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Spotting – what’s behind it

by Josephine Andrews
Published: Last Updated on 314 views

Spotting can occur at any time, independent of the regular menstrual bleeding The cause is usually found in hormonal changes. But it can also be caused by infections or more serious causes such as cervical or ovarian cancer. That is why women should always have intermenstrual bleeding that starts suddenly assessed by a gynaecologist. If necessary, he can then often treat the trigger of the spotting quickly and specifically.

quick overview

  • What is spotting? An unexpected, brownish discharge in women that varies in intensity and duration. Spotting can start at any time, regardless of normal menstrual bleeding.
  • Causes: Usually hormonal changes (e.g. due to hormonal contraceptives, puberty or menopause). Sometimes also signs of genital infections or cancer. Other possible causes are thyroid and liver diseases, burst capillaries in the vaginal area and psychological factors.
  • Diagnostics: Collection of the medical history in the doctor-patient conversation (anamnesis), gynecological examination, ultrasound , measurement of hormone levels, pregnancy test if necessary .
  • Treatment: The underlying cause is treated. Examples: administration of hormone preparations for hormonal imbalance, surgery for fibroids and cancer. If there is no organic cause, treatment with home remedies or medicinal plants such as shepherd’s purse or monk ‘s pepper can help.

Spotting: description

Spotting is a mostly weak, sometimes heavy, brownish discharge from the vagina. Sometimes it disappears after a few hours, while in other cases it lasts for several days. Intermenstrual bleeding occurs independently of regular menstrual bleeding.

Spotting is usually triggered by hormonal changes, such as those caused by hormonal contraceptives ( pill , spiral , etc.). The natural hormonal changes during puberty and menopause can also be the reason for frequent bleeding between periods. Last but not least, the psyche can also influence the fine interaction of hormones in the female body. Stress, grief, lovesickness, but also joy sometimes trigger intermenstrual bleeding.

Spotting: Difference to menstrual bleeding

Spotting differs from normal menstrual bleeding both in terms of when it occurs and the underlying causes:

Spotting – at any time and for various reasons

Spotting can happen at any time, regardless of your menstrual period. The causes can be varied – from hormonal changes to cancer.

The menstrual cycle – monthly routine

The female cycle is determined by the interaction of different hormones. It begins with the first menstrual period (menarche) during puberty and ends with menopause (climacteric). A menstrual cycle begins on the first day of the monthly menstrual period and ends one day before the next menstrual period. The length of a menstrual cycle varies from woman to woman. On average it is about 28 days.

In the first half of the cycle, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate the sacs (follicles) in the ovaries to grow. As a rule, however, only one follicle matures completely. It produces more and more estrogen. This causes the lining of the uterus to build up, preparing for possible implantation of the fertilized egg.

Around the middle of the cycle, LH triggers ovulation (when estrogen levels are highest): the mature egg cell leaves the follicle, is taken up by the fallopian tube and slowly travels through it to the uterus . She is fertile for about 24 hours after ovulation.

The shell of the follicle that remains in the ovary is transformed into the yellow body (corpus luteum). This produces the hormone progesterone and, to a lesser extent, estrogen. Progesterone (also called the luteal hormone) is also involved in preparing the uterine lining for implantation. In addition, progesterone and estrogen together inhibit the further secretion of FSH and LH from the pituitary gland. This prevents further egg cells from maturing in the ovaries.

However, if fertilization does not take place, the corpus luteum perishes after ten to twelve days. This significantly reduces the concentrations of progesterone and estrogen in the blood. In response, the thickened uterine lining and unfertilized egg are expelled along with blood as menstrual bleeding.

Spotting: causes

Altered hormonal balance usually triggers intermenstrual bleeding. But sometimes the spotting has a more serious background. Unscheduled discharge can indicate genital infections or tumors.

Hormonal causes

  • Ovulation bleeding: After ovulation, estrogen levels fall while progesterone levels rise. This can cause a short break in the middle of the cycle.
  • Yellow body weakness: After ovulation, the yellow body produces the hormone progesterone. It prepares the lining of the womb for the possible implantation of a fertilized egg and maintains a pregnancy. This means: For women with luteal insufficiency, the resulting progesterone deficiency makes pregnancy more difficult. Without medical help, they can hardly fulfill their desire to have children. A shortened second half of the menstrual cycle with spotting is typical of yellow body weakness.
  • Menopause and puberty: During puberty, the hormones first have to settle down – strong menstrual cycle fluctuations and frequent spotting cause problems for some young women. The hormonal rollercoaster ride during menopause also often leads to bleeding between periods.
  • Hormonal contraception : Hormones such as estrogen or progestin that are taken with the pill can cause bleeding between periods, especially when you first start taking the pill. Spotting often occurs at the beginning (after insertion) of the IUD as well.
  • Implantation bleeding : When a fertilized egg implants itself in the lining of the womb, small blood vessels can be injured. This becomes noticeable in about one third of all pregnant women as weak, short, bright red bleeding.

inflammation

  • Inflammation of the fallopian tubes (salpingitis) and ovaries (adnexitis): This serious inflammation mainly affects young, sexually active women between the ages of 25 and 40. In addition to severe abdominal pain, fever and vomiting, there is a risk of infertility as a long-term consequence . If scars remain after healing , the acute ovarian inflammation can become chronic. Typical signs of this are pain during sexual intercourse and during ovulation as well as spotting.
  • Inflammation of the uterus (endometritis) and vagina ( colpitis ): If inflammation rises from the vagina into the uterus, this can lead to spotting, abdominal pain and foul-smelling discharge. The vaginitis causes burning pain or itching in the vagina.

