What does brown discharge mean?

It can be distressing to notice brown vaginal discharge before it’s time for your period. Brown discharge occurs when a small amount of old blood mixes with your normal vaginal discharge. Research published in the American Journal of Epidemiology found that, on average, only 5% of women experience light bleeding, or spotting, in the middle of their cycle. Still, many women may experience occasional mid-cycle bleeding.

 Most of the time, mid-cycle brown discharge is associated with ovulation or hormonal fluctuations and isn’t something to worry about, says Michael Green, MD, OB/GYN and co-founder at Winona. “Brownish discharge during your menstrual cycle is typically no cause for concern unless it’s presenting with other symptoms,” says Dr. Green. Depending on what’s causing the discharge, additional symptoms that may require medical attention include itching, a burning sensation, pelvic pain, or an unpleasant odor.

RELATED: What does the color of your period mean?

What causes brown discharge mid-cycle?

Here, we’ll take a closer look into some causes of brown discharge, including those that require medical attention.

Ovulation bleeding

The majority of the time, brown discharge mid-cycle is caused by ovulation bleeding. This bleeding is usually minimal, says Dr. Ruth O. Arumala, DO, MPH, a board-certified gynecologist and co-chief medical officer at Zuri Fertility. “As blood travels from the lining of the uterus to outside the body, it gets oxidized and mixed with normal vaginal fluids to appear as a brown discharge.”

 Ovulation bleeding, or spotting, usually happens around the middle of a normal menstrual cycle, around the 14th day, according to the American College of Obstetricians and Gynecologists (ACOG). 

How long does brown discharge from ovulation bleeding last? “This brown discharge from ovulation typically occurs over a day or two, but naturally, it can go on longer in some individuals,” says Dr. Green. 

Implantation bleeding

If you’ve conceived during your cycle, you may also see a bit of brown discharge around the time that implantation occurs, which is usually about one or two weeks after fertilization, according to ACOG. This doesn’t happen for every woman, but it’s a fairly common occurrence, says Dr. Green.

Seeing blood when trying to get pregnant can be stressful, but brown discharge after conceiving is usually not a sign that something has gone wrong. 

“Brown discharge can be a sign of early pregnancy, potentially from implantation bleeding when the fertilized egg implants itself in the uterine wall, but it is not typically a sign of miscarriage,” says Dr Green. “If you experience bleeding that endures longer than average, it might be worth consulting a doctor, especially if you are pregnant.”

Hormonal imbalance

Another common cause of brown discharge is hormonal imbalance. For example, teenagers just beginning their periods and women approaching menopause may have irregular uterine bleeding due to hormone fluctuations, according to the National Library of Medicine. Additionally, hormonal imbalances (such as from polycystic ovary syndrome) can cause you to miss ovulation. This can lead to delayed or partial periods, which may look like brown discharge or brown bleeding in the middle of your cycle.

Hormonal birth control

You may also have brown discharge on different forms of birth control, according to the National Library of Medicine. That’s because hormonal contraception can cause hormonal changes and imbalances. People on hormonal birth control may experience brown discharge or irregular bleeding, usually called “breakthrough bleeding.”

 Several hormonal birth control methods can cause breakthrough bleeding, including birth control pills, implants, hormonal IUDs, birth control shots, vaginal rings, and skin patches, according to ACOG. This bleeding usually resolves as your body adjusts to the birth control, but you should reach out to your healthcare provider if bleeding continues for several menstrual cycles.

Bacterial vaginosis

Less commonly, brown discharge may be caused by a condition called bacterial vaginosis (BV), which is an overgrowth of bacteria that occurs in the vagina. 

“Bacterial vaginosis can sometimes present as a brownish or gray discharge, often accompanied by a fishy odor,” says Dr. Green. “If the discharge presents with any odor, itching, burning, or pain in the pelvis or lasts a long time past ovulation, it may be worth being evaluated by a doctor,” says Dr. Green.

 Although up to 30% of bacterial vaginosis cases resolve on their own, as per the National Library of Medicine, other times, you will need to be treated with antibiotic medications such as clindamycin or metronidazole.

Gonorrhea or chlamydia

Sometimes, sexually transmitted infections (STIs) like gonorrhea or chlamydia can cause brown discharge. Gonorrhea and chlamydia are two of the most prevalent STIs, and irregular bleeding, discharge, and mid-cycle spotting are some of the most typical symptoms, according to the Children’s Hospital of Philadelphia (CHOP). Other symptoms include pelvic pain and pain when peeing. 

It’s important that these conditions be treated because untreated gonorrhea or chlamydia can cause complications like pelvic inflammatory disease and infertility.

Ectopic pregnancy 

Ectopic pregnancies are when a fertilized egg attaches to a fallopian tube or another location other than the uterine lining. The condition is considered a medical emergency because there is a risk that the fallopian tube will burst. 

Ectopic pregnancies in their early stages don’t always cause obvious symptoms, according to the National Health Service (NHS). However, brown, watery discharge may be one of the symptoms when they do. Since ectopic pregnancy can be life-threatening, contact a healthcare provider if you have missed a period, may be pregnant, or have heavier bleeding, pelvic pain, or fever.

