Share This Article
Key Takeaways
- Most cases of black period blood are caused by oxidation — blood that’s spent more time in the uterus or vagina before exiting darkens from red to brown to black. This is most common at the start or end of a period and is typically completely normal.
- Black blood becomes a medical concern when it’s paired with foul odor, fever, severe pelvic pain, heavy bleeding, or when you’ve had a tampon in longer than recommended — retained foreign objects can cause life-threatening infections.
- Persistent black blood that doesn’t fit the start-or-end-of-period pattern, or appears alongside cycle irregularities, warrants a healthcare provider visit to rule out fibroids, polyps, endometriosis, or other conditions.
If you’re wondering why your period blood is black, take a breath — most of the time, this is completely normal. Blood oxidizes as it sits in the uterus or vagina before exiting, progressively darkening from bright red to dark red to brown to black. Black period blood is simply older blood that’s taken longer to leave the body, which most commonly happens at the very start or end of a period, on slow-flow days, or after sitting overnight.
That said, a small percentage of cases warrant medical attention — a retained tampon, an early miscarriage during pregnancy, or persistent patterns paired with pain or odor. This article walks through the 10 most common causes of black period blood, ordered from most common and benign to less common and more concerning.
What Causes Black Period Blood?
The 10 causes below are listed from most common (and benign) to less common (and more concerning). Most women noticing black period blood will find their answer in the first few causes — and most of those answers are reassuring.
1. Oxidized Old Blood (Most Common Cause — Normal)
Status: NORMAL.
Mechanism: blood that takes longer to exit the body oxidizes (loses oxygen) and progressively darkens from bright red to dark red to brown to black.
Typical pattern: small amounts of black blood mixed with brown or dark red, often on slow-flow days. The longer blood remains in the uterus or vagina before exiting, the more time it has to oxidize. This is the most common cause of black period blood and is completely normal.
2. Stagnant Blood From Overnight Pooling (Normal)
Status: NORMAL.
Mechanism: blood that’s pooled in the vagina overnight (especially when sleeping on your back or side) has more time to oxidize before exiting in the morning.
Typical pattern: the first pad or tampon of the morning shows darker (often black) blood, then transitions to red as flow normalizes throughout the day. This is a normal pattern that resolves within a few hours of waking.
3. End-of-Period Blood as Flow Tapers (Normal)
Status: NORMAL.
Mechanism: as the period flow tapers off, the remaining blood exits slowly, giving it more time to oxidize.
Typical pattern: black or dark brown spotting in the last 1 to 2 days of a period. Completely normal — most women experience darker blood at the tail end of their period. If you’re tracking the pattern alongside your cycle, luteal phase discharge covers what’s typical in the days leading up to and through menstruation.
4. Start-of-Period Blood Before Flow Establishes (Normal)
Status: NORMAL.
Mechanism: the very first hours of a period sometimes produce small amounts of older blood that’s been retained in the uterus, appearing as dark brown or black before the lighter red flow establishes.
Typical pattern: a small amount of black or brown blood in the first hours, transitioning to typical red flow within 24 hours. If you’re tracking imminent period signs, signs your period is coming tomorrow covers what to expect in the final 24 to 48 hours before menstruation begins.
5. Hormonal Birth Control Adjustments (Usually Benign)
Status: USUALLY BENIGN — discuss with provider if persistent.
Mechanism: hormonal contraceptives (pills, IUDs, implants, injections) often cause changes in flow patterns, including breakthrough bleeding and dark blood as the body adjusts.
Typical pattern: usually appears in the first 3 months of starting or changing hormonal contraceptives. If black blood persists beyond 3 months on the same contraceptive, talk to your healthcare provider about whether the method is right for you.
6. Cervical or Uterine Polyps (Benign Growths — Worth Checking)
Status: WORTH CHECKING.
Mechanism: polyps are benign growths on the cervix or uterine lining that can disrupt normal flow patterns and cause irregular bleeding, including dark or black blood.
Typical pattern: black blood appearing outside the expected period window, post-coital bleeding, or unusually long periods. Any persistent irregular bleeding warrants a healthcare provider visit. The article on spotting vs period covers how to distinguish unexpected bleeding from a normal period.
7. Fibroids (Common — Worth Checking)
Status: WORTH CHECKING.
Mechanism: fibroids are benign uterine growths that can cause heavy periods, prolonged bleeding, and darker blood from retained/older blood. Up to 80% of women develop fibroids by age 50.
