Spotting between periods: causes and next steps

Spotting refers here to a small amount of blood outside an expected period. It may appear pink, red, or brown, and the amount or colour cannot by itself distinguish a temporary hormone change from a condition needing treatment.

Blood can arise from the vagina, cervix, or uterus. Possible contributors include hormonal contraception, ovulation-related hormone shifts, pregnancy-related bleeding, vaginal dryness or injury, and changes near menopause. Chlamydia can present with bleeding between periods or after sex. Uterine fibroids and endometrial polyps can present with abnormal or irregular bleeding.

Cervical dysplasia, cervical cancer, and womb cancer can also present with unusual vaginal bleeding, although spotting has many non-cancerous explanations. The safe direction of reasoning is to assess the symptom and its context, not to infer a particular diagnosis from spotting alone.

Keep notes on cycle dates, spotting days, colour and flow, pain, discharge, bleeding after sex, pregnancy possibility, contraception, and medicines. Arrange a primary-care, gynaecology, or sexual-health visit for unexplained spotting. A clinician may suggest a pregnancy test, infection testing, examination of the vagina and cervix, blood tests, ultrasound, or a procedure that views the cervix or uterine cavity.

Stay current with cervical screening when you are eligible, but do not wait for a routine screening appointment to report symptoms. Screening is intended for people without symptoms and does not replace a diagnostic assessment of bleeding.

Obtain urgent care if spotting becomes heavy, you faint or feel severely dizzy, or you develop intense pelvic or abdominal pain. A missed period or positive pregnancy test combined with bleeding and pelvic pain, shoulder-tip pain, weakness, or collapse requires immediate assessment. Bleeding after menopause should be reported promptly even when it is only a small amount.

Ask which anatomical source is suspected, whether pregnancy or infection testing is needed, and whether your cervix should be examined. Discuss whether an ultrasound or closer examination is appropriate, how any medicine or contraceptive might affect the pattern, and when persistent spotting should lead to a specialist referral.