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Let’s talk about spotting, what it means and why it happens.

I’m sure we have all experienced spotting at some point in our lives. Don’t get me wrong I love a good spot like on clothing, but not really a fan of spotting in my underwear when I least expect it (which I am sure you will agree with).

For those of you that don’t know me, my name is Michelle Cooke, Period & Hormone Naturopath, Natural Fertility Educator & Naturopathic Emotional Release Practitioner. I’m the Founder and Director of Reproductive Wellness, a clinic located in Melbourne. I see patients online and face-to-face.

About Spotting

Defined as very light bleed which is taking place outside your actual period. Therefore; the bleed isn’t a result of having your period. It is noticeable but not enough blood to soak a pad or tampon. It is not heavy enough to warrant using a pad or tampon. Spotting is different to your period (which is due to the shedding of the endometrium – lining of your uterus).

The spotting bleed can come from either

  • Lower reproductive tract e.g. vagina or cervix

  • Upper reproductive tract e.g. your uterus

If the bleed is lighter it is usually from the lower or upper reproductive tract.

Whereas if the bleed is heavier that is generally from the upper reproductive tract for instance from your uterus.

Characteristics:

  • Might be brown or pink coloured blood

  • Blood is lighter in amount (compared to your period)

  • Variations in time frame: could be for a day, then it stops and starts up again or it could spot continuously in a row for a few days

Causes / contributing factors of spotting 

There are several reasons why spotting can take place, these are some potential contributing factors / causes:

 

  • Ovulation:

Taking place around the time of ovulation usually in the middle of the cycle and it is light. It is usually pink tinged.

  • Pregnancy:

About 1 in 4 women experience this generally between weeks 5 and 8 or 1-4 weeks after your period was to be expected. It is a common symptom of early pregnancy.

In the first trimester it can be due to:

  • Changes to the cervix

  • Hormonal changes

  • Having sex

  • Implantation

If it is heavier spotting or bleeding this is cause for potential concern

 

  • Implantation bleeding:

If it occurs early on it may be as a result of the embryo implanting. Usually only lasts for a day or two and generally takes place about a week after ovulation or around a week before your period is due.

  • Breastfeeding:

Breastfeeding suppresses ovulation. Some women can still experience spotting due to hormonal changes. Also when the body is preparing to ovulate spotting may occur.

  • Stress

Alters your hormone production because survival is more important to protect you against danger. It is not a safe time to reproduce. Your body will use pregnenolone which is a precursor hormone to progesterone to make cortisol to help you adapt to that stress. As a result, ovulation will be delayed or stopped, and you won’t produce sufficient progesterone which is released from the corpus luteum. Low progesterone can arise in spotting.

  • Thyroid Issues

  • PCOS

  • Perimenopause

The journey towards menopause as a result of hormonal changes.

  • Injury:

Uterus, cervix or vagina results in abnormal spotting. Rough sex could be one cause or as a result of something else.

  • Miscarriage:

This can range from spotting to a light bleed to a heavier bleed

  • Oral Contraceptive Pill:

This tends to happen when you start a new pill. It should tend to stop a few months later. It usually happens as you adjust to the contraceptive. But if you are still spotting (breakthrough bleeding) in between your withdrawal bleed (because remember it is a withdrawal bleed that you experience on the pill, you don’t get your period) then it might not be the right pill for you.

  • Other contraceptives:

  • Implants

  • Injection

  • Hormonal IUD

Spotting may occur for a few months after starting the contraceptives as your body adjusts to them.

  • Ectopic Pregnancy:

When a fertilised egg is implanting outside of the uterus, generally in one of your fallopian tubes.

Other symptoms you may notice are dizziness, shoulder pain, abdominal pain. This may be light or heavy spotting.

 

  • Low progesterone:

Particularly if spotting that takes place in the luteal phase (post ovulation) especially if you have a short luteal phase.

  • Fibroids:

Non-cancerous growths that are found in the uterus

  • Endometriosis:

Tissue that is similar to the lining of your uterus is growing outside your uterus where it doesn’t belong

  • Cervical polyps:

Abnormal growths  that grow on your cervix or inside your uterus

  • Postcoital spotting:

This is spotting that happens after penetrative sex. This is normal if it is your first-time having sex. But if not, it is not normal and could indicate:

  • You have polyps or an issue with your cervix etc.

