Spotting (Breakthrough Bleeding)

What it is

Breakthrough bleeding, or spotting, is the loss of a small amount of blood outside the menstrual period, usually pink or brownish, that doesn't soak through a pad. It's common in the first months of using hormonal birth control, the implant, or the IUD, and can also appear mid-cycle, around ovulation, in early pregnancy, and during the transition to menopause. Although usually benign, spotting that persists or comes with pain, discharge, or bleeding after intercourse may point to infections, polyps, or changes in the cervix or endometrium. The gynecology team at Femi Saúde investigates the cause and guides appropriate treatment.

Most common symptoms

• A small amount of pink or brown blood outside the cycle
• Spots on underwear that don't soak through a pad
• Spotting in the first months of birth control or the IUD
• Light bleeding mid-cycle, around ovulation
• Bleeding after intercourse
• Discharge streaked with blood

Causes and risk factors

• Adjusting to birth control, the implant, or the IUD
• Missed pills and irregular use of the method
• Ovulation, early pregnancy, and the transition to menopause
• Vaginal and cervical infections
• Cervical or endometrial polyps
• Thyroid and prolactin changes

How it is diagnosed

The work-up begins with the history: when in the cycle the spotting occurs, how long it's been going on, its relationship to the contraceptive method, to intercourse, or to missed pills, plus symptoms such as pain and discharge. The gynecological exam evaluates the vagina and cervix, and the Pap smear is updated if needed. Depending on the case, the gynecologist orders a pregnancy test, infection screening, thyroid hormones and prolactin, and transvaginal ultrasound to assess the endometrium, polyps, and IUD position. Hysteroscopy is reserved for suspected lesions inside the uterine cavity.

How we treat it at Femi Saúde

When spotting is an adjustment reaction to a recently started hormonal method, the usual advice is to wait a few cycles, since it tends to stop on its own. If it persists, the gynecology team at Femi Saúde may adjust the dose, switch the type of pill or method, or reposition the IUD. Infections are treated with specific medications; cervical polyps can be removed during the office visit, and endometrial ones by hysteroscopy. Thyroid and prolactin changes are corrected. During the transition to menopause, progestogens or hormone therapy help regulate the cycle. The plan is individualized and depends on the cause found.

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