Causes of spotting after menstruation

Spotting after menstruation can come from hormonal changes, contraception, infection, pregnancy-related bleeding, or changes in the cervix or uterus. A small amount of older menstrual blood may also leave the uterus after the main flow has stopped. The timing, colour, recurrence, pregnancy possibility, medicines, pain, discharge and bleeding after sex help narrow the explanation.

Light brown discharge immediately after a period may be blood that has taken longer to leave the uterus. Spotting later in the cycle may accompany ovulation or a temporary hormone shift. Starting, missing or changing hormonal contraception can alter the uterine lining and trigger breakthrough bleeding.

Bleeding between periods can also occur with chlamydia, endometrial polyps or uterine fibroids. Cervical dysplasia, cervical cancer and womb cancer can present with unexpected vaginal bleeding, but the symptom alone does not identify the cause. An examination and appropriate tests distinguish these possibilities.

Record when the spotting starts, whether it is pink, red or brown, how much protection you need, and whether it follows sex. Note pelvic discomfort, unusual discharge, odour, fever, missed contraception and any chance of pregnancy. Take a home pregnancy test when pregnancy is possible, following its instructions.

Arrange a routine medical assessment if spotting returns, persists, begins after menopause or is a new change for you. A clinician may discuss contraception and medicines, perform a pelvic or cervical examination, and consider pregnancy, infection or imaging tests according to your symptoms. Do not stop prescribed hormonal medicine without discussing the change with the prescriber.

Seek urgent medical care for heavy bleeding, fainting, marked dizziness, severe or worsening pelvic pain, shoulder-tip pain, or bleeding with a positive pregnancy test. Fever with pelvic pain or foul-smelling discharge also needs prompt assessment because infection may require treatment. Any bleeding after menopause should be medically evaluated even when it is light.

Ask whether your bleeding pattern fits a contraception effect, whether pregnancy or infection testing is appropriate, and whether you need a cervical check or pelvic ultrasound. Mention medicines that affect bleeding and explain any bleeding after sex, pelvic pressure, pain or change in discharge.