What causes mid-cycle spotting? Should I be worried?

When should I worry about mid-cycle spotting?

Spotting or bleeding in between periods can be troublesome and may cause anxiety. There are many reasons why this happens.

In most instances, it is only a minor issue that settles down over time. On other occasions, you need to see your GP and may need investigation and referral to see a Gynaecologist.

One of the most common questions that sisters ask me as a Gynaecologist is regarding irregular periods and bleeding in between cycles.

This causes considerable anxiety and you often think of the worst possibility.

The other concern that sisters have is whether or not to continue praying when you are bleeding in between periods.

Bleeding in between periods can be caused by so many different things.

I will attempt to talk you through common causes in different age groups.

What causes mid-cycle spotting in teens?

Once periods start, it takes a couple of years to settle into a pattern.

Regular periods is a result of a complex interplay between the brain, pituitary gland and the ovaries.

For the first couple of years, ovulation may not be regular. Periods can be all over the place with no pattern.

It is extremely inconvenient, but generally speaking its not a cause for worry.

The pattern should develop by 2 years after periods start.

If not, do see your GP.

If periods are very heavy, see your GP as you would need tests.

Other causes of spotting between periods:

  • Ovulation – Sometimes, there can be light spotting in the middle of the cycle. This is related to ovulation and not a cause to worry. It should not last more than a couple of days.
  • Hormones – If you are taking birth control pills, this can cause spotting and irregular bleeding. Changing the pill or stopping it can resolve the problem.
  • STI like chlamydia – If married, consider this possibility. You would need to see your GP. The test is either a urine test or a swab test. If positive, you and your partner will need antibiotics.
You may or may not have other symptoms like vaginal discharge and pain when passing water.

It is extremely important to take your antibiotics. If left untreated, Chlamydia can cause PID (Pelvic Inflammatory Disease). This may result in infection of the tubes causing blockage and difficulty in conceiving.

  • Pregnancy-related – Again if you are married, think of pregnancy and do a pregnancy test. I’ll talk about pregnancy-related issues in the next section.
What causes spotting in women in the reproductive age group?

Realistically speaking reproductive age group would span the entire time that you have periods, from starting periods to menopause.

However, I would include women from early 20s to 40 in this group.

Causes of spotting in between periods:

  • Pregnancy-related – If there is any possibility of pregnancy at all, do a pregnancy test.
  1. Normal pregnancy can cause spotting in between periods because of implantation bleeding. This happens as the fertilized egg gets attached to the lining of the womb. This is usually light bleeding and stops in a couple of days. Not to worry if you don’t have any further bleed or pain.
2. Miscarriage- If there is bleeding and pain, this could be suggestive of miscarriage. Make sure you see a doctor, your GP, or emergency services. Even if you haven’t missed a period you could still be pregnant if the pregnancy test is positive.

3. Ectopic pregnancy – If there is pain and any bleeding with a positive pregnancy test, think of ectopic pregnancy. 1 in every 90 pregnancies is ectopic, that is the fertilized egg implants outside the uterus, most commonly in the fallopian tube.

If an ectopic pregnancy is diagnosed, you will seen by a specialist in the hospital. In most cases, either the pregnancy is removed by surgery, usually key hole surgery, or sometimes treated by medication. A pregnancy in the tube can’t continue as the tube can only stretch so much and will eventually rupture.

  • Cervix – A name given to the neck of the womb. Many conditions of the cervix may cause spotting in between periods.
1.Polyp- non cancer growth of the cervix. It can usually be removed easily, sometimes during a gynaecological examination.

2. Cervical erosion – a harmless condition of the neck of the womb which may cause spotting. It may heal by itself.

3. Cervical precancer and cancer – Make sure you are up to date with your smear tests. Precancer changes in the cervix are picked up usually on smear tests. You may be called for an examination called colposcopy if the smear is abnormal.

This is a long topic by itself and I plan to write about HPV, colposcopy and cervical cancer separately.

  • Uterus – polyps and fibroids are non cancer growths of the womb that may sometimes cause spotting. They are easy to remove and bleeding stops after removal.
  • PCOD (Polycystic ovarian disease) can cause irregular periods. You may sometimes mistake this to be bleeding between cycles. Usually, PCOD makes cycles infrequent. Again, so much to be said about PCOD and this will probably be another post!
Bleeding between cycles in women after the age of 40

Generally speaking any irregularity of cycles, especially bleeding between cycles in this age group needs to be investigated further. Your GP would check your smear history, do an examination, sometimes an ultrasound and refer you to see a specialist.

The causes are:

  • Hormonal – Disturbances of the hormones could cause spotting. This could be birth control pill-related, PCOD or hormonal changes approaching menopause.
  • Cervix – All the conditions of the neck of the womb are applicable to this age group as well and would need investigation in the same way.
  • Uterus – Polyps and fibroids are common. There may be a precancer or cancer of the lining of the womb. Your GP would refer you to the hospital where you would have a sample of tissue taken from inside the womb called an endometrial biopsy.
  • Vagina and vulva – Dryness because of premenopause or menopause can cause bleeding. Your GP would prescribe hormone creams to treat this. Rarely, some women may have cancer of the vagina or vulva. This is uncommon and an examination would be able to pick this up easily.
To pray or not to pray?

Every spotting or bleeding in between periods is different and you need to ask somebody for a fatwa regarding whether you should pray or not.

Generally speaking, if the bleeding is separate from your period and is light and has no characteristic of your period, you regard it as abnormal. You should be able to clearly distinguish this bleeding from your normal period. In that case the ruling is that you pray during it as linked above.

Please do consult somebody with sound religious knowledge regarding this matter.

To wrap up

Remember, how much ever information I provide, each situation is different. You have to consult an expert who will assess you holistically.

I remember getting frustrated when my patients googled symptoms and came up with the most bizzare suggestions.

There is a lot of health information out there, some reliable and some that is so misleading.

Starting this blog is a small step in attempting to provide you with credible information in this age of infodemics.

It’s a mammoth task! I’ll try and bring you authentic information to the best of my ability in sha Allah.

Worry or not?

In younger girls spotting is not usually of much concern.

In the reproductive age group, think of pregnancy and always do a pregnancy test if in doubt.

Infections and cervical precancer conditions are again common in this age group.

If you are above 40, you must see your GP. It is most likely due to hormonal changes or infection/ erosion of the neck of the womb, but other conditions like cancer of the neck of the womb and of the womb must be ruled out.

Increase your awareness about your periods and see your GP if in doubt. Most conditions are treatable if detected early. Keep your smear test appointments. Make sure you complete any course of antibiotics you are given for infection.

See a specialist when in doubt. You will always need to be seen by a specialist who can either reassure you or perform further investigations, as the need may be.

Do share any experience regarding this which may benefit other sisters in a similar situation.