Spotting

and Sabine Schrör, medical journalist

Hanna Rutkowski is a freelance writer for the medical team.

More about the experts

Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Spotting can occur at any time, regardless of regular menstrual bleeding. The cause can usually be found in hormonal changes. But there can also be infections or more serious causes such as cervical or ovarian cancer. Therefore, women should always have a gynecologist assess any sudden intermenstrual bleeding. If necessary, he can often quickly and specifically treat the cause of the spotting.

Brief overview

• What is spotting? An unexpected, brownish discharge in women, which can vary in strength and last for different lengths of time. Spotting can start at any time, regardless of normal menstrual bleeding.
• Causes: Mostly hormonal changes (e.g. due to hormonal contraceptives, puberty or menopause). Sometimes signs of genital infections or cancer. Other possible causes are thyroid and liver diseases, broken veins in the vaginal area and psychological factors.
• Diagnostics: recording of the medical history in the doctor-patient conversation (anamnesis), gynecological examination, ultrasound, measurement of the hormone level, pregnancy test if necessary.
• Treatment: Treats the underlying cause. Examples: administration of hormone preparations for hormonal imbalances, surgery for fibroids and cancer. If there is no organic cause, treatment with home remedies or medicinal plants such as shepherd's purse or monk's pepper can help.

Spotting: Description

Spotting is usually a weak, sometimes stronger, brownish discharge from the vagina. Sometimes it disappears after a few hours, while in other cases it lasts for several days. The intermenstrual bleeding occurs independently of the regular menstrual bleeding.

Spotting is usually triggered by hormonal changes, such as those caused by hormonal contraceptives (pill, IUD, etc.). The natural hormonal changes during puberty and menopause can also be the reason for more frequent intermenstrual bleeding. Last but not least, the psyche can also influence the fine interplay of hormones in the female body. Stress, grief, lovesickness, but also joy sometimes trigger intermenstrual bleeding.

Spotting: Difference from menstrual bleeding

Spotting differs from normal menstrual bleeding in terms of both timing and underlying causes:

Spotting - anytime and for various reasons

Spotting can occur at any time, regardless of the menstrual period. The causes can be varied - from hormonal changes to cancer.

The menstrual cycle - monthly routine

The female cycle is determined by the interaction of various hormones. It begins with the first rule (menarche) in puberty and ends with the menopause (climacteric). A menstrual cycle begins on the first day of the monthly menstrual period and ends one day before the next menstrual period. How long a monthly cycle lasts varies from woman to woman. The average is around 28 days.

In the first half of the cycle, the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH) stimulate the follicles in the ovaries to grow. Usually only one follicle matures completely. It produces more and more estrogen in the process. This causes the lining of the uterus to build up and prepare itself for possible implantation of the fertilized egg.

Around the middle of the cycle, LH triggers ovulation (this is when the estrogen level is highest): the mature egg cell leaves the follicle, is absorbed by the fallopian tube and slowly migrates through it to the uterus. It can be fertilized for about 24 hours after ovulation.

The covering of the follicle remaining in the ovary is transformed into the corpus luteum. This produces the hormone progesterone and, in smaller quantities, also estrogen. Progesterone (also called luteal hormone) is also involved in preparing the lining of the uterus for possible implantation. In addition, progesterone and estrogen together inhibit the further release of FSH and LH from the pituitary gland. This prevents further egg cells from maturing in the ovaries.

But if fertilization does not take place, the corpus luteum perishes after ten to twelve days. This means that the concentrations of progesterone and estrogen in the blood drop significantly. In response, the thickened lining of the uterus and the unfertilized egg are excreted along with blood as a menstrual period.

Spotting: causes

A changed hormonal balance usually triggers intermenstrual bleeding. But sometimes the spotting has a more serious background. The unscheduled discharge can indicate infections of the genital area or tumors.

Hormonal causes

• Ovulatory bleeding: After ovulation, the level of estrogen decreases, while the level of progesterone increases. This can cause a brief intermenstrual bleeding in the middle of the cycle.
• Yellow corpuscle weakness: The corpus luteum produces the hormone progesterone after ovulation. It prepares the lining of the uterus for the possible implantation of a fertilized egg and sustains a pregnancy. This means: For women with luteal weakness, the resulting progesterone deficiency makes pregnancy more difficult. Without medical help, they can hardly fulfill their desire to have children. A shortened second half of the cycle with spotting is typical for luteal weakness.
• Menopause and puberty: During puberty, the hormones first have to level off - severe cycle fluctuations and frequent spotting are a problem for some young women. The hormonal roller coaster ride during menopause also often leads to intermenstrual bleeding.
• Hormonal contraception: Hormones such as estrogen or progestin administered with the pill can trigger intermenstrual bleeding, especially when you start taking it. Even with the IUD, spotting often occurs at the beginning (after insertion).
• Implantation bleeding: If a fertilized egg cells implant itself in the lining of the uterus, small vessels can be injured. This manifests itself in about a third of all pregnant women as weak, short, bright red bleeding.

Inflammation

• Inflammation of the fallopian tubes (salpingitis) and ovaries (adnexitis): This serious inflammation mainly affects young, sexually active women between the ages of 25 and 40. In addition to severe abdominal pain, fever and vomiting, infertility threatens as a long-term consequence. If scars remain after healing, the acute ovarian inflammation can become chronic. Typical signs of this are pain during sexual intercourse and during ovulation, as well as spotting.
• Inflammation of the uterus (endometritis) and vaginal inflammation (colpitis): If inflammation rises from the vagina into the uterus, this can lead to spotting, abdominal pain and foul-smelling discharge. Colpitis causes burning pain or itching in the vagina.

