Women's Health Ben Brown | 7 years ago

Spotting an Issue: Bleeding Between Periods

Vaginal bleeding or “spotting” that occurs between periods or after menopause (when periods stop completely) can be caused by a variety of things. “Most of the underlying issues of spotting are benign and treatable,” says Chandra Hollier, MD, from Union Obstetrics & Gynecology-Waxhaw part of Atrium Health. But, she adds, sometimes vaginal bleeding may be due to cancer or precancer. “So any unusual bleeding should be evaluated promptly by your doctor.” Although the duration of, time between and volume of every woman’s period varies somewhat, there is a general “norm” for most women. According to Dr. Hollier, normal menstrual flow lasts about four days (plus or minus two to three days). It produces a total blood loss of 30 to 80 ml (about two to eight tablespoons), and occurs normally every 28 days (plus or minus seven days). Unexpected bleeding of any kind can be upsetting. The best way to determine the cause of vaginal bleeding is to make an appointment for a careful exam with your primary care doctor or gynecologist. This exam can be accomplished even while you are bleeding, so do not delay getting an appointment just because you are currently bleeding. “When you call your doctor, be prepared to answer the following questions,” suggests Dr. Hollier.

 Time pattern

  • When did this bleeding between periods begin?
  • Does it occur consistently, such as every month?
  • At what point during the course of a menstrual cycle does this bleeding begin?
  • How long does the in-between bleeding last?


  • Is the bleeding heavy?
  • How many tampons or pads are required?

Aggravating factors

  • Does increased physical activity make the bleeding worse?
  • Does intercourse bring on the bleeding?
  • Is increased stress associated with the bleeding?
  • Does anything relieve or prevent it?

 Other symptoms

  • What other symptoms do you have?
  • Do you have abdominal pain or cramps?
  • Is there increased bruising elsewhere on the body?
  • Do you have any difficulty, pain or burning with urination?
  • Is there bloody urine or blood in the stools?
  “Again, there are many causes for spotting,” says Dr. Hollier. “They range from changes in hormone levels, complications from pregnancy and stress to uterine fibroids, infection, injury or even cancer. Your doctor will determine the cause and what treatment, if any, is appropriate.”