What should you know about mid-month spotting?

Mid-month spotting is light bleeding between expected periods; it can result from hormonal changes, contraception, infection, pregnancy-related changes, or conditions affecting the cervix or womb. The colour may be pink, red, or brown, and the amount can be small enough to notice only when wiping. A single episode may settle, but new, repeated, or unexplained bleeding deserves a clinical assessment.

Spotting around the middle of a cycle can happen when hormone levels shift around ovulation. Starting, stopping, missing, or changing hormonal contraception can also alter the lining of the womb and cause unexpected bleeding. A pregnancy test may be appropriate if pregnancy is possible, because early pregnancy and pregnancy complications can include bleeding.

Irritation of the cervix after sex, vaginal dryness, or an infection can cause bleeding, especially when there is pelvic pain, unusual discharge, burning when urinating, or bleeding after intercourse. Conditions such as endometrial polyps and uterine fibroids can also present with bleeding between periods. Chlamydia may present with bleeding between periods or after sex, sometimes without obvious symptoms. Cervical dysplasia and cervical cancer can present with unusual vaginal bleeding, so persistent or post-coital bleeding should not be ignored.

Record when the spotting began, how long it lasted, its colour and amount, and whether it followed sex, a missed contraceptive dose, or a new medicine. Note pain, discharge, fever, dizziness, or pregnancy possibility as well. Avoid vaginal douching, which can irritate tissue and make symptoms harder to interpret.

Arrange an appointment if the bleeding returns, continues, occurs after sex, or is accompanied by other symptoms. A clinician may ask about your cycle and contraception, perform an examination, and offer pregnancy, infection, or other tests based on your history. Do not stop prescribed contraception without advice; discuss troublesome bleeding with the prescriber.

Seek urgent medical help for heavy bleeding, severe or one-sided pelvic pain, fainting, marked dizziness, shoulder-tip pain, fever, or feeling very unwell. If pregnancy is possible, bleeding with pain, faintness, or shoulder-tip pain needs prompt assessment because an ectopic pregnancy can be dangerous. After menopause, any vaginal bleeding should be assessed, even if it is light.

You could ask: What causes fit my bleeding pattern and symptoms? Could contraception, infection, pregnancy, or a cervical or womb problem be involved? Which examination or tests do I need? What changes should make me seek urgent help?