PCOS spotting: What does discharge with blood mean?

PCOS spotting usually refers to any bleeding that happens between periods. Although different women experience this endocrine condition differently, some of the common PCOS symptoms are related to irregular periods, heavy bleeding, and unusual discharge with blood because of the hormonal imbalance. In fact, 70-80% of women with PCOS have either abnormal infrequent periods or cycles with no periods at all.

Sometimes, it can be hard to tell when the spotting is normal and when it’s a sign of something alerting, especially for PCOS-affected women.

To understand what is abnormal PCOS discharge with blood, let’s see when spotting can be normal:

• Ovulation spotting: happens during ovulation and is usually light blood drops.
• Hormonal birth control: taking hormonal contraception can cause some spotting while your body adapts to it.
• Early sign of pregnancy: implantation bleeding, which usually lasts a day or two, can be confused with spotting but might actually mean pregnancy. Implantation bleeding happens when a fertilized egg attaches to the lining of the uterus.

Generally, light spotting in certain cases is quite common for healthy females, but sometimes it can be a sign of some underlying conditions.

PCOS discharge with blood, for instance, is quite common for females with this condition. Let’s see when this type of spotting can happen during your cycle if you’re having PCOS.  

PCOS spotting during period cycle

There can be two cases when discharge with blood can happen during your cycle if you are having PCOS – spotting instead of normal menstrual bleeding or spotting between periods.

PCOS spotting instead of period

It can be common to experience super light spotting instead of period for females with PCOS. This can happen because of the hormonal imbalance when male hormone levels are too high and prevent the ovaries from releasing an egg (ovulation). If you don't ovulate, there's no egg to fertilize, no uterine lining to shed is formed, and so you technically can't menstruate. Long story short, if there is no ovulation, there is no menstruation. 

But at the same time, a woman with PCOS might just develop some thin endometrium due to low estrogen levels associated with PCOS. And when it’s time to shed this uterine lining (menstruation), it’s just not much of it, and so it looks like spotting or a light discharge with blood.

PCOS is a common cause of thin endometrium when normal thickness (for pregnancy) is somewhat 8 mm. This can be one of the reasons for PCOS spotting instead of menstruation, which looks like a light discharge with blood.

However, in one study they explored the endometrial thickness in women with PCOS and discovered that endometrium was significantly higher (11 mm) in a PCOS group. The ultra thick endometrium is a condition called endometrial hyperplasia. This condition is what makes some PCOS-affected women experience heavy bleeding. 

However, PCOS can manifest differently for different patients, and so the symptoms can vary from person to person. 

PCOS spotting between periods

PCOS spotting between menstruation can happen anywhere before or after a period (or anytime during the cycle with a missed period). This is a more complicated case since such spotting can mean many things, starting from some normal cases, such as ovulation or pregnancy implantation, to other underlying conditions. 

And because PCOS is a condition that is usually accompanied by other health issues, it's important to pay attention to the frequency and quality of such discharge with blood in between periods. If you notice anything unusual, it’s important to consult a doctor as soon as possible.

Now, let’s take a closer look at some possible reasons for PCOS spotting between periods.

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Does PCOS cause spotting? 

Simply speaking, yes, it does affect your hormonal balance, which leads to PCOS discharge with blood. There can be several reasons why PCOS spotting happens. 

Possible reasons for PCOS Spotting

The following underlying factors can explain why you might experience bloody discharge or spotting during your cycle when you have PCOS.

Oral contraceptives 

Oral contraceptives, which can be prescribed to manage PCOS symptoms, can sometimes cause side effects like spotting instead of or between periods. Some women who take birth control pills stop having monthly bleeding (period) or develop irregular spotting and bleeding. This usually resolves after a few menstrual cycles. If not, make sure to contact a doctor.

Anovulatory bleeding

Anovulatory bleeding is not menstruation but uterine bleeding caused by ovulatory dysfunction. This bleeding is irregular and doesn't follow a cycle. With this kind of bleeding, a woman can experience amenorrhea (lack of period) for months, then phases with either heavy bleeding or spotting. Also, there are usually no typical premenstrual symptoms with this anovulatory bleeding or spotting. Women with PCOS are especially susceptible to this condition.

Hormonal imbalance

PCOS disrupts the hormonal balance. Low estrogen levels and high androgen hormone levels can lead to irregular ovulation, which in turn affects the uterine lining, leading to spotting.

