Stress can cause your cortisol levels to spike, disrupting your body’s production of sex hormones. This can result in spotting and other menstrual changes.

Spotting generally takes the form of small droplets of blood in your underwear or a pink, red, or brown tinge to your discharge.

“The color of your spotting is determined by the amount of time that’s passed since the blood was released from the lining of the uterus,” says Jane van Dis, MD, OB-GYN, a medical advisor with menstrual company FLEX.

It typically occurs on either side of your menstrual period — before your period starts in earnest or after you think your period has ended — but can happen at any point in your monthly cycle.

High levels of stress can prompt your endocrine system to release more cortisol. Cortisol is a steroid hormone produced by your adrenal glands.

The entire endocrine system is connected, and increased cortisol can have a ripple effect. Both estrogen and testosterone, for example, can decrease when cortisol levels rise.

An unexpected change in your estrogen levels can disrupt your menstrual cycle, resulting in spotting, missed menstruation, or other irregularities.

“Anything that impacts you as a person has the potential to impact the menstrual cycle and therefore cause spotting,” explains reproductive health specialist Felice Gersh, MD, author of “PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones, and Happiness.”

“It’s reasonable, for instance, to assume that stress is the cause of spotting if you were recently laid off, dumped, or moved,” she says.

Stress-induced spotting is usually accompanied by other symptoms of stress, including:

“Spotting, by its name, implies that an individual is releasing a smaller amount of blood than they would during their period,” says van Dis.

As such, you shouldn’t need a sanitary pad or tampon to catch the blood. (If you do, you aren’t spotting — you have another form of vaginal bleeding).

A simple panty liner should do the trick. Though, if you already own period underwear, donning those would be a more environmentally-friendly option.

If you choose to free-bleed and end up staining your underwear, these blood-removal hacks should do the trick.

It may be easier said than done, but to manage stress-related spotting you need to manage your overall stress levels.

“You could incorporate meditation, journaling, grounding, or nature walking into your routine,” says Gersh.

Going to a physical therapist, massage therapist, or licensed acupuncturist for myofascial release therapy, deep tissue massage, or another form of bodywork could also prove useful, she says.

Prioritizing your overall health can also help you manage your stress levels. That means:

If you continue to feel stressed — or otherwise feel grumpier, less focused, or more irritable than normal — it may be time to talk with a mental health professional. The right therapist can help you deduce the root of your stress, as well as give you tools to manage it.

“If you have a regular period and this is your first time spotting, you’d be wise to rule out pregnancy as the underlying cause if there’s a chance that you could be pregnant,” says Gersh.

You can find out if you’re pregnant by taking an at-home urine test 10 or more days after you last had vaginal intercourse with a person who produces sperm.

You can also ask a healthcare professional to order a blood test, which can usually detect pregnancy a few days earlier.

If this is the first time you’ve ever spotted and there’s no chance you’re pregnant, Gersh says it’s probably OK to assume that stress — or some other lifestyle change — is the cause.

But if you’re experiencing other unusual symptoms or bodily changes, she recommends consulting with a healthcare professional.

Although stress commonly causes spotting, it isn’t the only cause. Do what you can to rule out pregnancy and take note of any other symptoms you may be experiencing.

If you use hormonal birth control, your spotting could be breakthrough bleeding. In some cases, spotting may be a sign of an underlying infection or other condition.

When in doubt, consult with a healthcare professional.

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.