Can Stress Cause Spotting Between Periods?

Unexpected changes in your period can be inconvenient, embarrassing, or even scary. Periods that show up early or late can be stressful. So can spotting — light bleeding or brownish discharge between periods. But can stress itself cause changes in your menstrual cycle?

Can stress cause spotting between periods?

When you’re faced with a problem or a challenge, your brain and body respond in a programmed way. The stress response is actually your body’s way of trying to keep you safe. When you’re stressed, your body prepares to take some kind of action. That’s why you might experience:

• A fast or pounding heart

• Tense muscles

• Faster breathing

• Dry mouth and sweaty palms

Short-term stress is unlikely to cause period changes like spotting. But when physical or mental stress lasts for weeks, months, or longer, it can have a bigger impact.

With chronic stress, your adrenal glands make more stress hormones like cortisol. This can interfere with hormones like estrogen and progesterone — hormones that regulate your menstrual cycle. When that happens, the lining of your uterus becomes less stable. And that can lead to irregular vaginal bleeding.

How does stress affect your period?

In a typical menstrual cycle, estrogen and progesterone rise and fall in a regular pattern. This usually leads to a period about every 28 days. (But a cycle length anywhere between 24 and 38 days can be normal.)

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Stress hormones may disrupt estrogen and progesterone levels, or the way they rise and fall during a menstrual cycle. That can lead to symptoms like:

• Missed periods

• Early or late periods

• Heavier or lighter periods than usual

• Spotting between periods

Chronic stress can also impact your immune system. And immune system cells and proteins affect your reproductive system. Stress may cause your immune system to become overactive or weaken. Either way, these changes can contribute to irregular periods.

A common symptom of stress is poor sleep — either trouble falling asleep or not getting quality rest. Disturbed sleep can magnify problems with hormone levels and your immune system, increasing the risk of irregular periods and spotting.

For some people, stress may also lead to changes in diet, activity levels, or substance use. Over time, these factors can also affect hormones, immunity, and your period.

Is it normal to spot between periods?

Occasional spotting can happen for all kinds of reasons. It’s more common when you’re younger and your period is first starting. This happens because hormone levels can be more erratic during that time. 

Spotting can also happen during perimenopause for the same reason. In the years before your period ends, hormone levels are more unpredictable.

But any vaginal bleeding after menopause needs to be checked out by a healthcare professional — even if it’s just spotting. That’s because the risk of certain kinds of cancer and precancerous conditions increases after menopause. 

Spotting is also common with some forms of hormonal birth control — especially when you’re starting a new method or device. Spotting can happen with birth control pills, shots, implants, rings, patches, or intrauterine devices (IUDs). But it’s most common with:

• Low-dose birth control pills

• Implants (Nexplanon)

• Hormonal IUDs (Mirena, Kyleena, Skyla, Liletta)

Your primary care provider or gynecologist can help with spotting that happens on birth control. You should also talk with them if spotting continues or lasts more than a few days. Something else may be happening in your body that needs medical attention.

Besides stress, what else causes spotting?

There are many causes of spotting between menstrual cycles. Stress is one possible reason, but other causes include:

• Pregnancy: Implantation bleeding may be an early sign of pregnancy. Spotting can also be a symptom of miscarriage or an ectopic pregnancy.

• Infections: Bacterial or yeast infections, including sexually transmitted infections (STIs), can sometimes cause spotting.

• Fibroids or polyps: These are noncancerous growths in your uterus or cervix that may cause heavy or irregular vaginal bleeding.

• Endometrial hyperplasia: This is when the lining of your uterus becomes too thick. While not cancerous, it can lead to cancer if left untreated.

• Cervical or endometrial (uterine) cancer: Different forms of cancer and precancerous conditions can cause heavy or irregular bleeding and spotting.

• Bleeding disorders or anticoagulants: If you have a condition that makes you bleed easily or you take medications to prevent blood clots, you may be more prone to heavy vaginal bleeding or spotting.

• Hormonal birth control: As discussed above, some forms of birth control are more likely to cause spotting.

• Gynecological health conditions: Polycystic ovarian syndrome (PCOS) and endometriosis may cause irregular periods and spotting.

• Hormone-related conditions: Thyroid disease and diabetes are two examples of conditions that may cause irregular menstrual cycles.

• Weight or lifestyle changes: Significant weight loss or gain may cause changes in your period. So can big differences in your diet or activity level.

It’s normal to have a day or two of light bleeding before or after a regular period. But if spotting lasts for more than a few days or it happens all the time between menstrual cycles, it’s time to see someone on your healthcare team.

When should you see a doctor about spotting?

Spotting may happen occasionally. Often, it’s not caused by anything serious. But if you’re concerned about any bleeding or spotting, talk to your primary care provider or gynecologist. 

It’s especially important to get medical attention if you have spotting and:

• You’re pregnant or could be pregnant

• You have pain or a fever

• The spotting lasts more than a few days or happens often between periods

• You have any bleeding or spotting after menopause (no period for a year or more)

• You have very heavy periods or no regular periods

• You experience other symptoms, like changes in weight or energy

• Your stress feels overwhelming

• You feel anxious or depressed along with stress 

Why trust our experts?

Written by:

Anne Jacobson, MD, MPH

Anne Jacobson, MD, MPH has been a board-certified family physician since 1999. She worked as a full-scope family physician (inpatient, outpatient, obstetrics, and office procedures) in the Cook County Ambulatory Health Network for 15 years.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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