Typical pattern: heavy periods, periods lasting longer than 7 days, large clots, dark or black blood mixed with red, and pelvic pressure. Any combination of these symptoms warrants medical evaluation. For more on heavy or unusual bleeding patterns, see types of abnormal menstruation. Premium fertility and hormone monitoring tools can also support tracking patterns alongside your provider’s evaluation.
8. Endometriosis (Worth Checking)
Status: WORTH CHECKING.
Mechanism: endometriosis is a condition where uterine-like tissue grows outside the uterus, often causing painful, irregular periods and dark or black blood. It affects approximately 10% of women of reproductive age.
Typical pattern: severe pelvic pain, painful periods, dark or black blood, irregular cycles, sometimes bleeding between periods. Severe period pain that interferes with daily life warrants medical evaluation.
9. Retained Foreign Object / Forgotten Tampon (Urgent)
Status: URGENT — seek medical attention immediately.
Mechanism: a forgotten tampon, lost contraceptive ring, or other retained object can cause black, foul-smelling discharge or bleeding within 24 to 48 hours.
Typical pattern: black or very dark blood with a foul odor, often paired with itching, discomfort, or pain. A retained tampon can lead to toxic shock syndrome (TSS) — a life-threatening infection. Seek immediate medical attention if you suspect a retained object, especially if accompanied by fever, vomiting, or rash.
10. Early Miscarriage (Urgent for Pregnant Women)
Status: URGENT — seek medical attention immediately.
Mechanism: in early pregnancy, dark brown or black bleeding can sometimes signal a miscarriage or other pregnancy complication.
Typical pattern: black or brown blood during a known or suspected pregnancy, often paired with cramping, tissue passing, or sharp pain. Any bleeding during pregnancy warrants same-day medical evaluation. The article on implantation bleeding vs period covers the differences for women trying to conceive.
What Does Period Blood Color Actually Mean?
Period blood color reflects how long the blood has been in the uterus or vagina before exiting — nothing more, nothing less. The spectrum runs predictably:
- Bright red: fresh, fast-flowing blood (typical of peak flow days).
- Dark red: slightly older blood (typical of mid-to-late period).
- Brown: older, oxidized blood (typical of start or end of period).
- Black: oldest, most oxidized blood (typical of very start or end of period, or slow-flow days).
None of these colors alone signals a problem. The combination with other symptoms (odor, pain, irregular timing, heaviness) is what matters. For broader context on the full menstrual cycle and what influences flow patterns, a reputable medical authority is a useful reference.
How Can Cycle Tracking Help You Understand Your Flow?
If you’re seeing black blood and unsure whether it fits a normal pattern, tracking your cycle for 2 to 3 months gives your healthcare provider concrete data. Note your cycle start date, flow color day by day, and any accompanying symptoms (pain, bloating, mood). A cycle-tracking app or the womeninbalance period calculator makes this straightforward.
After 2 to 3 cycles, patterns become clear: is the black blood always at the start? At the end? Or unpredictable? That answer tells you (and your provider) whether you’re seeing the normal oxidation pattern or something worth investigating further.
What Should You Do About Black Period Blood?
Black period blood is usually normal — it’s typically older blood that’s had more time to oxidize before exiting. The most common scenarios (start of period, end of period, overnight pooling, slow-flow days) need no medical intervention. Track your cycle for 2 to 3 months, note when the black blood appears in relation to your flow, and bring that data to your next appointment.
The patterns that warrant medical attention: persistent black blood outside the start/end pattern, foul odor, severe pain, fever, or any black bleeding during pregnancy. If you have any urgent symptoms — fever, foul odor, severe pain, or suspect a retained tampon — call your healthcare provider today.
Frequently Asked Questions
Is black period blood normal?
In most cases, yes. Black period blood is typically older blood that’s oxidized before exiting the body, most commonly at the very start or end of a period, on slow-flow days, or after pooling overnight. It becomes a concern when paired with foul odor, severe pain, fever, or known/suspected pregnancy.
Can black period blood mean pregnancy?
Black or brown bleeding during a known or suspected pregnancy can sometimes signal an early miscarriage and warrants same-day medical evaluation. Outside of pregnancy, black blood is not a pregnancy indicator — it simply reflects older, oxidized blood.
Should I see a doctor about black period blood?
See a doctor if the black blood is paired with foul odor, severe pelvic pain, fever, or known/suspected pregnancy, or if you’ve had a tampon in longer than recommended. Also see a provider if the pattern persists beyond a single cycle without a clear cause.
