Spotting and breakthrough bleeding

Many women have a very regular menstrual cycle and never experience bleeding in between. However, about a quarter sometimes suffer from interim bleeding. If this is light bleeding, we call this spotting. If there is more heavy bleeding, this is breakthrough bleeding. Spotting and breakthrough bleeding can have various causes. What are the causes and what can you do about them?


  • Abnormal vaginal bleeding
  • Causes of spotting and breakthrough bleeding
  • Use a menstrual cup or soft cup
  • When should I go to the doctor?


Abnormal vaginal bleeding

Two to three in ten women experience abnormal bleeding occasionally or regularly. This occurs when the bleeding:

  • …occurs when you do not expect to have your period;
  • …your period is lighter or heavier than you are used to;
  • …it occurs at a time in your life when this is not usual, such as before the age of 10, during pregnancy or when you are in menopause.

The terms spotting and breakthrough bleeding mainly indicate the difference in intensity. In most cases it lasts no longer than a day to several days. We can also speak of spotting when your first period ‘announces’. This often involves a brown discharge in the slip. Implantation bleeding may also occur when you become pregnant and a fertilized egg implants in the uterus. The color of the blood can vary greatly from time to time. It can be bright red but also brownish.

Causes of spotting and breakthrough bleeding

The causes of this abnormal bleeding can be numerous and are usually completely harmless. In some cases, however, there is a cause that requires medical attention. Breakthrough bleeding is often related to an abnormally thick endometrium (uterine lining). This is not dangerous at all, but the unpredictable and sometimes prolonged bleeding is of course very annoying. Breakthrough bleeding is often caused by the hormonal effects of ovulation. It can even be a symptom of pregnancy because the implantation of an egg can also be accompanied by some light blood loss. Women who smoke are more likely to experience breakthrough bleeding when they start using contraception.
Contraception often plays a role in abnormal bleeding. This is not surprising. Estrogens are responsible for regulating blood loss. When you take in new hormones through oral contraception, you can expect a response from your body. After starting the pill, habituation slowly develops and therefore stabilization.
The most common causes of spotting and breakthrough bleeding are the following:

  • Community
  • Fluctuations in the hormone balance
  • Start using the pill
  • Changing the type of pill
  • Swallowing the pill
  • Stopping the pill
  • The use of an IUD
  • Trauma
  • An underactive thyroid gland
  • Vaginal infection
  • Endometriosis or adenomyosis (uterine lining outside the uterine cavity)

In addition, there are numerous other – less common – causes of abnormal vaginal bleeding. Some possibilities are as follows:

  • Ectopic Pregnancy
  • Miscarriage
  • Polycystic ovary syndrome
  • Von Willebrand’s disease
  • Chronic hormonal imbalance
  • Enlarged uterus
  • Polyps
  • Leiomyomas (a fibroid in the smooth muscle of the uterus)
  • Cervicitis (inflammation of the cervix)
  • Salpingitis (inflammation of the fallopian tube)
  • Following a low-carb diet that induces ketosis such as the Atkins diet
  • Various forms of cancer


Use a menstrual cup or soft cup

If you suffer from heavy bleeding, it may be nice to opt for a menstrual cup or soft cup instead of a tampon or sanitary towel. The cup is a kind of inverted cup that you insert and that then collects the blood. It can collect between 30 and 60 ml of blood. When used properly, it does not leak or release odors.
The menstrual cups are available in disposable and reusable versions. You should empty and rinse the reusable one two to three times a day, after which you can reinsert it. A soft cup is a cup that becomes soft under the influence of your own body temperature, so that in no time you will hardly feel the cup anymore. Many women find removing a soft cup more pleasant than removing a regular menstrual cup.

When should I go to the doctor?

As you have read, there can be various causes for spotting or breakthrough bleeding. Every body reacts differently to fluctuations in your hormone levels or other things that your body has to adapt to. Experience shows that people are quite good at assessing whether a situation is abnormal for them. If you are concerned, consult your doctor. Chances are there’s nothing serious going on, but it’s better to be safe than sorry.

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