I’m 32 and trying to conceive, and today blown away by aspects of my cycle I never noticed or that have changed over the last few years. One of those is mid-cycle bleeding, and it’s got me down the Google Rabbit Hole on a monthly basis, not least because I work overseas in the Horn of Africa where trusted gynecological healthcare is a bit of a challenge to find. For the last 6 months or so I’ve had dark red- and/or light pink- tinged cervical mucus between cycle days 15 to 20 (on a 32-day cycle) and am tearing my hair out over it. It’s startling and also confuses my ovulation calculations. Some sources say “Polyps! Fibroids! Hormones! Oh my!” while others say “this is a normal indicator of healthy ovulation.” I’m at a loss. What gives? Why does this happen and what does it (usually) mean? Some clarity would help me rise above the suffocating TTC message boards of the interwebs.
In most cases, this is considered normal. In fact, this kind of spotting is a sign of fertility when it happens only at ovulation and you’re not spotting at other times in your cycle as well. True ovulation spotting occurs only with ovulation, and usually lasts for around 1-3 days. It looks like fertile cervical fluid streaked with bright red, light red or pink. Estrogen rises significantly and then drops right before ovulation. This causes a mini estrogen-withdrawal and slight partial shedding of the uterine lining, because progesterone hasn’t had a chance to kick in (to keep the uterine lining in place). It’s more likely to occur in women with lower baseline estrogen, but I’ve also seen it in women with estrogen dominance. It’s considered to be perfectly normal and doesn’t need treatment. Interestingly, there is a study that suggests it occurs in women who have a higher estrogen and LH spike at ovulation time, and higher progesterone rise in the second half of the cycle. See figure 3 on the study page. Another scenario is that ovulation spotting is caused by the follicle rupturing as the egg is released into the fallopian tube. This would typically happen on the day of ovulation. If you notice the blood is brown in color, you should get your estradiol tested (the type of estrogen most prevalent in cycling women), and consider getting a full thyroid panel done as well (TSH, free T3, free T4, TPO and TGAB, along with reverse T3). Higher estrogen and low thyroid function (which often is a cause of low progesterone) is typically associated with brown blood spotting.
Nicole Jardim (@NicoleMJardim) aka “the period girl”, is a womxn’s health & functional nutrition coach on a mission to help #womxn around the world naturally fix their periods!
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