Dear Dr. Kate,
About three months ago, I started spotting between periods. The first time it happened, it only lasted for a couple days—my sister-in-law walked me through it and I didn’t think anything of it. These last two months, my period had been over for about a week and boom, here it comes again. Now it’s taking on the shape of a normal flow for me, except in reverse. It starts out light and then it progresses over three days to a heavy flow, clots and all! I don’t have a history of anything being irregular with me down there, and I don’t have pain or anything odd during sex. I’m currently not on any birth control pills, but I’m planning to talk to my doc about that when I see her in October. Is there any possible explanation you can give me, or shed some general light on spotting, so that I don’t continue freaking out?
A. in Illinois
I’m glad you wrote in—because there’s no need to panic. When you’re not using hormonal birth control, it’s totally normal for your periods to get wiggy once in a while. You can skip a period on occasion, “double up” for a month or two, or get a single period that doesn’t seem to END. And spotting in between periods is even more common. When my patients report to me some weird-for-them bleeding pattern, I ask them to start tracking their bleeding. You can use an app on your phone, or old-school paper and pencil. It’s helpful for your gyno if you can show her what your bleeding looks like in detail on some sort of calendar, from this past spring until your visit with her in the fall.
I usually start a workup for patients with irregular bleeding after 4 to 6 months of irregularity. Your gyno may test you for common causes of spotting: STDs (specifically chlamydia and gonorrhea) and hormonal imbalances (specifically thyroid and pituitary disease). If you haven’t had a recent pap smear, she may do one. She may also order a pelvic ultrasound, looking for fibroids and polyps. Both of these conditions are benign but common causes of irregular bleeding. If these tests are all negative, your irregular bleeding is likely due to randomness or stress, and nothing to be alarmed about.
If you continue to have spotting, your gyno may talk to you about starting hormonal birth control for regulation of your bleeding. But if you’re not anemic, and other testing is fine, you don’t have to do anything. Let me know if your OB/GYN tells you things that scare you…and until then, try not to worry.