The first time I got brown discharge, I was terrified.

I remember going to the loo and finding the usual slippery vaginal discharge that I get around ovulation. I brought the loo roll out to inspect it; and saw (what looked like) an endless array of thick, brown streaks.

I was horrified; but I got it checked out, and it turned out to be harmless. I still get brown discharge (usually when I’m ovulating, but often just before or just after my period); but after a couple of years of seeing vaginal discharge with intermittent thick, stringy lines of brown, I’ve come to accept it as part and parcel of my body.

But while mine occurs around ovulation, brown discharge can have any number of causes. And, as a chronic hypochondriac whose heart felt like it was about to stop when I saw it for the first time, I’m particularly keen to make brown discharge a regular part of everyday gynaecological discourse; and to shine a light on what it could mean for you.

What exactly is brown vaginal discharge?

There’s no way to answer this one without jumping the gun slightly and heading straight for one of the potential causes.

“Often, brown discharge is old blood, while fresh blood appears pink or bright red in the [vaginal] discharge,” says Urogynaecologist Dr. Betsey Greenleaf DO, Distinguished FACOOG, CEO of The Pelvic Floor Store.

The key phrase there is ‘old blood’: otherwise known as one of the most common causes of brown discharge. When you menstruate, it can take a little time for all the blood to leave the cervix. During this time, the blood oxidises – a natural process that happens when blood comes into contact with oxygen, turning from bright red to brown. So, if you experience brown discharge as your period draws to a close, it’s more than likely residual menstrual blood – and this is perfectly normal.

It’s not just post-period, though; old blood could occur pre-period, too. “Some people will start their menstrual cycle with a day or two of brown discharge,” Greenleaf explains. “The menstrual cycle is triggered by a drop in hormones that leads to the shedding of the uterine cavity made up of tissue and blood. The early [vaginal] discharge occurs because one isn’t actively shedding the lining yet, but then it picks up with the full menstrual bleeding.”

In other words: If your period takes a couple of days to get going, some early blood might take a while to leave the cervix – resulting in brown discharge (again, normal). Once the menstrual flow kicks off fully, the blood is bright red.

“Brown discharge can be watery, or thick and creamy,” says Greenleaf. “[It] can range from light tan, to a deep, mahogany brown.” Safe to say, I’ve had all shades of brown appearing in my vaginal discharge.

When are you most likely to notice brown discharge?

As discussed, the beginning and end of your period are common times to see this sort of discharge; but ovulation – when the ovaries release an egg approximately 14 days before your period – might be another key occasion. Like I said, I’m no stranger to brown vaginal discharge during ovulation.

“[Brown discharge during ovulation] happens because of fluctuating hormones [estrogen and progesterone] at the time of ovulation,” says Greenleaf, adding that the discharge can range from red to a brownish pink.

There’s a chance, though, that your brown discharge doesn’t have anything to do with your menstrual cycle; so let’s dive into some other possible causes.

Potential Causes of Brown Discharge

Hormonal contraception

Continuing along the hormonal theme (for now), there’s a possibility you could experience brown discharge when you start using a new birth control method, such as the coil (also known as an IUD, which stands for intra-uterine device) or an implant. These sorts of birth control methods release the hormone progestin to prevent pregnancy; and, as your body adjusts, you might see brown discharge together with irregular periods and spotting or breakthrough bleeding.

Perimenopause

Perimenopause is the gradual transition into menopause; so, if you’re roughly aged between 35 and 50, your brown discharge could be the result of changes to your hormonal balances. If your brown discharge occurs alongside night sweats, mood changes, insomnia, hot flashes or vaginal dryness, perimenopause may well be the cause.

Implantation bleeding

Brown discharge could – could! – be a sign that you’re pregnant. In this case, it’s known as implantation bleeding, which is when a fertilized egg implants itself into the uterus – sometimes resulting in some light bleeding, which could then lead to brown discharge.

Verywell Health recommends taking a pregnancy test if you notice brown discharge a few days before your period, and if your period never ultimately arrives.

Lochia

Continuing along the baby theme, now – brown discharge might occur in postpartum individuals who have just given birth. The early days might see you bleeding quite heavily, before gradually getting lighter and possibly turning brown (or pink).

That said – if you’re concerned about anything to do with any postpartum bleeding, you should always contact a healthcare provider.

Vigorous sex

Recently enjoyed a night of sweaty, riotous sex? Lucky you. But, in the same breath – our sympathies if you’re noticing some post-sex bleeding. Vaginal irritation can happen during vigorous sex, and may well occur as a result of your breathless night of passion. This could lead to brown discharge as the blood oxidises while slowly exiting the body.

Gynaecological examination

Ever noticed some blood after your cervical screening (also known as a Pap smear) or a pelvic exam? This is normal (and certainly not a reason not to get your Pap smear!); as the tools used by healthcare professionals can irritate the walls of the vagina or the lining of the cervix, possibly resulting in bleeding and subsequent brown discharge.

Foreign objects

Greenleaf suggests some examples of foreign bodies in the vagina – which can cause bleeding in the form of brown discharge, which is often accompanied by an unpleasant odour – as including the following:

• Forgotten tampon
• Toilet paper that has been pushed into the vagina
• Pessary
• Retained condom

If you believe you have a foreign object in your vagina that you can’t locate yourself, don’t panic! It can’t get stuck inside you, and it will be easy for a health professional to locate. Make an appointment with your local sexual health clinic or GP, explaining the problem and they will be able to remove it for you. 

