Irregular Bleeding and Spotting: Causes Across Ages

Irregular bleeding and spotting describe vaginal or uterine bleeding that occurs outside of your menstrual period. It can happen at any age, even before or after the reproductive years. While most cases are not a cause for concern, the problem can sometimes result from serious issues.

Irregular bleeding and spotting can range from light bloody discharge to heavier, constant bleeding. It can result from conditions such as hormone therapy, pregnancy, infections, or other health concerns.

Living with irregular bleeding and spotting can be frustrating and may pose some health dangers. Finding out the reasons for spotting can help you get the right treatment and reduce the bleeding.

Causes of Bleeding Outside of Period

Medical Conditions Related to Age

Uterine fibroids (leiomyomas): Fibroids are muscular tumors that grow in the wall of the uterus. These growths are usually benign (not cancerous) and may be asymptomatic or cause symptoms such as bleeding between menstrual periods.

Uterine polyps: Polyps are overgrowths of the inner lining of the uterus. They are usually benign, though some can be malignant (cancerous). Uterine polyps are rare in people younger than 20 and become more common with age. They peak in the 40s and decline in menopause (the end of menstrual periods).

Adenomyosis: This occurs when endometrial tissue (tissue similar to that which lines the uterus) grows into the myometrium (the muscle wall of your uterus). It can cause the uterus to double or triple in size. People age 35 to 50 who have had at least one pregnancy are most often affected.

Endometrial hyperplasia: In this condition, the endometrium becomes too thick. It is often linked to excess estrogen and/or inadequate levels of progesterone, resulting in too many endometrial cells. It is more likely to occur after age 35.

Gynecologic cancers: Gynecologic cancers begin in the reproductive organs. Abnormal vaginal bleeding and discharge can occur with any type of gynecologic cancer. The risk of these cancers increases with age. These cancers include:

Polycystic ovary syndrome (PCOS): This condition causes issues with ovulation and the function of the ovaries. It typically affects 1 in 10 women of childbearing age. Most people find out they have it when they have problems getting pregnant.

Other Medical Conditions

Bleeding disorders: Inherited bleeding disorders such as hemophilia or von Willebrand disease, a low platelet count (thrombocytopenia), or a deficiency of Vitamin K (which helps produce blood-clotting factors) can cause vaginal bleeding.

Cervicitis: Cervicitis is an inflammation of the cervix, the canal that connects your uterus and vagina allowing fluids to pass from your uterus to your vagina. Cervicitis can often be traced to a sexually transmitted infection (STI). It can also cause bleeding or spotting between periods or after menopause.

Thyroid conditions: Different thyroid conditions can affect or interfere with your normal menstrual cycle, causing long periods, absent periods, and spotting. The thyroid is a gland that produces hormones that regulate metabolism and influence the menstrual cycle.

Hormone-Related Problems

Hormone-based birth control: Combined hormonal contraceptive methods such as pills, implants, patches, shots, or rings use synthetic hormones to help regulate your menstrual cycle. Spotting and bleeding, called breakthrough bleeding, can occur as your body adjusts to these hormones when you start them or switch products. It is most likely to happen with low-dose and ultra-low-dose birth control pills, the implant, and hormonal intrauterine device (IUD) in the first months after use or after stopping them. This problem usually improves within two to six months.

Hormone replacement therapy (HRT): HRT is a treatment that can help symptoms associated with menopause. During this time, the body gradually decreases production of estrogen and progesterone. HRT can help relieve symptoms such as hot flashes, night sweats, and vaginal dryness that occur during menopause.

Perimenopause: Spotting is normal during perimenopause, the stage that occurs before menopause. Perimenopause can last five to 10 years as your ovaries become smaller and produce less estrogen, causing irregular periods and varying amounts of bleeding until your periods stop.

Pregnancy

Ectopic pregnancy: An ectopic pregnancy is when a fertilized egg attaches itself to the wall of a fallopian tube or somewhere else outside the uterus. Bleeding is a sign of an ectopic pregnancy.