  • Endometriosis

  • Sexually transmitted infections

  • Dry vaginal tissues: It could indicate that the delicate vaginal tissue has been irritated as a result of dryness and lack of lubrication to the area. If your vagina is dry it means you have a lack of hydration in your tissues this may be due to a hormonal imbalance. Using a lube might assist in the meantime, until you get to the bottom of what it is happening.

    Make sure it is a lube that is free from toxins and doesn’t impact the pH of the vagina which increases the risk of infection. A good brand to consider is ‘Bonk’ they have one that is water based (for use with condoms) and one that is oil based (do not use with condoms as it may break down the condom). Evening primrose oil is useful to hydrate the vaginal tissues which you can take internally and also break open the capsule and use topically on the vulva.

  • Sexually Transmitted Infections

Gonorrhoea for instance can cause burning when you do a wee and an unusual discharge along with spotting (abnormal vaginal bleeding). Chlamydia is another one too.

 

  • Pelvic Inflammatory Disease:

Symptoms include spotting, pain in lower abdomen, fever and unusual vaginal discharge. This can happen when sexually transmitted infections haven’t been treated. Can results in infertility if symptoms are not treated. Spotting can occur randomly or after having sex.

  • Cancer:

These types of cancer can result in spotting:-

  • Ovarian

  • Uterine

  • Cervical

  • Vaginal

What can help prevent further spotting?

It depends why it is happening, if it considered a normal occurrence for instance as a result of breastfeeding, implantation or ovulation for example you wouldn’t need to be concerned.

However, if it is due to a condition, infection, occurring after sex, low progesterone, miscarriage, thyroid issues, stress, this would need to be investigated and treated accordingly.

 

THOROUGH INVESTIGATION

  • Hormones (oestrogen, progesterone, testosterone, FSH, LH etc.)

  • Vitamin and mineral status

  • Thyroid testing

  • Adrenal testing: either cortisol levels through blood draw or salivary testing

In terms of thyroid testing: I am not talking about just TSH (thyroid stimulating hormone) this is just one little part of such a bigger puzzle. It needs to be TSH, fT4, fT3, thyroid antibodies and urinary iodine and if possible rT3 as well. Because TSH could be normal but your actual thyroid hormones T4 and T3 may not be normal, and if you just had TSH tested you wouldn’t know. T4 converts to T3 which is your active thyroid hormone, so we want to know what those levels are like too. We also want to know if you have enough iodine for your thyroid to be working properly.

 

What I would recommend doing if you have spotting

If you are not sure if the spotting is a concern or not I would recommend taking a trip to your GP just to double check. A thorough investigation into why you are experiencing spotting whether it be a once off or recurrent will be essential in future prevention. I would highly recommend being referred by your GP to a Gynaecologist if indicated. I would also recommend booking an appointment with a Naturopath who specialises in periods & hormones. FYI this is what I do.

 

Naturopaths will take a rather thorough approach looking at your pathology testing in a very different way than a GP or specialist would. The pathology reference range is so broad on a pathology test is so broad. A GP or specialist will only treat you if you are outside that broad pathology range (when the wheels fall off the wagon) because they are trained in treating disease and symptoms. It is no fault of the doctor or specialists they are just trained this way. But at the end of the day: “Normal test results won’t help you”.

 

Whereas a Naturopath will be making sure that you are within the optimal range. Because the truth is if you fall outside the optimal range which is a smaller range within the broad range you can still present with symptoms and not feel the best. Naturopaths will also look at nutrient levels like vitamins and minerals as well which are essential for hormone balance. Then treatment will be the use of things that support the body like herbal medicine, nutritional medicine, diet and lifestyle advice to improve hormone balance etc.

 

If you would like some help, I would love to help you, go ahead and book a FREE 15 min discovery call to find out more about how we would work together and if we are a good fit.

Thank you so much for watching, if you have any comments or questions pop them below in the comments box