Ovulation is when your ovaries release an egg, which occurs in the middle of your menstrual cycle. Ovulation bleeding or spotting is a common experience for many women and often nothing to worry about. Spotting between periods can be indicative of issues outside normal ovulation. But how do you know? Let’s explore the various causes of spotting, what’s normal, what’s not, and when to seek medical attention.
What Causes Normal Ovulation Bleeding?
Spotting can occur just before, during, or just after ovulation. Ovulation happens in the middle of your menstrual cycle, approximately 11 to 21 days after the first day of your last period. During ovulation, your ovaries release a mature egg so it can be fertilized by male sperm. If the egg is not fertilized, it is shed during menstruation.
Every woman’s normal menstrual cycle varies, and each woman’s cycle can vary from month to month. Right before ovulation, estrogen levels rise in preparation for the egg being released. Once released, estrogen levels drop, and progesterone levels rise. As these hormones shift, light bleeding can occur for a day or two. It can vary in color from light pink (indicating the presence of cervical fluid) to bright red or dark brown, depending on the speed of the blood flow. This contrasts with regular menstrual bleeding, which requires the use of pads, tampons, or menstrual cups, lasts around five days, and occurs every 21 to 35 days, depending on your individual menstrual cycle.
Ovulation bleeding is much lighter than a period, happens between periods, and near or during ovulation. It’s normal that some women always spot, many others will only spot sometimes, and many never spot at all.
What If You’re Spotting Before Ovulation?
While some spotting before ovulation is normal, it can also indicate a problem. Spotting that occurs one or two weeks apart falls outside the normal ovulation window and is considered irregular. This irregular bleeding may be signs of:
- Polycystic Ovary Syndrome (PCOS): This syndrome occurs when numerous fluid-filled sacs develop on the ovaries due to unusually high levels of male sex hormones called androgens.
- Hyperprolactinemia: This condition involves the body producing excess prolactin, the hormone responsible for breast milk production, and can indicate the presence of a tumor, or pregnancy. Certain medications can also be responsible.
- Thyroid Issues: Your thyroid, which is controlled by the hypothalamus in your brain and the pituitary gland, makes two hormones that regulate how fast your heart beats and how many calories you burn. Sometimes the thyroid makes too little of the hormones, resulting in hypothyroidism. Too much of those hormones leads to hyperthyroidism. Both conditions can affect your heart rate, weight, mood, energy levels, and menstrual cycle. Left unregulated, thyroid issues can lead to serious health problems.
Spotting During Ovulation
Spotting during ovulation is often no cause for concern. Normal ovulation bleeding will last about a day or two and will be quite light, not requiring the use of pads, tampons, or menstrual cups. A drop in estrogen levels occurs, indicating the body is ready to ovulate. Signs you are ovulating include:
- An increase in cervical fluid, that resembles egg whites
- Changes in temperature: decreasing before ovulation and increasing after
- Increased heart rate
- Increased sex drive
- Pain or aching on one side of the abdomen
- Breast swelling and tenderness
- Increased sense of smell, taste, and vision
These are normal symptoms of ovulation and are no cause for concern.
Spotting After Ovulation
If you experience spotting after ovulation, you might be pregnant. Sometimes implantation bleeding occurs when a fertilized egg implants in the uterus, often 10 to 14 days after conception. This blood will be light pink or brown, with a light flow that lasts a few hours or days; and is of no danger to an embryo. Headaches and nausea, cramps, and fatigue may also occur. Taking a pregnancy test will make it clear if this is the reason for your bleeding.
Between-Period Bleeding: When to be Concerned
Many women experience bleeding between their menstrual periods, and there’s no reason to worry. But sometimes this bleeding is abnormal, indicative of an underlying health problem and should not be ignored.
We’ve already discussed PCOS, thyroid issues, hyperprolactinemia, and pregnancy. Here are some other health issues potentially causing your between-period bleeding:
- Ovarian cysts: Many ovarian cysts are asymptomatic and will go away on their own, but some can cause pain or even burst. Treatments for ovarian cysts include birth control pills and surgery.
- Perimenopause: If you’re over 40, you may be in perimenopause, the stage before menopause lasting two to 10 years, involving changes in the menstrual cycle, often accompanied by physical and emotional side effects for which relief can be sought. Treatments include hormone therapy, vaginal estrogen, antidepressants, and gabapentin.
- Ectopic pregnancy: Left untreated, this is a life-threatening condition where a fertilized egg implants somewhere outside the uterus, like in a fallopian tube or abdominal cavity. Treatments include medication and surgery.
- Infections: Sexually transmitted infections (STI) like chlamydia, gonorrhea, human papillomavirus (HPV), and pelvic inflammatory disease left untreated can cause infertility. Tests are available to determine if you have an STI.
- Reproductive cancers: There are five main gynecological cancers, including ovarian, cervical, uterine, vaginal, and vulvar. Women between the ages of 25 and 70 should have smear tests every three years to detect any precancers or cancers. Early detection is key. Treatments include surgery, chemotherapy, and radiation.
- Kidney or liver disease: These organs regulate waste production. Waste not properly removed from the body can lead to serious health issues, including death. A disruption in the menstrual cycle can be an early sign your kidneys and liver are not functioning adequately.
External reasons can be responsible for between-period bleeding, can be painful or dangerous, and might require attention. These include:
- Sexual or blunt force trauma to the pelvis can lead to long-term health consequences.
- Forgotten tampons can create a life-threatening buildup of bacteria known as toxic shock syndrome.
- Penetration of the vagina or cervix by a foreign object can cause serious damage and may require surgery.
Hormonal birth control and certain breast cancer treatments may also cause between-period bleeding and are not a reason for concern.
Care is Available Today
Most ovulation bleeding is normal, but when it isn’t, medical treatment should be sought. At American Family Care, we offer urgent care gynecology. Regular female physical exams are the best way to maintain your health. Our Well-Woman checks include a pelvic exam, pap immunizations, breast exam, a referral for a mammogram, as well as several other tests, and will give you a clear understanding of your health. Our medical staff is prepared to discuss birth control and hormone therapy, providing you options for family planning and feeling your best. AFC’s urgent care model is based around walk-ins, no appointment needed, we accept most major forms of insurance, and offer on-site lab testing. AFC gets you back home or to work as quickly as possible, with minimal stress and worry.
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