Spotting before a period is common and usually caused by hormone changes. See a doctor if it is heavy or frequent.
Common causes
- Ovulation.
- Hormonal birth control.
- Implantation bleeding.
- Stress.
- Perimenopause.
- Infections, polyps or fibroids.
Is it normal
Light spotting a few days before a period is common.
Pregnancy
Take a test if you might be pregnant.
See a doctor
If spotting is heavy, frequent or comes with pain.
Types of pre-period spotting
Light spotting a day or two before a period is common and is often the start of the period. Spotting a week or more before may relate to ovulation, hormones, birth control or implantation.
Hormonal causes
Progesterone drops before a period. If it falls early or unevenly, the uterine lining can shed in small amounts. This is more common in perimenopause, after childbirth, or when starting or stopping birth control.
Contraception
Breakthrough bleeding is common during the first 3 to 6 months of using pills, patches, rings, implants or hormonal IUDs. Missed pills can also trigger it.
Luteal phase defect
A short second half of the cycle (under 10 days) with low progesterone is sometimes linked with premenstrual spotting, though the diagnosis is debated.
Conditions to consider
- Polycystic ovary syndrome.
- Thyroid disease.
- Endometriosis or adenomyosis.
- Uterine polyps or fibroids.
- Cervical or vaginal infections, including chlamydia and gonorrhea.
- Cervical ectropion.
- Ovarian cysts.
Pregnancy
Light spotting before an expected period may be implantation bleeding, which occurs 6 to 12 days after ovulation in a minority of pregnancies. Take a pregnancy test if your period is late.
Lifestyle factors
Stress, sudden weight change, intense exercise and travel can disrupt cycles.
Track
Note dates, flow, color and symptoms in a period app.
See a doctor if
Spotting happens in most cycles, lasts more than a few days, comes with pain, heavy bleeding, fever, unusual discharge, bleeding after sex or after menopause, or you are pregnant with bleeding. Heavy bleeding with dizziness or severe one sided pain needs emergency care.
Hormones behind pre-period spotting
Light spotting 1 to 2 days before a period is common and can result from the drop in progesterone that triggers the lining to shed. Low progesterone in the second half of the cycle, called a short luteal phase, can cause spotting. Starting or changing hormonal birth control, stress, intense exercise, weight change, thyroid disease and perimenopause are other causes. Polyps, fibroids, endometriosis, polycystic ovary syndrome and sexually transmitted infections can cause spotting too.
When to test or get checked
If spotting is followed by a missed period, take a pregnancy test, since implantation bleeding can look like spotting about 6 to 12 days after ovulation. Track dates in an app. See a doctor if spotting occurs most months, lasts several days, comes with pain, bleeding after sex, foul discharge or fever, or if you are over 45 and have changes in pattern. Treatment depends on the cause, and hormonal therapy can help some cases.
Based on data from ACOG and the Mayo Clinic
