Black spotting between periods: causes and next steps

Blood darkens as it remains in the uterus or vagina before leaving the body. The colour does not reveal the source, so timing, amount, pain, discharge, medicines, contraception, and pregnancy possibility all matter.

Light dark discharge may occur near the start or end of a period. Hormonal contraception, a missed dose, ovulation-related hormonal change, irritation after sex, cervical inflammation, or an infection such as chlamydia can also produce bleeding between periods.

Uterine fibroids and endometrial polyps may present with bleeding between periods. Cervical dysplasia, cervical cancer, and womb cancer can also present with abnormal vaginal bleeding, especially when it persists, follows sex, or occurs after menopause; these possibilities require examination rather than diagnosis by colour.

Record the spotting dates, whether it follows sex, how much appears, and any pelvic pain, odour, itching, fever, or change in discharge. Check your contraceptive instructions if a pill was late or missed, but do not stop prescribed hormones without clinical advice.

Take a pregnancy test when pregnancy is possible. Arrange an appointment if the bleeding is new, unexplained, repeated, or accompanied by symptoms of infection; assessment may include a pregnancy test, infection testing, pelvic examination, or ultrasound depending on your history.

Seek urgent help for heavy bleeding, fainting, marked dizziness, severe or worsening pelvic pain, shoulder-tip pain, or bleeding with a positive pregnancy test. These features need timely assessment for blood loss or a pregnancy complication.

Contact a clinician promptly for fever, foul-smelling discharge, bleeding after sex, or any vaginal bleeding after menopause. Persistent spotting also deserves review even when there is no pain.

Ask whether cervical screening is due, whether an infection test is suitable, and whether your contraception or another medicine could affect bleeding. Tell the clinician the date of your last normal period, pregnancy-test result, menopausal status, and any bleeding after sex.