Most women have spotting between their periods at some point and certainly I do get asked whether or not this is normal.

Usually, it’s nothing to worry about but there are a number of things can cause it to happen.

These are the most common:

Hormone-based birth control.

If you’re on birth control that contains hormones (pills, patches, shots, rings, or implants), you might spot during the first 3 months of using it. Doctors call this “breakthrough bleeding.” They believe the extra hormones may cause changes in the lining of your uterus.

However, because many women do use such products in order to help with heavy bleeding, rather than contraception, you need to be aware that it can have this effect at Menopause as well.

Some sexually transmitted infections (STIs), like chlamydia can also see you getting some breakthrough or spotting.

Infection of the cervix or lining of your uterus can also result in some bleeding.

Blood clotting disorders, like von Willebrand disease.

Other health conditions, like hypothyroidism, liver disease, or chronic kidney disease.

Fibroids or polyps. These are noncancerous tumors that grow in the lining or muscle of the uterus.

Polycystic ovary syndrome (PCOS). If you have this condition, your ovaries don’t release eggs the way they should. They become enlarged with fluid-filled sacs that surround your eggs.

Your body also makes too many male hormones (called androgens). This can lead to irregular periods, spotting, and sometimes no period at all.

Hormonal cancers which include uterine cancer. They’re most common in women who’ve already gone through menopause.

But if you’re over 40 and spotting between periods, see the doctor to rule out more serious problems.

Perimenopause. As you get closer to menopause, your periods might be harder to predict. Your hormone levels change, and the lining of your uterus gets thicker.

This can sometimes lead to spotting.

When do I need to see my doctor?

Spotting is different from persistent bleeding, and any woman with persistent, heavy, or prolonged bleeding should make an appointment to get it checked out.

It is always best to be cautious, so also make an appointment if spotting concerns you, or if you have spotting along with the following symptoms:

– Pain in your lower abdomen

– Fever

– Symptoms that get worse or happen more often

– Any type of vaginal bleeding — including spotting — after you’ve gone through menopause.

Possible complications 

Abnormal vaginal bleeding may be minor. But it could signal something more serious or even life- threatening, such as a benign growth like a polyp or fibroid, a bleeding disorder, an infection, or an injury.

It’s rare, but spotting can sometimes be a sign of cancer. To be safe, have your doctor check it out.

Helpful information

It is always a good policy to pay attention to any variations in your cycle, whether spotting or a change in length or increase in flow.

At menopause there is certainly a significant increase in fibroids, around 80% of women can experience them, and they are linked to oestrogen dominance.

So checking for hormone balance and adjusting if you need to reduce your oestrogen or increase your progesterone can help you.