Miscarriage: The loss of pregnancy, known as miscarriage, can cause bleeding. Typically, bleeding in the first 20 weeks of pregnancy can be a sign that you have miscarried. About 10% to 20% of pregnancies end in miscarriage.

Implantation bleeding: Implantation occurs when a fertilized egg attaches itself to the endometrium. Implantation bleeding occurs in about 25% of pregnancies in the first trimester. It usually does not indicate a problem.

Vasa previa: With this condition, blood vessels from the placenta (the organ that develops in the uterus in pregnancy to nourish the fetus) burst because they pass over or through cervical membranes and are at risk of rupture when the supporting membranes rupture.

Placental abruption: This serious but rare condition is when the placenta separates from the uterine wall before birth.

Placenta previa: This serious complication of pregnancy occurs when the placenta covers all or part of the cervix. It usually causes vaginal bleeding in the second or third trimester. The condition is an indication for a cesarean section (C-section, surgical delivery of the baby).

Low-lying placenta: When the placenta attaches itself lower than it should within the uterus. It often improves as the pregnancy progresses and the uterus grows.

Premature labor: Premature labor is uterine contractions before the 37th week of pregnancy. These contractions cause the cervix to open earlier than normal, resulting in premature birth.

Other Possible Causes

Stress: Psychological stress can trigger a physiological response that can cause irregular menstrual patterns, including irregular vaginal bleeding.

Medical procedures: Medical procedures such as a cervical or endometrial biopsy (removal of a tissue sample for examination in the laboratory), pelvic exam, or other medical procedures can cause spotting.

Trauma: Genital injuries such as cuts or tears in the vaginal area from rough sex, sexual abuse, rape, or a straddle injury (groin injury from falling on an object that is being straddled) can cause bleeding.

Obesity: Research indicates that obesity plays a role in the prevalence of infrequent periods and abnormal uterine bleeding.

Medications: Many medications can cause spotting or bleeding. They include:

Patterns of Irregular Bleeding and Spotting

“Normal” vaginal bleeding occurs during a menstrual cycle. Most menstrual cycles are between 24 and 34 days apart. The cycle begins on the first day of menstruation, with menstrual bleeding usually lasting about five to seven days. Younger people may have cycles between 21 and 45 days apart, while people in their 40s may have a longer time between periods.

Patterns of irregular bleeding and spotting can occur at any time in the lifespan. Spotting is light vaginal bleeding that usually doesn’t require a pad or tampon. It can appear as red, light brown, or dark brown blood. Brown blood is usually older blood that is exiting the uterus slowly.

Vaginal bleeding and spotting is considered irregular with it occurs in the following circumstances:

• Metrorrhagia (spotting or bleeding between periods not linked to menstrual bleeding)
• Bleeding after sex
• Postmenopausal bleeding
• Bleeding when pregnant
• Polymenorrhea (menstrual cycles shorter than 21 days)
• Oligomenorrhea (menstrual bleeding characterized by infrequent or scanty periods at intervals longer than 35 days)
• Bleeding before age 9
• Amenorrhea (absence of periods for three to six months in women of reproductive age)

How to Manage Constant Bleeding and Spotting

Constant bleeding and spotting can be a challenge to manage. The unpredictability of symptoms can make you anxious or cause you to limit your activities to compensate for the possibility of bleeding. As your healthcare provider works with you to determine the cause and potential treatments, follow these strategies to help manage your symptoms:

