When you see light blood on toilet paper or find brown discharge on your underwear, you may look at the calendar again and wonder, “Is my period starting already?” If it does not match the expected date, worry can come first. At a moment like this, the first thing to do is not to guess the cause but to note the bleeding you saw just as it was.
On the day you noticed bleeding, what should you write down?
Write down when it appeared, how much there was, what the circumstances were, and any symptoms that came with it. These four points help narrow down the cause at a visit.
- When it was Write the date you noticed the bleeding together with the start date of your last period. Note where it fell—right after a period ended, around the middle between two periods, or just before the expected date.
- How much, and what color Note whether it was only on toilet paper or whether you needed a liner or pad. Also note the color you saw, such as red, pink, or brown, and whether it ended in a day or continued for several days.
- What the circumstances were Check whether it appeared after sex, whether you had newly started birth control pills or missed any, whether it was after an intrauterine device (IUD) was placed, and whether you had taken emergency contraception. Please also write down whether you could be pregnant.
- Changes you felt at the same time Write down whether you had lower abdominal pain, a feverish feeling, discharge with a changed smell or color, itching, or dizziness. Having had no symptoms at all is also worth recording.
How to keep a steady record of your period dates and the amount of bleeding is covered in the article on keeping a menstrual cycle record. If you mark abnormal vaginal bleeding separately in that record, it becomes easier to tell apart from your usual period.
Why does bleeding between periods happen?
There are many common and relatively minor reasons, such as hormonal changes or your contraceptive method, but it can also be due to an infection or changes in the uterus or cervix. Rarely, it may be related to cancer, so the cause should be confirmed through an examination.
| When the bleeding appeared | Possible groups of causes to consider |
|---|---|
| After starting or changing the pill, or after missing pills | Bleeding related to hormonal contraception |
| After starting an intrauterine device (IUD), a contraceptive injection, or a contraceptive implant placed under the skin | Bleeding related to hormonal changes or the contraceptive device |
| Spotting for a day or two around the middle between two periods | Hormonal changes around ovulation |
| After sex | Changes on the surface of the cervix or polyps, vaginal dryness, infection |
| Along with changes in discharge, pain, or fever | Infection of the vagina, cervix, or pelvis |
| Recurring or becoming more frequent | Changes in the uterus such as polyps or fibroids, hormone-related conditions |
This table is only a summary to help you think it through; it is not a diagnostic chart. Taking the pill does not mean there is no other cause, and two or more causes can overlap. The color of the bleeding alone cannot tell you the cause either. Brown discharge can also be blood mixed in, so do not judge it as minor because it is pale, or as serious because it is red.
Are there times when it is all right to watch and wait for a while?
As with light bleeding in the first few months after starting the pill, if the reason can be guessed and there are no other symptoms, it is often not a situation that calls for rushing to the emergency room. However, watching and waiting does not mean simply letting it go.
In the first few months after starting or changing a hormonal contraceptive method, it is common for blood to appear between periods. Even then, do not stop the medicine or change how you take it on your own. If the bleeding continues or bothers you, please talk with the place that prescribed it. You also need to check whether the situation could affect how well the contraception works.
If spotting appeared once around the middle between two periods and then stopped, mark the date and see whether it happens again in the next cycle. Still, whatever the cause, it is recommended to have bleeding between periods checked at a visit at least once. If the same thing keeps happening, if it appeared after sex, or if the bleeding goes on longer, do not wait—schedule a visit.
When should you seek care right away?
If the bleeding is heavy or you feel dizzy, if you could be pregnant and have abdominal pain, or if blood appears after menopause, do not wait while gathering records—get medical care.
When a pregnancy test result is unclear, you can read about when to test again in the article on a pregnancy test that shows one line. However, if any of the signs above are present, do not wait for the retest date.
What should you talk about at your visit?
Show the notes you made and describe “since when, in what situation, and how much” just as it happened. It also helps to tell us the names of any birth control pills or hormone medicines and other medicines you take, along with your most recent cervical cancer screening result.
Having an examination does not mean every test is done at once. The checks needed are chosen according to the possibility of pregnancy, the pattern of bleeding, and the examination findings. You can first look at what to prepare before your visit in LILEAP’s abnormal vaginal bleeding care information.