Sometimes I have spotting about two days after my period had stopped, usually after I exercise. Sometimes it lasts for a day or two. I run a lot on the treadmill and I run pretty fast. Am I spotting because I push myself too hard? Should I just continue with my workout routine or tone it down a little? I was hoping to train for a race, so I hope I can amp up my workouts. And if it's not because of my workout, what do you think is causing this? I really want to run in a race this year. Your advice is greatly appreciated.
— Worried Runner
Menstrual spotting is menstrual bleeding that occurs at times other than during your period. While menstrual spotting is a relatively uncommon problem, it’s not always abnormal or cause for worry, and to learn why, keep on reading.
For some women, spotting is a normal part of their menstrual cycle. You say that the spotting comes immediately after your period "stopped" and is usually associated with rigorous exercise. Depending on how long your actual period was, if it was short in length, the additional two days of spotting could be normal. But if it coincides with an already long period, it could also be normal, but may be a sign of abnormal menstrual bleeding. According to Medscape, excessive exercise, stress, and weight loss can cause abnormal uterine bleeding or spotting, but the more common outcome of excessive exercise is an absence of menstruation. It is almost impossible for me to determine if your spotting is abnormal or normal to begin with, and as you will see below, the list of causes for abnormal menstrual bleeding is long. Thus, if you are concerned about what the spotting/bleeding represents, it would be prudent of you to see your primary care physician or gynecologist for a history and physical evaluation.
One common cause of spotting, according to Dr. Mary Jane Merkin, co-author of A Woman’s Guide to Sexual Health, is that birth control pills can often lead to breakthrough bleeding, especially in the first few months of taking the pill. Dr. Merkin also reports that this spotting is not abnormal most of the time. If the spotting continues for more than a couple of months after starting the birth control pill, it would be smart to see your physician. Other causes of menstrual spotting include mid-cycle spotting secondary to ovulation. Sometimes, menstrual spotting can be a sign of pregnancy and thus a pregnancy test could rule this out.
Systemic diseases such as diabetes, thyroid dysfunction, or other hormonal imbalances can also cause abnormal bleeding or spotting and can be diagnosed with simple blood tests. Structural abnormalities of the female reproductive system can also cause spotting or abnormal bleeding and include uterine fibroids, ovarian cysts, uterine polyps, endometriosis, or abnormalities of the cervix. Abnormal cervical cells or other genital tract diseases can also present as bleeding or spotting after sexual intercourse. More serious causes of abnormal bleeding and spotting are cancers of the vagina, cervix, uterus and ovaries. Bleeding abnormalities such as Von Willebrand disease or low platelet count can also result in abnormal spotting or bleeding. A good reference for the different causes of abnormal bleeding can be found at the Mayo Clinic website.
Like I said before, it is very difficult to determine if your problem is normal or abnormal because I do not have the appropriate information from a history and physical exam. I would not stop your physical activity as this seems to be an important part of your life and I commend you for setting goals in terms of running in a race. You could try decreasing your intensity of workouts around your period to see if it makes a difference in the spotting. But, as I’ve said before many times, if you are at all concerned, which it seems you are, you should visit your primary care physician or your gynecologist to have a complete evaluation, which will include a history and physical exam and possible blood tests or radiologic imaging depending on what your physician finds.
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