• If you take birth control, take it exactly as prescribed. If you take pills, take them at the same time every day and avoid skipping days. Following the directions can help you avoid hormonal imbalances that can lead to spotting.
• Ensure that your bleeding or spotting is coming from your vagina, not your rectum or urine. Insert a tampon into your vagina to verify that blood is coming from your vagina, cervix, or uterus.
• Avoid the use of aspirin since it may prolong bleeding. You can use other NSAIDs like Motrin or Advil (ibuprofen) for the cramping that may occur with the bleeding and spotting.
• Maintain a healthy lifestyle by exercising regularly and eating a diet full of whole, fresh foods. This can help you maintain a healthy body and weight.
• Keep track of the frequency, volume, duration, and pattern of your spotting or bleeding. Tracking the characteristics of your bleeding and spotting can help your healthcare provider determine the cause of your symptoms.
• Consult with your healthcare provider about taking an iron supplement to avoid the risk of anemia.
• Use a condom during sex to reduce your risk of STIs, which can cause spotting or irregular bleeding.
• Talk to a healthcare provider about changing medications or your method of birth control if these factors may be contributing to abnormal uterine bleeding.

Complications and Risk Factors

Some types of irregular bleeding or spotting are normal. However, some causes can cause one or more of the following complications if the source of the problem is not treated:

• Infertility (inability to get pregnant)
• Severe anemia (a low number of healthy red blood cells) due to significant blood loss over time
• Increased risk of endometrial cancer
• Symptoms of abnormal hormone levels, such as hirsutism (excessive growth of body hair in a male pattern), mood swings, hot flashes, vaginal dryness

While spotting or abnormal bleeding can occur anytime during your lifespan, you have a higher chance of having irregular bleeding or spotting with the following risk factors:

• Age: Being at the start or end of your reproductive years increases your chances of irregular bleeding or spotting. Adolescents and those over age 45 have the highest risk.
• Birth control: Using hormonal birth control or an IUD increases your risk of bleeding between periods.
• Obesity: Being overweight or having obesity increases your risk of spotting or abnormal bleeding.
• Medication: You have a higher risk if you take certain medications, including blood thinners, cancer medications, or anti-inflammatory medications.

Treatments to Regulate Bleeding

The treatments prescribed to regulate spotting and irregular bleeding depend on the cause of the problem. Considerations also include whether you have plans for pregnancy. In some cases, treatment may not be necessary. When needed, common treatments include the following.

Nonhormonal Medications

Nonhormonal medications: These drugs can help control bleeding with fewer risks and adverse effects than hormone therapy and can be administered as needed. They include:

• NSAIDs, which reduce bleeding by 25% to 35% by decreasing prostaglandin levels (substances the body produces at areas of injury or inflammation)
• Tranexamic acid, which inhibits plasminogen activators (substances your body produces to break down blood clots) to promote a 40% to 60% reduction in menstrual blood loss
• Antibiotics to treat infections
• Medications to treat underlying health disorders

Hormone Therapy

Hormone therapy can help suppress endometrial development and reestablish predictable bleeding patterns. Hormone therapy can often help the bleeding problems that occur in perimenopause while also helping reduce symptoms such as night sweats and hot flashes. These drugs include:

• Combined estrogen/progestin oral contraceptives
• Oral progestins
• Long-acting progestin-releasing IUD to confine the dose of hormones to the uterus

Other hormonal medications occasionally used depending on the cause of irregular bleeding include:

Surgical Management

Surgical management depends on the cause and severity of irregular bleeding. Procedures include:

• Hysteroscopy with dilation and curettage (D&C) (removal of tissue from the lining of the uterus) to treat causes such as endometrial hyperplasia (a thickening of the uterine lining)
• Hysterectomy (removal of the uterus) for causes that involve gynecologic cancer
• Endometrial ablation (the use of heat, cold, or energy to destroy the uterine lining)
• Hysteroscopic myomectomy (removal of uterine fibroids while preserving the uterus) or hysteroscopic polyp removal
• Robotic surgery for anatomic abnormalities

Summary

Spotting and irregular bleeding can occur as a result of harmless causes. However, these issues can sometimes be a sign of a hormone imbalance, pregnancy complications, or an unknown health problem.

Since they can be linked to some severe health risks, spotting and irregular bleeding should not be ignored. Contact your healthcare provider if these symptoms persist for over a week or occur with other symptoms like cramping or a fever. Getting the right treatment can help relieve symptoms and protect your well-being.