Tumors

• Fibroids: Many women between 35 and 50 develop benign growths on the uterine muscle layer called myomas. The tumors can be of different sizes, but treatment is usually not necessary. However, fibroids often cause spotting and prolonged, excessively heavy menstrual bleeding (menorrhagia).
• Polyps on the cervix or uterus: These benign changes in the lining of the uterus can cause a foreign body sensation, pain during intercourse, and intermenstrual bleeding.
• Portioectopy: the cervix and uterus are covered by layers of mucous membrane. With portioectopy, these layers shift around the cervix.Spotting can occur.
• Cervical cancer (cervical cancer): Certain types of the human papillomavirus (HPV) usually cause this cancerous tumor. He can grow up painlessly and unnoticed for a long time. Occasional spotting or bleeding during intercourse can be the first signs of cervical cancer.
• Uterine cancer (endometrial cancer): Malignant tumors of the uterine lining develop especially in older women in their 70s. Sudden spotting, which occurs long after the menopause has ended, is an alarm signal. If endometrial cancer is treated early, the chances of recovery are good.
• Ovarian cancer (ovarian cancer): This tumor grows for a long time without causing pain. That is why it is often discovered very late. Unspecified symptoms such as fatigue, pelvic pain, and constipation are the first easily overlooked symptoms. In the later stage there is also an ascites (ascites).
• Vaginal cancer: vaginal cancer is usually associated with cervical cancer. Common symptoms are pain and bleeding during intercourse and irregular, bright red bleeding.
• Vulvar cancer: Malignant tumors on the labia are rare. They show up as knotty changes and are often accompanied by bloody discharge.

Other causes

• Endometriosis: In this disease, the mucous membrane from the uterus reaches other parts of the body, the abdomen is particularly affected. The scattered mucous membrane changes during the monthly cycle just like the mucous membrane inside the uterus. This means that during normal menstrual bleeding, bleeding outside the uterus also occurs. Severe pain during menstruation and sexual intercourse suggests endometriosis. Other signs include irregular cycles and spotting.
• Thyroid disorders: Both an excess and a deficiency of thyroid hormones (hyper- or hypothyroidism) affect the entire metabolism and cause a variety of symptoms. The cycle also changes - anything is possible, from missing your period (amenorrhea) to long-lasting intermenstrual bleeding.
• Liver diseases: Liver diseases such as cirrhosis also cause menstrual cycle disorders in an advanced stage. This can also lead to spotting.
• Broken veins during sexual intercourse can also lead to spotting.
• Psyche: Strong emotions such as joy or sadness as well as stress can also trigger spotting.

Spotting during pregnancy

Particular care should be taken if spotting occurs during pregnancy. They are often only due to harmless hormonal fluctuations. But sometimes they can also be an indication of serious complications. You can read everything you need to know about this topic in the text Spotting during pregnancy.

Spotting: when do you need to see a doctor?

Almost every woman knows spotting from her own experience. If they occur once, they are usually not worrying. If, however, intermenstrual bleeding occurs during several cycles or if these follow one another in quick succession, you should consult a gynecologist. Pregnant women should be particularly careful and always have any sudden bleeding medically clarified immediately.

Basically, you should see a gynecologist with:

• several intermenstrual bleeding in a row
• frequent spotting
• Intermenstrual bleeding after the end of menopause
• heavy or prolonged bleeding
• Spotting during pregnancy
• additional symptoms such as weakness, fainting, or severe pain

Spotting: what does the doctor do?

Your contact person in the event of spotting is the gynecologist. He will first ask you in detail about your symptoms and your medical history (anamnesis).

This is followed by a gynecological examination. The doctor scans the vagina and, if necessary, carries out an ultrasound examination. Changes such as myomas or other tumors that may be responsible for the spotting can be identified. If necessary, the doctor will use a blood test to check whether you have an early pregnancy, which can explain the intermenstrual bleeding.

If there are no organic changes, the hormone levels in the urine and blood can provide clues to possible causes.

Treatment for spotting

Treatment for spotting depends on the trigger. If your hormone fluctuates, your doctor may prescribe herbal or artificial hormones for you. Smaller myomas or benign tumors can be removed in a short surgical procedure. In the case of inflammation or fungal infections, antibiotics or antimycotics can help. Cancer diseases must be treated comprehensively (e.g. surgical removal of tumors, chemotherapy, radiation therapy, etc.)

Spotting: you can do it yourself

In principle, we recommend the annual preventive medical check-up, which women aged 20 and over can take advantage of free of charge. This allows many gynecological diseases to be recognized or prevented at an early stage. The PAP test is particularly important - a cell smear for the early detection of cervical cancer. Girls who have not yet had sexual intercourse can also get vaccinated against the human papillomavirus (HPV). This pathogen is considered to be the main cause of cervical cancer.

Once you have checked by a doctor that there is no organic cause for your spotting, you can use selected home remedies. Various medicinal plants have a calming and balancing effect on hormonal fluctuations. In addition, hemostatic agents are well suited for spotting:

• Shepherd's purse: The shepherd's purse has a hemostatic effect and stimulates the uterus to contract. Pour a teaspoon of shepherd's purse with boiling water and drink two to three cups a day.
• Monk's pepper: This medicinal plant contains a phytohormone that promotes the production of the body's own progesterone. Monk's pepper also gently regulates the spotting cycle and alleviates symptoms such as premenstrual syndrome (PMS). The plant is available in capsule form in the pharmacy.

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