It's normal to experience occasional vaginal spotting (light bleeding) before, after, or between periods. Common causes of spotting include medications, stress, or perimenopause. It's usually not a cause for concern, but sometimes spotting may signal a sexually transmitted infection (STI) or, rarely, cancer.

Hormonal Birth Control

Using hormonal birth control—like the pill, implant, injection, or an IUD—is one of the most common reasons for spotting. With pills or IUDs, spotting usually improves after three to six months. Implant or injection users may experience ongoing spotting.

Switching birth control methods may help if spotting becomes bothersome.

Certain Medical Conditions

Health conditions that disrupt hormone levels—such as hypothyroidism and polycystic ovary syndrome (PCOS)—can cause spotting. Treating the underlying condition often helps regulate cycles and reduce spotting.

Pregnancy

You stop having periods during pregnancy, but spotting—especially in the first trimester—is very common. Implantation bleeding may happen one to two weeks after fertilization. Increased blood flow to the cervix can also cause light bleeding.

Contact a healthcare provider if you experience any bleeding during pregnancy.

Medications

Several medications can cause spotting, including:

  • blood thinners

  • certain antidepressants and antipsychotics

  • hormone therapy

  • emergency contraception

  • tamoxifen (breast cancer treatment)

Talk to a healthcare provider if you suspect medications are the cause.

Uterine Fibroids Or Polyps

Fibroids and polyps are non-cancerous growths inside the uterus that can lead to spotting or cramping. They tend to become more common with age and may require medications or, in some cases, surgery.

Sexually Transmitted Infection (STI)

STIs like chlamydia or gonorrhea may cause vaginal bleeding, unusual discharge, or burning during urination. These infections need medical diagnosis and treatment.

Sex

Spotting after penetrative sex is common. Possible reasons include:

  • endometriosis

  • inflammation

  • polyps

  • thin or dry vaginal tissue

If spotting continues or is painful, consult a healthcare provider.

Injury Or Trauma

Any injury to the vaginal area—such as a Pap smear or rough intercourse—can cause spotting. Seek medical care if bleeding persists or is painful.

Perimenopause

Hormonal fluctuations in your 40s can cause changes in periods, including spotting. However, spotting is not considered a normal perimenopause symptom and should be evaluated. Other symptoms include hot flashes, insomnia, and vaginal dryness.

Stress

Physical or emotional stress can disrupt hormone regulation and trigger spotting. Lifestyle changes, dieting, or new exercise routines may also contribute.

Miscarriage Or Ectopic Pregnancy

Heavy spotting with cramps may indicate miscarriage or ectopic pregnancy—both medical emergencies. Symptoms may include pelvic pain, back pain, or passing tissue.

Seek immediate medical attention if pregnancy is possible.

Endometrial, Cervical, Or Ovarian Cancer

Spotting is rarely linked to cancer, but persistent or unexplained bleeding may signal endometrial, cervical, or ovarian cancer. Often, pain or other symptoms accompany the spotting.

Spotting Vs. Your Period

Spotting involves very light bleeding, while periods involve heavier blood loss (5–80 ml). Spotting is also normal one to two days before your period begins.

When To Contact A Healthcare Provider

Reach out to a provider if you experience:

  • cramps

  • unusual cycle changes

  • frequent or prolonged spotting

Seek urgent care if spotting is:

  • happening after menopause

  • accompanied by dizziness, fever, or abdominal pain

  • severe or worsening

A Quick Review

Spotting before your period is usually harmless, especially if linked to hormonal birth control. However, spotting may indicate an STI, thyroid condition, pregnancy-related complications, or—rarely—cancer. Contact a healthcare provider if you're concerned or notice unusual patterns.