Causes

About 10 percent of women regularly have spotting around the time of ovulation. Bleeding between periods is also common when hormones are fluctuating (rising and falling) the most—during the first few years of menstruation and again as women approach menopause.

Spotting is very common in women with intrauterine devices (IUDs). It may also occur if the hormone levels in the birth control pills a woman is taking are not well suited to her body. In most of these cases, spotting is not cause for concern, but your doctor may be able to help end the problem by prescribing a different pill or recommending another form of birth control. Spotting and breakthrough bleeding are also very common with Depo-Provera (a birth control shot), especially during the first 3 months. Also, if you miss a dose of the pill, you may have spotting.

Bleeding between periods also can be a sign of a more serious problem, such as ectopic pregnancy or cancer.

Treatment

Your doctor may recommend an endometrial biopsy to check for cancer and other problems. A dilation and curettage (D&C), in which the uterine lining is gently scraped and cleaned away, may be suggested. For some women, a D&C will end the problem of spotting.

Self-Care

It’s important to keep a menstrual diary if you begin having bleeding that is unusual for you. This diary can help your doctor or nurse practitioner find the possible cause and decide whether the between-period bleeding is anything to be concerned about. Keep a written record of the dates of your periods and any bleeding between periods. Note how long the bleeding lasted and how heavy the flow was.

Call your doctor if your menstrual pattern does not return to normal by the third month.