Dear Doctor,

My period usually lasts  no longer than three days and a week after it ended, I noticed that I was spotting. I have been spotting for a little over two weeks now and it is not consistent. What is the cause of this? My friends say morning after pills cause this but I have never taken any. Do I need to go to the hospital?

Helen

Dear Helen,

You have not specified your age, number of pregnancies and living children. Spotting is a streaky vaginal bleeding occurring between menstrual periods. Normally, a menstrual period can last from three to seven days, recurring after 28 to 35 days, plus, minus one week.  This cycle is highly variable among different women. Interval between periods, duration of periods, and quantity of blood loss, varies depending on their hormonal status, body weight, level of physical activity, use of birth control pills and hereditary factors. The entire menstrual cycle is governed by balance of levels of estrogen and progesterone in the body. These, in turn, are controlled by hormones released from pituitary and thyroid glands and also estrogens produced by the ovaries.

Sometimes spotting may occur during early pregnancy, till change in level of hormones is stabilised. On a sinister side, it may be a sign of an early miscarriage.  Spotting can also occur due to ectopic pregnancy (where the fertilised ovum is implanted outside the uterus). This is an emergency situation needing urgent intervention. Untreated ectopic pregnancy can be fatal.  After stopping hormonal contraception, or even sometimes after removing an intra uterine device for birth control, one gets slight spotting for some days.  Around menopause, the menstrual cycles tend to become irregular and inter-menstrual spotting can occur. Some women may have slight spotting after sexual intercourse or insertion of some foreign body in the vagina.

Disorders or disease of the thyroid or pituitary gland can affect the hormonal balance and cause spotting in between periods. Ovarian dysfunction also alters the balance between estrogen and progesterone causing inter-menstrual spotting.  Conditions like polycystic disease of ovary may cause dysequlibrium between estrogen and progesterone levels causing spotting as one of the manifestations.

Women taking anabolic steroids for any reason, doing vigorous athletic training may have altered hormonal balance and can have slight spotting. This may also occur with uterine fibroids, which are benign growths occurring in the layers of the uterus. Polyps in the uterus are yet another cause, for spotting. Cancer of the uterus, cervix (that is, lower part of the uterus), ovaries or vagina can have slight vaginal bleeding as one of the manifestations. Vaginal spotting can also be due to certain infections like chronic pelvic infections, gonorrhea, and etcetera.

The underlying cause for spotting can be detected by a clinical evaluation including speculum examination and imaging techniques. Treatment depends on an underlying cause.  If spotting is of recent onset, it is better to consult a gynecologist and get all possible investigations done to detect the possible underlying cause of spotting. Most of the causes are treatable.

 Dr Rachna is a specialist in internal medicine at Ruhengeri Hospital.

rachna212002@yahoo.co.uk