Lower abdominal pain and spotting between periods

Light spotting can occur with cycle changes, contraception, or irritation, but pain alongside it deserves attention. Pelvic inflammatory disease presents with pelvic pain and may cause unusual discharge, fever, or pain during sex. Endometriosis, adenomyosis, and fibroids can present with pelvic pain and irregular or unexpected bleeding. Ovarian cysts present with pelvic pain and may alter bleeding patterns. Ectopic pregnancy presents with pelvic pain and spotting when pregnancy is possible, even if bleeding seems light.

Note the colour and amount of bleeding, the date of your last period, contraception, pregnancy possibility, pain location, and symptoms such as fever, dizziness, discharge, nausea, or urinary discomfort. A clinician may need a pregnancy test, examination, swabs, urine testing, or ultrasound to identify the cause.

Use a pad or liner so you can observe the bleeding, and record when it starts and stops. Avoid sex if it increases pain or bleeding until you have advice. Arrange a medical appointment for new, repeated, or unexplained spotting with pain, particularly after sex or when cycles have changed. Do not assume the symptom is simply ovulation if it is different from your usual pattern.

Seek urgent care for severe or worsening pain, fainting, marked dizziness, heavy bleeding, shoulder-tip pain, fever, or repeated vomiting. If pregnancy is possible, pain with spotting needs prompt assessment because ectopic pregnancy can become serious. Seek routine review for recurring spotting, bleeding after sex, or persistent pelvic pain.

Ask whether pregnancy testing or infection testing is needed, whether the bleeding pattern suggests a pelvic condition, whether ultrasound is appropriate, and what amount of bleeding or pain should prompt urgent care.