Endometriosis 

Endometriosis occurs when cells from the uterus grow on other parts of the body, such as the ovaries, bowels, bladder, pelvic lining, and fallopian tubes. 

The main symptoms of endometriosis are very painful periods, pain during sex, low back pain, and painful urination and bowel movements, according to the National Library of Medicine. 

Abnormal bleeding is another possible symptom of endometriosis, which may include heavy bleeding or bleeding in the middle of your cycle.

Cervical polyps

Cervical polyps are small, benign growths found on your cervix. About 2% to 5% of women experience them, according to the Cleveland Clinic, and they are a common cause of mid-cycle bleeding. 

Often, you’ll notice this bleeding after sexual intercourse. 

Cervical polyps can also cause heavier-than-normal menstrual bleeding and abnormal vaginal discharge, including yellowish or pus-like discharge.

Trichomoniasis

Brown discharge can also be a symptom of trichomoniasis, says Praveen Guntipalli, MD, an internal medicine/obesity medicine physician and medical director and owner of Sanjiva Medical Spa. “Trichomoniasis is a sexually transmitted infection caused by a tiny parasite in your vaginal area or urethra.”

 “Trichomoniasis might also make your discharge look strange,” says Dr. Guntipalli. In addition to brown discharge, you might notice white, yellow, greenish, or thin and bubbly or frothy discharge with an unpleasant odor. These are all signs that you should visit a healthcare provider as soon as possible, Dr. Guntipalli advises.

RELATED: Trichomoniasis treatments

Cervical cancer

Abnormal discharge and vaginal bleeding are symptoms of cervical cancer or cervical dysplasia (pre-cancer). 

Cervical dysplasia and early-stage cervical cancer don’t typically result in symptoms, but if symptoms do appear, they include abnormal discharge; spotting between periods; bleeding after sex; pelvic pain or painful sex; heavier or longer periods than usual; and bleeding during or after menopause.

Advanced cervical cancer symptoms include the symptoms above as well as difficult or painful bowel movements; rectal bleeding when having a bowel movement; difficult or painful urination or blood in the urine; dull backache; swollen legs; abdominal pain; or fatigue.

Cervical cancer screening should begin at age 21. You can reduce your risk of HPV, which is the cause of almost all cervical cancers, by getting vaccinated with Gardasil 9.

Endometrial cancer

In rare cases, brown discharge may be a sign of endometrial cancer, cancer of the uterus. Though uncommon in women younger than 45, endometrial cancer is the most common type of reproductive organ cancer in women, as per the American Cancer Society. The condition is most likely to affect postmenopausal women in their 60s and 70s. 

Abnormal vaginal bleeding is the most prevalent symptom of endometrial cancer. Additional symptoms include abnormal discharge, painful urination, pain during sex, and pelvic pain. 

Any post-menopausal woman with vaginal bleeding should visit a healthcare provider right away.

Normal vs. abnormal discharge: When to see a doctor

Brown discharge on its own is usually not serious, says Dr. Arumala. But when accompanied by other symptoms, it can be a sign of an abnormal inflammatory, infectious, or anatomic condition. “If it is accompanied by persistent pain, foul odor, or persistent bleeding mid-cycle, it should be evaluated by a gynecologist,” says Dr. Arumala.

 What might happen if you visit your healthcare provider about abnormal bleeding? Your healthcare provider will likely perform a pelvic exam and ask detailed questions about your symptoms and medical history. Depending on your symptoms, they may order testing.

 These tests may include:

• Pap smear
• Test for infections, including gonorrhea, chlamydia, trichomonas, HPV, and bacterial vaginosis
• Urine test
• Thyroid and other hormone levels
• Iron test
• Pregnancy test
• Ultrasound
• MRI
• Sonohysterography
• Hysteroscopy
• Biopsies of endometrial lining 

Does brown discharge require treatment?

Brown discharge mid-cycle may or may not require treatment. It depends on the cause. You should discuss any brown discharge with your physician if it lasts more than a day or two, keeps happening, or if other symptoms, like pain, unfamiliar odors, or other discomforts accompany it.

 Dr. Green says that if your brown discharge is caused by hormonal imbalance, treatments like birth control pills can regulate your period. Stress reduction techniques to regulate cortisol in your body may also be advised. 

“If the discharge is caused by a polyp, STI, or infection, however, it may be necessary to take medication or have the polyps removed by a healthcare provider,” says Dr. Green.

Summary: Annual well-woman exams are important 

While the most common causes of brown discharge don’t require immediate medical attention, it’s important to visit your healthcare provider yearly for your well-woman exam. These visits help prevent and detect women’s health issues such as cervical cancer, STDs, and breast cancer. Your well-woman visit is also a wonderful opportunity to share any questions and concerns about your menstrual cycle, discharge, abnormal bleeding, or spotting you may notice. Your provider can help you understand what’s normal for someone your age and if further testing may be necessary.