Here’s the reality of women’s health: We’re not given enough information about our bodies, and that can affect us in major ways. 

Take periods, for example. For so long, we’ve been told that discussing our cycles is “TMI”, “gross”, or “too personal”. We internalize those messages, and as a result, we don’t talk about our menstrual health — not in social instances, and often not when it comes time to advocate for ourselves in medical settings either. 

It’s a vicious cycle: When we don’t speak up about our menstrual health, we don’t get a sense of what’s “normal” and what’s not…and as a result, we can’t identify and explore those red flags our own bodies send us.

What can the color of your period blood tell you?

While there are several things to pay attention to when it comes to menstrual health, one aspect we often overlook is the color of period blood. Even though we’ve been told it’s “disgusting” to talk about such things, this is something we need to pay attention to, as it can reveal important information about our bodies. 

Jessica Salas Mann, MD, a reproductive endocrinologist and the Director of Third Party Reproduction at IRMS broke down the importance of paying attention to the color of menstrual blood, and what it can tell us about our menstrual health.

Brown blood may be concerning

Some people may notice brown spotting, either when they’re expecting their period or mid-cycle. 

“Sometimes patients may have a little bit of brown spotting — that might not be full flow,” says Dr. Mann.”That might be [old blood], but not a real flow that means you got your period. Usually the period comes when the lining of the uterus sloughs off completely and you have your flow. Sometimes patients have this brownish spotting at other times, not really at the time [they’re expecting a period, which] can be very confusing.”

This brown spotting doesn’t necessarily mean something is wrong, but it may be something worth discussing with your doctor if you notice it. 

More on what this brown blood may (or may not) indicate is below.

Pink blood can be misleading

If you see pink blood, you may think you’re bleeding more than you actually are. In reality, there may be a small amount of blood mixing with discharge.

“It might just be the start of [your period] but not a full flow,” says Dr. Mann. “It may just be some withdrawal bleeding without an ovulatory cycle."

When it comes to period blood, bright red is optimal

“Red is healthier, you could say that,” says Dr. Mann. 

With that being said, some people may notice they start their cycles with brown blood before they begin bleeding red — that’s likely a good sign, according to Dr. Mann.

Don’t automatically count any blood as a period

Someone may see pink or brown spotting and think they’ve started their period, which can affect cycle tracking. It may even cause people to discount the possibility of pregnancy — but brown or pink blood or spotting doesn’t necessarily mean you’re having a period.

According to Dr. Mann, this frequently causes confusion.

“Patients may start bleeding or spotting before their pregnancy test and may think ‘oh, it’s over, I’m not pregnant’, and that’s not always the case,” she says. “Sometimes, it’s abnormal implantation or you may have had intercourse recently and it’s not [blood] from the uterus, [but rather] from the cervix. We always tell patients who are doing luteal support, ‘don’t stop your medications [if you think you’ve started your period] because you might be pregnant’. Until you have the blood test, you shouldn’t think you’re not.”

Spotting during pregnancy could indicate an issue with the pregnancy, but it can also happen during a perfectly healthy pregnancy, and not be a sign that anything is amiss. 

Blood that isn’t a bright red flow doesn’t necessarily indicate that you’ve ovulated either

Periods come about 14 days after ovulation, so if you see blood, you may think you’ve ovulated when tracking your cycle. But, if you’re only seeing brown blood, that may not be the case. 

“There are patients that tell me ‘I’m getting the cycles a week off or a few days off’’ and when I monitor them, I [see that they’re] not really ovulating,” says Dr. Mann.

“When someone ovulates, they make a hormone called progesterone, and progesterone stabilizes the lining and then when the ovary no longer makes estrogen or progesterone, those hormones drop and you get the full flow,” she adds. 

What color period blood is concerning?

Blood that isn’t a “healthy” color can indicate something is off.

“I can tell you that many of my patients with endometriosis have this history of mid-cycle spotting and it’s brownish. That’s not to freak anybody out or scare anybody,” says Dr. Mann.

Does seeing brown spotting mean you have endometriosis or another condition? No. But it may be worth considering, particularly in the presence of other issues such as infertility and/or pelvic pain. Ultimately, though…

It’s just one piece of a clinical picture 

“Typically if you see this [brown spotting in] somebody who has pelvic pain issues, who has infertility, maybe spotting after intercourse — those things can point to [the possibility of] something else going on,” says Dr. Mann. These issues could include endometriosis, infections, scarring in the uterus that could cause someone to not have full flow, polyps, or fibroids. 

“If there’s a fibroid in the cavity that is degenerating [which can happen when] it starts to be starved of blood and becomes necrotic, then you have bleeding that could be different colors,” she adds. “In general, polyps and fibroids tend to give a patient heavier flow, but if anything is out of the ordinary for a woman, it should be evaluated with an ultrasound.”

Brown or pink spotting alone may not be a cause for concern, though

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According to Dr. Mann, people who initially see brown blood, which becomes bright red as the period goes on, may not need to worry — but as always, it’s a good idea to run any concerns by an OB/GYN. Similarly, pink blood may not be a cause for concern in every case. 

‘If somebody’s blood is pink but they’ve had [no other] issues, there may be nothing to worry about,” says Dr. Mann.

Either way, you can bring this up to your doctor and they’ll help you put a clinical picture together to see if there’s any need for additional testing like an ultrasound.

A ‘normal’ pap smear isn’t a reason to ignore any of these red flags

According to Dr. Mann, people may have normal pap smear results and assume all is well, even if they have menstrual health red flags. However, a pap smear doesn’t tell the full story.

An ultrasound may be necessary to fully explore what’s going on.

Flow, period length, and cycle regularity also matter

Color of blood isn’t the only thing to pay attention to where periods are concerned. The amount of bleeding, length of periods, and regularity of cycles are also important. 

“If bleeding is very heavy, [or lasts] more than seven days, that’s also concerning. If somebody is bleeding more than two pads per hour for two hours, that’s a lot of bleeding, you have to let your doctor know,” says Dr. Mann.

Light bleeding may be a cause for concern as well — but it also may not, depending on other factors. 

“If someone is on a birth control pill, I’m not worried if the periods are light. In fact, sometimes you don’t even get a period. It matters whether someone is on the pill or not,” says Dr. Mann. “Some women who have a lower BMI, maybe there’s not too much estrogen in the body. They might have lighter periods and that’s okay for them. It’s a clinical picture of putting everything together. Just a specific finding doesn’t [necessarily indicate] something bad. In a patient who has had a history of D&Cs, who has had a pelvic infection, who went from heavier periods to much lighter periods, then that is more problematic. In general, heavier flow with clots and things are more concerning, but we have to pay attention to light periods too.”

Ultimately, consistency is a good sign

If your periods have always followed a predictable pattern, that’s a good sign. However, if you’ve noticed an unexplained change — like blood in a different color, shorter or lighter periods, or irregular cycles — that may warrant a chat with your doctor.