Spotting between periods can be caused by a variety of reproductive health issues. Sometimes, spotting may be a symptom of endometriosis. Spotting may vary from a few days of brown discharge after your period ends to irregular periods. While spotting doesn’t necessarily mean you have endometriosis, it may be a reason to speak to your gynecologist.

In this article, we’ll explore spotting as it relates to endometriosis, discuss other potential causes of spotting, and share tips for managing this condition.

What Is Spotting?

The menstrual cycle lasts for approximately 28 days, in which menstruation (your period) occurs for about five days. Spotting, also called intermenstrual bleeding, is when light bleeding happens in between your periods.

Although spotting is common, it’s also considered abnormal, so you may want to talk to your doctor to figure out the cause.

What Is Endometriosis?

Endometriosis is a condition when the endometrium (the tissue that is supposed to line the uterus) grows outside of the uterus in the pelvic region. During the menstrual cycle, normal uterine endometrial tissue thickens, breaks down, and bleeds as a period. Endometrial lesions (growths of endometrial tissue outside of the uterus) also follow the menstrual cycle, shedding into the pelvic cavity during menstruation. The tissue that sheds outside of the uterus cannot escape the body and can cause painful scar tissue to form in the pelvic cavity.

What Are the Warning Signs of Endometriosis?

Symptoms of endometriosis include heavy periods, severe pelvic pain, lower back pain, pain during intercourse, infertility, and painful bowel movements. Most people with endometriosis complain of dysmenorrhea (severely painful periods).

Is Spotting a Symptom of Endometriosis?

Spotting is a common symptom of endometriosis. One MyEndometriosisTeam member commented, “I have been spotting before and after my regular menstrual cycle every month since February. It has been accompanied with severe pelvic pain recently.”

This member’s experience is backed by research. A study from the American Journal of Obstetrics and Gynecology looked at 80 women with fertility problems who had more than two days of premenstrual spotting. It found that 89 percent of these women had endometriosis. These researchers concluded that premenstrual spotting of more than two days may be a better predictor of endometriosis in women who have infertility issues than painful periods or pain during intercourse.

What Does Endometriosis Spotting Look Like?

Spotting before a period can vary from person to person. This is especially true for those with endometriosis, as it often causes irregular periods. This can make it hard to tell if you’re starting your period or experiencing bleeding between periods. Spotting can be heavy or light. It may look like there’s a little bit of blood in your discharge. Endometriosis spotting may appear brown or dark red because the blood may have been clotted for a while.

You may also notice blood clots when you’re spotting. While small blood clots, even if you’re not having your period, are OK, you should talk to your doctor about large blood clots. A good rule of thumb is that clots smaller than a quarter are not a problem, but frequent clots that are the size of a golf ball or larger can be concerning.

If you have heavy bleeding lasting more than seven days, including times when you have to change a pad or tampon more than once an hour, it’s a good idea to talk to your gynecologist.

What Are Other Known Causes of Spotting?

Spotting can be caused by endometriosis, but there are a few other reasons why some people experience bleeding in between their menstrual cycles.

Birth Control

Most hormonal contraceptives (birth control) can cause breakthrough bleeding or light spotting in between menstrual cycles. Although breakthrough bleeding can be caused by any type of hormonal birth control methods, low-dose birth control pills, hormonal intrauterine devices (IUDs), and other implants are more likely to cause spotting or light bleeding in between periods.

In addition to traditional oral contraceptives, newer hormonal treatments, such as elagolix (Orilissa), are now also used to manage endometriosis. These treatments can also cause spotting or irregular bleeding, especially during the first few months.

MyEndometriosisTeam members who have taken oral progesterone drugs, such as dienogest (Visanne) and norethisterone (Aygestin), which shorten, lighten, or eliminate a period, frequently report brown spotting. “They told me when I started that after six months, it’s common to have irregular spotting,” one member shared.

Pregnancy or Implantation Bleeding

The American College of Obstetricians and Gynecologists notes that up to 25 percent of pregnant women will experience some light bleeding or spotting one to two weeks after the egg implants into the uterus. The cervix will develop more blood vessels during pregnancy, which may lead to light bleeding or spotting after sex or a pelvic exam.

Perimenopause or Menopause

According to Mayo Clinic, the perimenopause phase is a stage before menopause, which occurs when you have gone 12 months without a menstrual period. Many women experience lighter menstrual flows or spotting in between menstrual cycles as they reach the end of their reproductive age and get closer to menopause. Other symptoms of perimenopause include vaginal dryness and hot flashes.

Mild Trauma

It is possible to experience light bleeding after a Pap smear, pelvic exam, or sex. One MyEndometriosisTeam member wrote, “I sometimes had some spotting after a pap, especially if I got it the week before my period.”

Cancer

Some of the more serious causes of spotting include endometrial cancer and cervical cancer as well as some other types of cancer. Although the spotting is likely caused by something else (especially if you’re under 45), make sure to see your doctor about any new or unexpected bleeding as soon as possible so they can check it out.

Other Causes

There are many other potential causes of bleeding between your periods, including:

• Ectopic pregnancy
• Miscarriage
• Stress
• Improper use of birth control and other hormone fluctuations (shifts in hormone levels)
• Blood thinner use

Talk to Your Doctor

Spotting is a common symptom for individuals with endometriosis. However, it’s important to report any changes in your menstrual flow, including heavy spotting, to your health care provider immediately. If you already know you have endometriosis, a change of medication can often reduce or eliminate spotting and endometriosis pain.

If you’re concerned that you may have endometriosis, talk to your doctor about running a diagnostic exam. This exam may involve a laparoscopy, which is a minor surgical procedure where a slim tube called a laparoscope is inserted in the abdomen and pelvic area. This procedure can be used to take a biopsy of tissue to help diagnose endometriosis or to remove small endometriosis lesions.

If you have endometriosis, your doctor will help determine the best treatment options and help you prevent complications and maintain a better quality of life.

Find Your Team

On MyEndometriosisTeam, the social network for people with endometriosis, more than 136,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

If you have endometriosis, was abnormal vaginal bleeding an early sign? How do you manage spotting? Share your experience in the comments below, or start a conversation by posting on your Activities page.