bleeding in between periods is common. It can range from spotting (a drop or two of blood) to heavy bleeding. Some causes, like medications and perimenopause, are not a concern. But bleeding after one period is over and before the next one starts can sometimes be a sign of a potentially more serious condition.

For example, spotting after your period can be a sign of miscarriage, a hormonal condition, or cancerous or noncancerous growths. Bleeding that is accompanied by vaginal discharge can indicate an infection.

This article will go over the most common reasons for bleeding between periods. You'll also learn when to call your healthcare provider.

Spotting After a Period

A tinge on your toilet paper or a drop or two of blood in your underwear is likely to be spotting. Your healthcare provider will only consider bleeding to be "spotting" if it occurs before or after your period and does not require you to use a pad or tampon.

You're probably used to seeing bright red or slightly dark red blood when you're on your period. If you're spotting, the blood might be lighter (pinker) or darker (brown). Older blood is usually brown or even close to black.

If you have an infection, you may have vaginal discharge along with spotting. Depending on what is causing the infection, the discharge can be white, yellow, or green.

Light to Heavy Bleeding Between Periods

More substantial bleeding in between periods may or may not be worrisome:

• Light bleeding: This type of bleeding occurs just before or after your period. It's not technically spotting—it's considered part of your period.
• Breakthrough bleeding: Breakthrough bleeding happens if you are taking oral contraceptives. This type of bleeding between periods is usually caused by low estrogen levels.
• Abnormal bleeding: Any heavy bleeding that requires the use of a tampon or pad that happens outside of your cycle and is not caused by hormonal birth control pills is abnormal. It is also called abnormal uterine bleeding or abnormal vaginal bleeding.

What Is Normal Menstrual Bleeding?

Normal menstrual bleeding lasts for about five to seven days. The average menstrual cycle has about 28 days between periods, but it's still normal to have a cycle that's anywhere from 21 to 35 days.

Most people who menstruate get to know their cycles over time. Although it may seem like you are losing a lot of blood, it usually only adds up to around 2 to 3 tablespoons per period.

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. However, you should tell your provider if you notice it.

If the egg is not fertilized, a period starts approximately two weeks after ovulation. During a period, the uterine lining is shed because it's not needed to support a pregnancy.

Causes of Spotting and Light Bleeding

There are several possible causes of light bleeding between periods.

Pregnancy

Spotting can occur during pregnancy. There are a few different causes, some of which are serious:

• Implantation bleeding: Spotting can happen when the fertilized egg implants in the uterus and begins to grow.
• Miscarriage: Bleeding that happens early in 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 is a medical emergency.
• Abortion: Bleeding can occur after terminating a pregnancy using medication or having an abortion procedure.

Birth Control

Bleeding between periods can also happen because of your birth control method.

• Oral contraceptives: Starting, stopping, or missing oral contraceptives (birth control pills) can cause spotting or breakthrough bleeding.
• Other hormonal birth control methods: Irregular vaginal bleeding can happen if you're using the contraceptive patch, implant, or injection.
• Intrauterine devices (IUDs): Intrauterine devices may cause occasional spotting.

Hormonal Conditions

If you have certain medical conditions related to your hormones, you might be more likely to experience spotting between periods.

• Thyroid disease (either low or high thyroid hormone levels)
• Polycystic ovary syndrome (PCOS) (a hormone imbalance that affects ovulation)
• Perimenopause (which can cause irregular periods, vaginal dryness, or vaginal atrophy)

Common Infections

Infections are another common cause of bleeding between periods.

• Vaginal, cervical, and uterine infections and inflammatory conditions
• Sexually transmitted infections (e.g. chlamydia, gonorrhea, and genital warts)
• Pelvic inflammatory disease (PID)

Other Causes

There are also some other causes of spotting between periods:

• Endometriosis (abnormal growth of uterine-like tissue outside the uterus)
• Injury (e.g., insertion of foreign objects into the vagina or sexual trauma)
• Uterine fibroids (noncancerous growths in the uterus)
• Cancer (e.g. cervical cancer, uterine cancer, uterine sarcoma, ovarian cancer, and vaginal cancer)
• Medications (e.g., anticoagulants and tamoxifen)
• Gynecological procedures (e.g., a Pap smear)
• Urethral prolapse or uterine 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 provider. It is especially important to call if you haven't yet gone through puberty or if you are past menopause. 

When Is Bleeding Between Periods an Emergency?

