Expert: Ramona Quilter - 4/4/2007

Question
I returned to fertility about eight months ago after nursing my fourth child.  I have been having a longer cycle, ranging from 29 to 35 days.  My chiropractor/acupuncturist put me on some herbs to help regulate my cycle and help with some hormonal headaches I have been experiencing.  I started them shortly after my the completion of my last cycle.  This month I spotted very lightly for two days before I actually started normal menstruation (this is not normal for me).  And I started the spotting at day 31 with normal menstruation beginning on day 33.  How do I cart this?  Do I include the spotting as day one of my next cycle?  

Answer
I looked up "spotting" and found the following information.

Many women experience spotting at some point during their cycle, be in after the major bleeding period, in the middle or days before their period is due. There are times when it’s perfectly normal to spot, and there are times when spotting is an indication of something wrong, be it minor or major.

First, let’s define “spotting”. Spotting is when a bit of blood is passed through the vagina. Normally it doesn’t reach the underwear, but rather is swiped with toilet paper after a bowel movement or urination. The blood can be pink-tinged mucus, rusty brown or bright red. Spotting can be a one-time occurrence, or it can last for several hours or even several days. Spotting does NOT define the first day of menstruation. The first day of menstruation should always be the first day of actual bleeding.

“Normal” Spotting

Normal spotting is what may occur at the very end of your bleeding days. A day or two of spotting after 3 to 5 days of “bleeding” is normal, and just the end of the bleeding period.

Spotting that occurs in the middle of your cycle or spotting that occurs some ten to fourteen days prior to the start of the next cycle is normal too. This spotting may occur during ovulation. Seeing a spot of blood during ovulation is considered an excellent fertility sign. It is thought that mid-cycle spotting occurs for one of two reasons. First reason is possibly that when the egg bursts through the follicle, a little bleeding may occur. This blood will then make its way out and show up as “spotting”. Or, during ovulation, the level of estrogens rise, and this sometimes prompts the uterus to shed a bit of lining, which shows up in the form of “spotting.”

Spotting that occurs about a week before the cycle is due – and only lasts for less than one day – is possibly considered implantation spotting. This happens as a result of the fertilized egg burrowing into the uterine lining. Or another reason for seeing implantation spotting may be due to a slight rise in estrogen and drop in progesterone before the corpus luteum takes over the production of progesterone. The corpus luteum takes over the production when the implanted fertilized egg signals the body that pregnancy has occurred and that the lining must be maintained. Keep in mind that spotting that continues for days is not implantation spotting.

“Abnormal” Spotting

Abnormal spotting shows up at times other than the above mentioned times. Abnormal spotting lasts for days. It’s abnormal to spot days before your menstrual cycle is due. The causes of abnormal spotting vary.

One common cause of spotting several days before the menstrual cycle is due is low progesterone. It’s the hormone progesterone that helps to maintain the uterine lining for pregnancy and when progesterone level drops, the menstrual cycle occurs. In women who are deficient in progesterone, they will see spotting several days to a week before their cycle is due. This can also cause minor infertility and early miscarriage.

Another reason spotting may occur could be uterine fibroids, which are fairly harmless, but need to be kept an eye on. Endometriosis, birth control pills are a few other reasons spotting may occur. The most harmful reasons for spotting are possible sexually transmitted diseases and some cancers.

It is advisable if you have re-curring spotting each month to have your healthcare provider to exam you, just to rule out possible harmful reasons for it and to help you to deal with and/or cure the reasons behind the spotting.

I hope this helps.  It seems there may be some reason to be concerned beyond fertility issues.  As far as the fertility issues are concerned, I would count the first day of full bleeding as the beginning of your cycle.