Insulin resistance 

IR can also disturb the hormones and disrupt ovarian function, contributing to irregular bleeding. Although IR can disrupt hormonal balance in anyone, it's particularly common in women with PCOS. This is why experts recommend monitoring your insulin level.

Hyperplasia

Women with PCOS are more likely to develop endometrial thickening, which is often caused by excess estrogen without progesterone. If ovulation does not happen, progesterone is not produced, and the lining is not shed. The endometrium in that case may continue to grow in response to estrogen, and the endometrium becomes thicker. As a result, the lining cells may become abnormal and, in more rare cases, can lead to cancer. 

Endometrial (uterine) cancer can manifest in irregular bleeding, intermenstrual spotting, light discharge with blood, or postmenopausal bleeding. 

Ovarian cysts

Although not the primary cause of PCOS spotting, the presence of cysts on the ovaries in females with PCOS can indirectly contribute to vaginal discharge and period disturbances.

The problem with those ovarian cysts is that a woman might not even know she has them unless she experiences dull pain in the lower abdomen (pelvic pain). Large cysts may cause a swollen tummy, pain when urinating, or constipation.

These cysts can cause irregular periods and spotting (abnormal vaginal bleeding between periods). When they rupture, they might cause sudden pain and a brownish vaginal discharge, which can seem like PCOS discharge with blood.

However, not all females with PCOS have these cysts.

Other factors

Some other factors, like stress, weight fluctuations, and certain medications, can also play a role in causing irregular bleeding or spotting. Women with PCOS might be even more susceptible to some of such lifestyle changes.

Can PCOS cause bleeding during intercourse?

The short answer is yes – PCOS can cause bleeding during or after sex. It actually has a name: post-coital bleeding (PCB), a non-menstrual bleeding that occurs immediately after sexual intercourse.

This PCOS bleeding during or after sex can be caused by several factors:

• Cysts or polyps (small growths on the cervix), often found in PCOS-affected women, can burst during sex and cause bleeding. 
• Some infections, including sexually transmitted infections (STIs), can cause bleeding when having sex or immediately after. For example, chlamydia may cause pain in the tummy and bleeding after sex and between periods. Gonorrhea and pelvic inflammatory disease (PID) can also be the reasons for such unexpected bleeding. And while women with PCOS are potentially more likely to have an imbalanced vaginal microbiome, they can be especially vulnerable to these infections.

Besides these factors, there can be other causes, such as vaginal dryness due to hormonal imbalances associated with PCOS. The low estrogen and high level of male hormones is what causes the vaginal dryness, burning, and irritation, especially during sex. This irritation because of the reduced vaginal lubrication can also lead to spotting and bleeding.

Vaginal bleeding during or after intercourse is not normal and needs to be examined by a health care provider.

Final thought

PCOS spotting instead of periods or between periods is quite common for women with Polycystic Ovary Syndrome, although not normal. 

There are a number of reasons why PCOS causes spotting, and PCOS discharge with blood can sometimes be confused with ovulation spotting, pregnancy implantation, or spotting from oral contraceptives (birth control pills), which are actually normal and are not related to PCOS.

However, if this spotting lasts for more than several days or/and is accompanied by pain or/and fever, it’s important to contact a doctor to rule out any underlying conditions.

PCOS can cause bleeding during intercourse or after sex. There can be several reasons for it, among which are cysts or polyps eruption, STIs, or vaginal dryness and vaginal microbiome imbalance. Females with PCOS are usually more vulnerable to it.

Make sure to reach out to your health care provider immediately if you notice any unusual and persistent spotting, especially accompanied by pain or/and fever.

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References:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9619128/

https://my.clevelandclinic.org/health/diseases/21698-anovulation

https://pubmed.ncbi.nlm.nih.gov/33305667/

https://www.sciencedirect.com/science/article/abs/pii/S0301211506000637

https://my.clevelandclinic.org/health/diseases/16569-atypical-endometrial-hyperplasia

https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics/print

https://www.ncbi.nlm.nih.gov/books/NBK549773/

https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

https://pmc.ncbi.nlm.nih.gov/articles/PMC10244367/

https://www.acog.org/womens-health/faqs/endometrial-hyperplasia

https://pmc.ncbi.nlm.nih.gov/articles/PMC8718643/

https://pmc.ncbi.nlm.nih.gov/articles/PMC5393469/

https://www.ncbi.nlm.nih.gov/books/NBK539572/

https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos

https://www.sciencedirect.com/science/article/abs/pii/S1751721411001333

https://www.nhs.uk/conditions/chlamydia/

https://www.mdpi.com/2075-4418/14/4/404

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