Difference between breakthrough bleeding and implantation bleeding

Spotting - Bleeding between Periods

Bleeding between periods (spotting or intermenstrual bleeding) can be due to a variety of things that range from non-harmful, for example, implantation bleeding, to serious conditions like miscarriage or ectopic pregnancy.

What to do if you are not sure if you are spotting or having your period

Talk to your doctor or other health care professional if you are not sure if it is your period, or if you are spotting.

Remember, spotting is light bleeding that does not get heavier like a typical menstrual period. The normal menstrual period usually is associated with some other symptoms like breast tenderness or cramps as described previously, and often is accompanied by the heavy flow. During the first day of your period bleeding may be light, but it typically becomes heavier over the next few days.

Light bleeding that does not worsen and is not associated with the symptoms of your period is likely to be spotting.

A home pregnancy test can be helpful if you believe you are spotting due to early pregnancy, or you may experience early signs and symptoms of pregnancy.

You should always contact your doctor or other health care professional if you experience any vaginal bleeding, spotting if you are pregnant or if you have reached menopause or any time you have unusual bleeding that concerns you.

QUESTION

What causes spotting? Is it serious?

Spotting has a number of medical causes, ranging from harmless to potentially serious:

• Implantation bleeding: Many women experience spotting in the early weeks (first trimester) of pregnancy. Implantation bleeding is a common cause of spotting. This occurs early in pregnancy when a fertilized egg attaches to the wall of the uterus (known as implantation). A woman may mistake this light implantation bleeding for a menstrual period and therefore not realize she is pregnant.
• Birth control: Certain birth control methods can cause spotting, including birth control pills, especially when they are first used. Switching birth control pills or using continuous birth control pills can also cause spotting. Some women with an IUD (intrauterine device) for birth control also report spotting.
• Polycystic ovary syndrome (PCOS) is a common condition in which multiple cysts form in the ovaries. It can make it difficult to get pregnant and can cause irregular periods and bleeding.
• Benign growths in the uterus or cervix, like fibroids or cervical polyps, can cause irregular bleeding and spotting.
• Infections, including sexually transmitted diseases (STDs), are another possible cause of spotting or breakthrough bleeding in between periods.
• The menopausal transition is a time when women’s hormone levels can vary widely, sometimes causing spotting or irregular periods.
• The trauma of any kind, including assault or rough sex, can injure the vagina and lead to bleeding or spotting.
• While the vast majority of spotting in pregnant women is not due to serious causes, spotting and bleeding in early pregnancy are sometimes related to miscarriage or ectopic pregnancy (a pregnancy that has been implanted outside the womb or uterus, most commonly in the Fallopian tube).

If you have continuous spotting or abnormal vaginal bleeding or spotting postmenopausal you need to be evaluated by a doctor or other health care professional.

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How do doctors diagnose the cause of spotting?

The cause of vaginal bleeding or spotting requires a thorough history of the symptoms (when the bleeding or spotting is occurring and any associated symptoms, birth control methods, and history of any medical conditions or infections).

• A pelvic examination is usually the first step to diagnosis.
• A pregnancy test is performed for women of reproductive age.
• Special tests like a Pap smear or cultures may be ordered.
• In some cases, blood or urine tests are ordered.
• Imaging studies such as vaginal or abdominal ultrasounds may be useful in diagnosing the cause of spotting or bleeding.

SLIDESHOW

What are the treatments for spotting?

Treatments for spotting depend on the underlying cause of the spotting.

• Many causes of spotting are not serious, and there is no treatment required.
• For infections, antibiotic therapy is indicated.
• Women with PCOS who desire to become pregnant can be treated with fertility-enhancing drugs or assisted reproductive technologies.
• Surgery can be required in some cases to remove cervical polyps or uterine fibroids that are causing bleeding.
• For women who desire a more regular menstrual cycle, sometimes birth control pills or hormonal treatments can be helpful.

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Medically Reviewed on 3/9/2022

References

American College of Obstetricians and Gynecologists. "Bleeding During Pregnancy." <https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy>.

American Pregnancy Association. "Signs of Ovulation." <?https://americanpregnancy.org/getting-pregnant/signs-of-ovulation/>.?

Behera, M.A. "Abnormal (Dysfunctional) Uterine Bleeding." Medscape. Dec. 7, 2018. <http://emedicine.medscape.com/article/257007-overview>.

Ecochard, Rene, et al. "Self-identification of the clinical fertile window and the ovulation period." Fertility and Sterility 103.5 May 2015: 1319-1325.e3.

Tenore, Josie L. "Ectopic Pregnancy." Am Fam Physician 61.4 Feb. 15, 2000. <https://www.aafp.org/afp/2000/0215/p1080.html>.

What does breakthrough bleeding look like in early pregnancy?

Does breakthrough bleeding mean your pregnant?

How can you tell the difference between breakthrough bleeding and a period?

What kind of blood comes out during implantation bleeding?