EP.332/ Is spotting before your period normal or a sign of endo?
Today is one of my shorter episodes, a bite size episode!
Recently I started working with two new clients and they were both really concerned that they were spotting one to two days before their periods.
First up, what do I mean by spotting? Spotting is typically spots of blood appearing in your underwear - it’s light and is typically not very consistent. Often it’s dark red or brown, and we’ll get to why it’s that colour in a minute.
So, if you’re spotting one to two days before your period, is this a problem and is it anything to do with endo?
Some of you may be surprised to learn that spotting one to two days before your period is okay and normal.
Not everyone gets it, but it’s indicative of your hormones beginning to drop in the lead up to your period. This allows for a gradual beginning of bleeding, but it’s usually from old, left over blood that comes away first. The full on uterine lining shedding hasn’t begun yet - when that kicks in, you’ll see fresh red blood that flows easily and is a syrup-like consistency.
In contrast, this ‘spotting’ blood is slow to move because your period isn’t in full swing yet and it may also be residual blood from the last cycle. Either way, the prolonged exposure to air oxidises the blood, which changes its colour, resulting in a dark red or brown. However, for some people, spotting may be pink, light red or red. This is okay too, it just suggests that this is fresh blood from your uterine lining, rather than left over or slow moving blood. It’s just in small amounts because the uterine lining is only mildly beginning to shed because the hormone drop is only just beginning and your period hasn’t full begun yet.
Now, if you’re getting spotting 3 or more days before your period, or all luteal phase, this is a sign of low progesterone and is not healthy. In some rare cases, it may also be a sign of endo on the cervix, but often I see bleeding at other times of the cycle with this, and out of thousands of students and clients, I’ve only ever had one with endo on the cervix. I will be doing more episodes on how to raise low progesterone soon, so stay tuned for that.
But spotting is not the only sign of low progesterone. Low progesterone symptoms include irritability and tearfulness, anxiety, poor sleep or insomnia before your period and general PMS.
Now PMS doesn’t just occur with low progesterone. PMS can also occur with oestrogen dominance, and you can have totally healthy progesterone levels and yet your oestrogen is too high, resulting in an imbalance which triggers PMS like bloating and water retention, sore boobs, etc. So, don’t assume just because you have PMS that your progesterone is low.
A good clue that your progesterone is not doing well, are those other signs I shared - irritability or anger, tearfulness or low moods and sadness, anxiety and insomnia and poor sleep. This is because progesterone supports your calming neurotransmitter, GABA, which is also essential for sleep. When progesterone is low, it has a knock on effect on GABA, and as a result, we experience mental health, mood and sleep challenges.
So could you have 1 to 2 days of spotting and yet still have low progesterone, even if this amount of spotting is okay? Yes. If you have other symptoms, then your progesterone may need some support. It’s just not dropping so low that you’re having prolonged and early spotting, which is a positive sign!
I have previously done an entire episode on low progesterone signs and how to test your progesterone levels, so I’ll link to that episode in the show notes.
So when you’re trying to address your low progesterone levels, if the other symptoms improve, but the spotting 1 to 2 days before your period doesn’t, don’t panic. Everyone is different and for some people, they will have a reduction in spotting, but if you don’t, it’s not that there’s anything wrong. It’s just your body getting ready for your period. If you want to be entirely sure, recheck your progesterone levels at this stage. This may be when you want to do a DUTCH Cycle Mapping test, because it monitors your progesterone every day of your cycle, but I explain all your test options in that other episode I mentioned.
Lastly, it’s worth noting, that clinically, we see left over blood from the last cycle as quite common with a tilted uterus because the blood doesn’t always clear efficiently. So, if you’re someone with a titled uterus, spotting for 1 to 2 days before your period may always be a thing for you. You may find visceral manipulation or some other pelvic massage like Mercier Therapy can help with that.
I hope this clears up some confusion about spotting. If this is helpful, I will share more about spotting at other points in your cycle, so let me know on IG or drop me an email.
See you next week!
Show notes
Low progesterone signs and testing options
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Produced by Chris Robson