Menstrual Spotting

WHEN TO SEE YOUR DOCTOR

* Spotting happens at the time you normally expect your menstrual period, and you could possibly be pregnant.

* Unexplained spotting persists for more than three months.

* Your spotting is accompanied by fever or pelvic pain.

What Your Symptom Is Telling You

About 5 percent of women will experience spotting—a light staining of blood—regularly with ovulation. The key to this harmless kind of spotting doctors say, is that it happens almost every month near the middle of your menstrual cycle. Often this spotting is accompanied by mild pain on the right or left side of the abdomen. (However, in some women, lack of ovulation, which causes the uterine lining to grow thicker and then shed small areas of tissue at different times, may also be a cause of spotting.)

If you are experiencing spotting that does not seem related to ovulation, there can be a variety of causes, including infections of the vagina, bladder, cervix or edometrium (uterine lining). Other possible causes include polyps, little fleshy growths in the uterus; cervical dysplasia, abnormal cells in the cervix; cancer; pregnancy complications; the wrong birth control pills or hormonal imbalances.

Symptom Relief

Your doctor will have to diagnose and prescribe treatment for unexplained spotting. Here's what to expect.

Clarify the cause. Your doctor will perform a careful physical exam, examining the outer areas, the vaginal lining and cervix, says Wulf Utian, M.D., Ph.D., chairman of the Department of Reproductive Biology at Case Western Reserve University in Cleveland. If necessary, he may take small tissue samples for closer examination under the microscope.

Harmonize the hormones. You may need to keep a temperature chart to determine whether or not you are ovulating, says Susan Haas, M.D., a reproductive endocrinologist and assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School. If lack of ovulation turns out to be the cause of your spotting, your doctor will probably prescribe hormones, either in the form of birth control pills or progesterone.

Although birth control pills are a frequent treatment for this type of spotting, Dr. Haas says, for some women they may also be the cause. In that case, your doctor will adjust your birth control prescription.

Treat any infections. If an infection of the vagina or bladder is the cause of your spotting, your doctor will prescribe a course of antibiotics to clear it up, says Brian Walsh, M.D., assistant professor of obstetrics/gynecology and reproductive biology at Harvard Medical School and director of the Menopause Unit at Brigham and Women's Hospital in Boston.

Safeguard the cervix. Occasionally the cervix (the narrow opening to the womb) produces abnormal cells. This condition, known as dysplasia, can cause spotting and is usually easy to treat. Your doctor can use a laser to vaporize the abnormal cells, says Dr. Walsh. Dysplasia is very common, he adds, and two-thirds of the time represents no threat to your health. Dysplasia can be a precursor of cancer, though, so careful monitoring and treatment are vital, he says.

If you have been diagnosed with dysplasia, you can help protect the cervix by shielding it with a condom or diaphragm during intercourse.