tumors

  • Fibroids: Many women between the ages of 35 and 50 develop benign growths in the muscle layer of the uterus called fibroids. The tumors can vary in size, but treatment is usually not necessary. However, fibroids often cause spotting and long-lasting, excessively heavy menstrual bleeding (menorrhagia).
  • Polyps on the cervix or womb : These benign changes in the lining of the womb can cause a foreign body sensation, painful intercourse, and bleeding between periods.
  • Portioectopia: The cervix and uterus are covered by layers of mucous membrane. In portioectopia, these layers shift at the cervix. There may be spotting.
  • Cancer of the cervix (cervical carcinoma): Certain types of the human papillomavirus (HPV) usually cause this cancerous tumor. He can grow pain-free and unnoticed for a long time. Occasional spotting or bleeding during intercourse can be the first indication of cervical cancer.
  • Cancer of the uterus (endometrial carcinoma): Malignant tumors of the lining of the uterus mainly develop in older women around the age of 70. Sudden spotting, which occurs long after menopause, is an alarm signal. If endometrial cancer is treated early, there are good chances of recovery.
  • Ovarian cancer (ovarian carcinoma): This tumor grows for a long time without causing pain. That is why it is often not discovered until very late. Undetermined symptoms such as fatigue , lower abdominal pain and constipation are the first, easily overlooked symptoms. In the later stage, there is also ascites (abdominal dropsy).
  • Vaginal cancer (vaginal carcinoma): Vaginal cancer is usually associated with cervical cancer. Common symptoms are pain and bleeding during sexual intercourse, as well as irregular, bright red bleeding.
  • Vulvar cancer: Malignant tumors on the labia are rare. They appear as nodular changes and are often accompanied by a bloody discharge.

other causes

  • Endometriosis : In this disease, mucous membrane from the uterus reaches other parts of the body, the abdomen is particularly affected. The scattered mucous membrane changes during the menstrual cycle just like the mucous membrane inside the uterus. This means that bleeding outside the uterus also occurs during normal menstrual bleeding. Severe pain during menstruation and sexual intercourse indicate endometriosis. Other signs are cycle fluctuations and spotting.
  • Thyroid disorders: Both an excess and a deficiency of thyroid hormones (hyper- or hypothyroidism) affect the entire metabolism and cause a variety of symptoms. The menstrual cycle also changes – from missing a period ( amenorrhea ) to long-lasting bleeding between periods, anything is possible.
  • Liver diseases: Liver diseases such as liver cirrhosis also cause menstrual cycle disorders in advanced stages. It can also lead to spotting.
  • Broken veins during intercourse can also lead to spotting.
  • Psyche: Even strong emotions such as joy or sadness as well as stress can trigger spotting.

spotting during pregnancy

Particular caution is required if spotting occurs during pregnancy. They are often only due to harmless hormonal fluctuations. Sometimes, however, they can also be an indication of serious complications. You can read everything you need to know about this topic in the text spotting during pregnancy .

Spotting: when do you need to see a doctor?

Almost every woman knows spotting from her own experience. If they occur once, they are usually not a cause for concern. However, if intermenstrual bleeding occurs during several cycles or if this occurs in quick succession, you should consult a gynaecologist. Pregnant women should be particularly careful and should always have sudden bleeding medically clarified immediately.

Basically, you should see a gynecologist if:

  • several intermenstrual bleedings in a row
  • frequent spotting
  • Intermenstrual bleeding after menopause
  • heavy or prolonged bleeding
  • spotting during pregnancy
  • additional symptoms such as weakness, fainting or severe pain

Spotting: what does the doctor do?

Your contact for spotting is the gynaecologist. He will first question you in detail about your symptoms and your medical history (anamnesis).

This is followed by a gynecological examination. The doctor feels the vagina and, if necessary, carries out an ultrasound examination. In this way, changes such as fibroids or other tumors that may be responsible for the spotting can be identified. If necessary, the doctor will use a blood test to check whether an early pregnancy is present, which can explain the bleeding between periods.

If there are no organic changes, the hormone levels in the urine and blood can provide clues to possible causes.

Treatment for spotting

The treatment of spotting depends on the trigger. In the event of hormone fluctuations, the doctor may prescribe herbal or artificial hormones for you. Smaller fibroids or benign tumors can be removed in a short surgical procedure. Antibiotics or antimycotics can help with inflammation or fungal infections . Cancer diseases must be treated comprehensively (e.g. surgical tumor removal, chemotherapy, radiotherapy , etc.)

Spotting: You can do this yourself

The annual check- up, which women over 20 can take advantage of free of charge , is generally recommended . This allows many gynecological diseases to be recognized or prevented at an early stage. The PAP test is particularly important – a cell smear for the early detection of cervical cancer. Girls who have not yet had sexual intercourse can also be vaccinated against the human papilloma virus (HPV) . This pathogen is considered the main trigger of cervical carcinoma.

If you have clarified from a doctor that your spotting has no organic cause, you can resort to selected home remedies . Various medicinal plants have a calming and balancing effect on hormonal fluctuations. In addition, hemostatic agents are well suited for spotting:

  • Shepherd’s purse herb: The shepherd’s purse has a haemostatic effect and stimulates the uterus to contract. Pour boiling water over a teaspoon of shepherd’s purse and drink two to three cups a day.
  • Monk’s Pepper: This medicinal plant contains a phytohormone that promotes the production of the body’s own progesterone. Monk’s pepper also gently regulates the cycle of spotting and relieves symptoms such as premenstrual syndrome (PMS) . The plant is available in capsule form in pharmacies.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

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