If you are experiencing heavy bleeding or you also have pain, fever, dizziness, chills, nausea, or vomiting, seek medical care right away.

Diagnosis

When you see your provider about bleeding or spotting between periods, they will ask about your medical history. If you've been tracking your menstrual cycle, that information will help them.

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, let your provider know. You should also tell them if you've been injured or undergone any gynecological or surgical procedure recently.

If you’re seeing a provider for the first time, they’ll want to know how old you were when you first started having periods. They will also ask if you are sexually active, and which birth control method you use.

Remember to tell your provider about any prescription or over-the-counter (OTC) 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 or it's been a while since your last one. They might want you to have additional tests, such as blood tests or imaging tests, to help them make a diagnosis.

Treatment

The treatment for bleeding between periods depends on what's causing it. Medications like birth control or antibiotics for infections might be prescribed. In some cases, your provider might want you to have a procedure or surgery.

Summary

Many people experience spotting or bleeding between periods. Most of the time, a little bleeding when you're not on your period is not a reason to worry.

However, if you're also having other symptoms like pain, spotting between periods can be a sign that something is wrong.

If you experience any vaginal bleeding, light or heavy, tell your healthcare provider. That's the only way to find out for sure what is causing it—and make sure you get the right treatment.

Frequently Asked Questions

• What is the most common cause of bleeding between periods?

  Hormonal fluctuations are the most common cause of bleeding between periods. Hormonal fluctuations can have many causes—from hormonal contraceptives to menopause.

• Who is most likely to experience breakthrough bleeding on hormonal contraceptives?

• Should I be concerned if bleeding between periods is accompanied by other symptoms?

  If you are bleeding between periods and also have fever, dizziness, bruising, or pain, tell your provider right away or seek emergency medical care (especially if the bleeding is very heavy and you can't stop it)

• Can anxiety cause spotting between periods?

  Stress can affect your menstrual cycle. Sometimes, being under a lot of stress can make your period late or early. You might even miss a period. It's possible that you could have bleeding between periods that's related to stress, but there has not been a lot of research on the topic.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. American Pregnancy Association. Spotting during pregnancy.

2. Sutter Health. Vaginal discharge.

3. American College of Obstetricians and Gynecologists. What you should know about breakthrough bleeding.

4. Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65. doi:10.1016/j.bpobgyn.2015.11.012

5. Cleveland Clinic. Normal menstruation.

6. Centers for Disease Control and Prevention (CDC). Heavy menstrual bleeding.

7. Massachusetts General Hospital. Bleeding in early pregnancy.

8. Hosseini R, Asgari Z, Moini A. Unexpected outcome after expectant management of ectopic pregnancy in two persons. Iran J Reprod Med. 2013;11(12):1027-1030.

9. Planned Parenthood of Michigan. Caring for yourself after an abortion.

10. Planned Parenthood. Will missing my birth control mess up my period?

11. Planned Parenthood. What are the side effects of the birth control implant?

12. Sanders JN, Adkins DE, Kaur S, Storck K, Gawron LM, Turok DK. Bleeding, cramping, and satisfaction among new copper IUD users: A prospective study. PLoS One. 2018;13(11):e0199724. Published 2018 Nov 7. doi:10.1371/journal.pone.0199724

13. Sinha U, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK. Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India. Indian J Endocrinol Metab. 2013;17(2):304-309. doi:10.4103/2230-8210.109714

14. Nappi RE, Martini E, Cucinella L, et al. Addressing vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM) for healthy aging in women. Front Endocrinol (Lausanne). 2019;10:561. doi:10.3389/fendo.2019.00561

15. Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: A synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 2016;3:4.  doi:10.1186/s40779-016-0074-5

16. Khan AT, Shehmar M, Gupta JK. Uterine fibroids: Current perspectives. Int J Womens Health. 2014;6:95-114. doi:10.2147/IJWH.S51083

17. Urology Care Foundation. Benign (not cancerous) urethral lesions.

18. Cleveland Clinic. Bleeding between periods? How to tell if it's a problem.

19. Nagma S, Kapoor G, Bharti R, et al. To evaluate the effect of perceived stress on menstrual function. J Clin Diagn Res. 2015;9(3):QC01-QC3. doi:10.7860/JCDR/2015/6906.5611

Additional Reading

• National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Vaginal bleeding between periods.

By Tracee Cornforth
Tracee Cornforth is a freelance writer who covers menstruation, menstrual disorders, and other women's health issues. 

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