The other night, I had a nosebleed. It came out of nowhere, and I’m pretty sure the last time I had a nosebleed was around age 12. Thinking I was maybe hemorrhaging from the brain, I freaked out at all of the blood and called my doctor, who was probably spending some quality time with her family and enjoying a break from hypochondriac patients like me.
Needless to say, my doctor assured me that nosebleeds are rather common in dry, cold weather such as we are currently experiencing in Boulder, and that it was really nothing to worry about. Sheepishly, I hung up the phone, and the bleeding stopped a few seconds later (although apparently, I should have used a tampon).
ANYWAY. My point in telling you this is that bleeding, when unexpected, can be really scary! And when it comes to sudden and unforeseen vaginal bleeding (i.e., bleeding that is not part of the normal menstrual period), it can be even more bewildering. But while there are instances where irregular vaginal bleeding can indicate a more serious problem, many of the causes for bleeding outside of the period are totally normal and can even be healthy indicators of fertility in some cases. So, in the hopes of preventing unnecessary freak-outs like mine last night, I want to distinguish between what’s normal, and what’s not.
First and foremost, let’s clear up the difference between spotting and bleeding. Spotting is any menstrual fluid that is VERY light - too light to warrant the use of a tampon (or menstrual cup!) or to soak through a pad. Bleeding is when you do need to use a tampon/pad/menstrual cup/washable pad/your device of choice (although menstrual cups are the bomb, just sayin).
Spotting can occur at a lot of different times throughout the cycle, and in most cases is nothing to worry about. Here are some of the common types of non-premenstrual spotting:
- Ovulation spotting: Some women will experience light spotting for a day or two right around the time of ovulation. It’s not exactly clear WHY ovulation spotting occurs (some argue that it’s due to the tiny rupture the egg makes when leaving the ovary, others say it’s a result of the sudden drop in estrogen levels right before the egg is released), but it’s totally normal, and can actually be a helpful indicator that ovulation has/is about to occur (along with your BBT, cervical fluid, and cervical position, of course).
- Implantation spotting: If you’ve been trying to conceive and notice spotting (not bleeding) about a week after your temperature shift or later, you might want to take a pregnancy test. This is because the implantation of a fertilized egg in the uterus can sometimes cause light spotting to occur. Like ovulation spotting, this doesn’t happen for all women – so if you don’t notice any spotting but think you may be pregnant, wait it out and see if your temperatures stay high for more than 18 days past your temperature shift. If so, you are probably pregnant :)
- Breastfeeding spotting: Some women who are breastfeeding experience spotting about 6 weeks after giving birth, and may experience spotting intermittently throughout the time they are breastfeeding. This is due to fluctuations in hormone levels from pregnancy to postpartum, and also to changes in hormone levels due to the baby’s needs.
- Spotting after visiting the gynecologist: Spotting after gynecological procedures such as Pap smears, colposcopies, pelvic exams, etc. is common - However, if the spotting continues for more than 24 hours, or turns into heavier bleeding, alert your ob-gyn.
Bleeding outside of the period can be quite a bit more unnerving than spotting. Again, sometimes it’s not a cause for concern, but there are cases where you’ll want to check in with your doctor. Causes for bleeding outside of the period include:
- Bleeding after going off the Pill: After a woman goes off the Pill, she may experience bleeding that seems like a period within the next few days. This is normal, but the bleeding is not an actual period – rather, it’s ‘withdrawal bleeding’ caused by the withdrawal of the artificial hormones supplied by the Pill.
- Bleeding after intercourse: Nothing kills the afterglow quite like discovering you’re bleeding after having sex. There are a number of possible causes for bleeding after intercourse, the most common of which are cervical polyps and vaginal infections. In some cases, bleeding after sex is due to developmental changes in the cervix, and is nothing to worry about - but if you experience postcoital bleeding, you should tell your doctor, just in case.
- Bleeding after an anovulatory cycle: If you determine through tracking your primary fertility signs that you did not ovulate during your cycle, yet you still experience bleeding that seems like a period, this is not an actual menstrual period but rather is ‘breakthrough bleeding.’ Read more about anovulatory cycles and breakthrough bleeding.
- Bleeding during pregnancy: If you experience bleeding (bleeding, not spotting, remember) during pregnancy, call your doctor right away. This could be a sign of a complication with the pregnancy.
There are a number of other possible causes for bleeding between periods, some of whichinclude the presence of noncancerous uterine fibroids or cervical polyps, vaginal infection or disease, endometriosis, or even extreme stress, among other causes. If you experience bleeding between periods and it’s not due to coming off the Pill or any other known cause listed above, check in with your doctor.
If you have any questions, comments, or embarrassing stories like mine to share, please let us know in the comments section below! We’d love to hear from you :)