Regular uterine bleeding in the form of vaginal discharge of the purple or the dark-brown blood, sometimes containing admixtures, is referred to as menstruation. Having scanty periods may be associated with a number of factors (including menopause or intake of contraceptives). In some cases, women observe spotting but no period. It may occur in the form of light spotting or intense bleeding. There is also another possible form of physiological spotting between periods. Defining the difference between spotting and a period can only be done by a specialist, after thorough examination.
Menstrual cycle (MC) presents a regular monthly process of alterations within the female organism, involving maturation and emergence of the ovum from the follicle in the first half and preparation of endometrium to possible conception in the second half of the cycle. In the case conception does not occur, proliferated endometrial lining is rejected due to “futility” while the second cycle commences with its discharge – the period.
As a rule, discharge between periods, does not contain blood. This discharge is almost transparent and may have various consistency, depending on the stage of mucus production. It has no foul odor.
What is spotting? Natural spotting between periods
We distinguish between three physiological causes of bleeding between periods – ovulation bleeding (OB), implantation bleeding (IB) and bleeding, associated with adjustment to a new type of hormonal contraceptives (AB).
In order to be able to tell the difference between them, one should pay attention to:
1. The time, when bleeding occurs, as well as its duration.
In the majority of women, MC consists of 28 ± 7 days. That is to say, periods should be expected within the time frames of one’s individual cycle, with consistent periodicity. As for other types of bloody discharge, it should be mentioned that:
- Ovulation bleeding occurs in the very middle of the cycle, since it this blood is discharged from vessels, affected by the ovum during ovulation;
- Implantation bleeding occurs a few days prior to the anticipated period, since it accompanies the process of implantation, which takes place on the 6th day after conception (ovulation+ a few days for conception+ 6 days);
- Adjustment related bleeding may occur on any day of the cycle.
All the mentioned types of bleeding persist for no longer than 3 days whereas periods may last for almost a week (4±2 days).
2. How does bleeding look?
Menstrual blood can be purple or brown, sometimes it contains admixtures, and quite few women observe very light periods. Having scanty periods may be associated with congenial development disorders, adhesive changes in uterine or cervical mucous membranes, endocrine pathologies, rapid weight loss, stress or moving to a new climatic zone. Besides, menstrual discharge becomes minimal during the premenopausal period and on the background of hormonal contraceptives.
Usually physiological bleeding appears in the form of brown spots on the underwear or a pink sticky mass, in case spotting overlaps with the period of maximally intense production of cervical mucus (most typical for OB and IB).
3. Concomitant symptoms
Periods are rather painful for many women. A number of women experience acute dragging abdominal or back pain, which may additionally be preceded by the premenstrual syndrome (PMS):
- Increase of body mass and general swelling;
- Painful and tender breasts;
- Skin rash (pimples, acne);
- Indigestion (diarrhea and constipation);
- Irritability and mood
OB takes a much milder course, rarely involving slight pricking pain or abdominal cramps, caused by the ovulating ovary. AB may also be accompanied by slight uterine contractions, whereas IB assumes no pain. One distinctive feature of implantation is that it is followed by early pregnancy symptoms: sickness, taste disturbance, frequent urination, fatigue.
Spotting but no period – pathological causes
Both slight spotting and intense (up to profuse) bleeding may be observed between periods. What does spotting mean?:
- Presence of micro traumas inflicted during sex;
- Sexually transmitted diseases;
- Precancer and endometrial or cervical cancer;
- Nonmalignant and malignant uterine neoplasms, including myomas, adenomyosis and endometriosis;
- Polycystic ovarian syndrome;
- Thyroid pathologies;
- Blood coagulation problems.
In the first instant, these conditions can be differentiated by the way they look. As it has already been said, periods are hardly ever constrained to light spotting, while other types of pathological bleeding are characterized by irregularity and varying frequency of occurrence (unrelated to the cycle, with possibility of reoccurrence within a short period).
Besides, one should keep in mind that pathological bleeding is more likely to occur after unprotected sexual intercourse or in the presence of chronic diseases (general or gynecological). Apart from blood, abnormal spotting may contain other admixtures, such as matter, foam, etc. It can be accompanied by itching, reddening and genital discomfort. It is highly important to keep a record of medicine that one takes since some drugs provoke blood thinning, which may eventually result in breakthrough bleeding.
Anomalous bleeding between periods may be provoked by:
- Inflammatory diseases (endometritis, salpingitis, etc.);
- Disturbance of the course of an undiagnosed pregnancy – whether normal or ectopic;
- Compensatory bleeding after a long delay (for example due to several anovulatory cycles in a row);
- Apoplexy (necrosis) of the ovary or disruption of cyst;
- Dysfunctional uterine bleeding, of which the cause has not yet been established.
To tell the difference between spotting and a period in these situations, one should keep in mind that periods are never accompanied by rise of body temperature or disturbance of general well-being. Periods are maximally regular, at that the volume of blood loss should not exceed 35-5ml. Acute, intense pain, as well as massive and progressive bleeding, are not characteristic of menstruation and require an immediate visit to a clinic. Only a specialist can accurately define etiology of bloody discharge and prescribe corresponding treatment.