Stress

I’ve suspected (keyword being 'suspected') for a while that my brown discharge could be linked to stress; and so I felt seriously vindicated when reading the following by Verywell Health: “The hormonal changes that large amounts of stress cause in your body can lead to spotting or brown discharge between periods”. (It’s worth noting that they added: “If the brown discharge seems especially heavy, or if you have other unusual symptoms like pelvic pain, fatigue, or dizziness, contact your healthcare provider right away.”)

No one should ever assume stress is the cause of their brown discharge – but, if you are feeling particularly stressed and have started experiencing brown discharge; well, there could be a link. That’s all I’m saying.

Ectopic pregnancy

Now, we’re getting to some of the more serious causes of brown discharge that may require treatment or urgent medical attention.

An ectopic pregnancy is when a fertilised egg implants outside the uterus, such as into one of the fallopian tubes. As K Health says, this is serious and can lead to life-threatening complications. There aren’t always signs; but signs can include spotting, abdominal cramps, nausea and/or vomiting and light-headedness.

Stool

“When one sees discharge in the underwear, it can be difficult to pinpoint its origin; which could be from the urethra, vulva/vagina, or rectum,” says Greenleaf. “If determined to definitively be coming from the vagina and has the consistency of stool, or is worse when one has diarrhoea, then there is a concern of a fistula: a hole between the vagina and gastrointestinal tract.

“Fistulas can be caused by previous surgery or injury, or due to incomplete healing related to inflammatory bowel diseases such as diverticulitis, Crohn’s disease or ulcerative colitis,” Greenleaf continues.

If you’re at all concerned about a fistula, it’s best to make an appointment with your healthcare provider as soon as you can.

Ovarian cyst

What to Expect has a pretty stellar explanation of this one: ‘An ovarian cyst, a fluid-filled sac that forms on or inside an ovary, is benign in the majority of cases, but it can cause brown discharge as well as abdominal pain or pressure, a dull ache in the lower back and thighs, and pain during sex and your period.’

Couldn’t have put it better ourselves.

Infection

Yes, by infection we do mean sexually transmitted infections, including the following culprits:

• Trichomoniasis
• Chlamydia
• Gonorrhoea

If you’re also noticing that your discharge has a foul smell, experiencing pain during sex or generalised pain in your abdomen, or experiencing burning urination, a sexually transmitted infection might be behind it.

STIs aren’t the only infections that can cause brown discharge, though. Bacterial vaginosis (BV) isn’t an STI, but instead an infection caused by an overgrowth of harmful bacteria in the vagina. If your brown discharge is accompanied by a fishy smell down below, vaginal itching or irritation, or pain when peeing, it’s worth making an appointment – as bacterial vaginosis may well be behind it.

Pelvic inflammatory disease (PID)

PID is when an infection occurs in the cervix and the uterus; typically caused by an untreated STI or vaginal infection (that’s why it’s so important to make an appointment ASAP if you notice any of the above symptoms). It can result in brown discharge, together with pain in the abdomen or pelvis, pain during sex or urination, fever, or a bad smell accompanying the discharge.

Endometriosis

You’re more than likely aware that endometriosis is a chronic condition where cells similar to the uterine lining start to grow in other areas – like the ovaries, fallopian tubes and bowels – causing heavy periods and severe pain.

Flo flags that endometriosis can cause bleeding outside the period, ‘including brown discharge from trapped endometrial tissue that’s not able to shed’; but asks us to remember, too, that ‘brown discharge isn’t considered to be a common presenting symptom of endometriosis.’

Polycystic ovary syndrome (PCOS)

PCOS is common, affecting one in ten people with vaginas who are of reproductive age. It’s a hormonal condition stemming from an imbalance number of reproductive hormones – one hormone, known as androgen, is produced at higher levels and this can lead to irregular or missed periods; not to mention a period being replaced by brown discharge.

Other symptoms include issues with fertility, excessive body or facial hair, weight gain and acne.

Cervical cancer

It’s rare, and very unlikely –  but we’d be remiss if we didn’t acknowledge cervical cancer as a potential cause of brown discharge, because there is a possibility – however faint.

The early stages often have no symptoms, but the vaginal discharge can be foul smelling, watery, pale, pink, bloody or brown. When there are symptoms, these include: pain during sex; bleeding after sex; heavy or prolonged periods; and bleeding in between periods. If you suspect cervical cancer, make an appointment with your healthcare provider for a check-up. The best way to protect against cervical cancer is to have the HPV vaccination and attend for cervical screening. 

When is brown discharge a cause for concern?

Brown discharge at the beginning and end of your period, without any other symptoms, is usually normal; but any abnormal discharge should always be checked out thoroughly by a medical professional. In the meantime, here’s a (non-exhaustive) recap on the other symptoms that, when accompanying brown vaginal discharge, mean brown discharge could be a sign of a more serious condition:

• Unpleasant odor
• Pelvic/lower abdominal pain
• Fatigue
• Nausea
• Pain during/after sex
• Bleeding after sex (especially as a regular occurrence)
• Itching/irritation
• Burning sensation when urinating
• Fever/chills/sweats
• Heavy/irregular/missed periods
• Breakthrough/abnormal bleeding
• Brown discharge after menopause

Greenleaf sums it up nicely. “I’d rather patients ask their healthcare practitioner about any concerns,” she says. “I would say the big factors that make one seek timely care is if the discharge is associated with any other symptoms such as fever, chills, sweats, odor or pain. I would also be concerned if it is not going away, and definitely if the consistency is more like stool or diarrhoea.”

“The body is miraculous and has many ways to communicate with us,” Greenleaf concludes. “Brown discharge could just be due to hormone changes; but listen to what your body, mind and gut is telling you – and if you have any questions, reach out to a healthcare provider.”