(Midcycle Bleeding, Spotting)
Ovulation bleeding or midcycle spotting is a term used to describe mild bleeding or spotting that occurs at around the time of ovulation. In most cases, this bleeding occurs approximately 14 to 16 days after the last menses in a normal 28 day cycle.
Many women who complain of irregular periods may actually have episodes of ovulation bleeding interspersed with normal periods.
Spotting that occurs just before the periods is usually due to a fall in the level of progesterone in the blood. This may be quite normal and does not necessarily need treatment. But bleeding that occurs at other times in the menstrual cycle can be abnormal and needs to be investigated.
Causes of Midcycle Bleeding
Ovulation:Ovulation bleeding is the commonest cause of midcycle bleeding. It occurs approximately 14 - 16 days after the last menstrual period.
Ovulation bleeding usually lasts for only 2-3 hours and may be so slight as to cause only a brownish discharge that stains the underclothes. Occasionally it may last for 1 to 2 days but even then only a brown discharge with a few spots of red may be seen. Heavy bleeding is rare. A little blood tinging the profuse clear egg-white mucus secreted at this time is more common.
Sometimes ovulation bleeding may be accompanied by pain on one or other side of the lower abdomen. It depends on the site of ovulation - on which ovary is expelling the ovum on that cycle. This pain , also called 'ovulation pain' or 'mittelschmerz', lasts for about 12 - 24 hours. It increases on any movement, even during walking.
Causes of Ovulation Bleeding
- The bleeding may be a result of temporary withdrawal of estrogen at the time of ovulation. This causes the endometrium to shrink a little and cause bleeding. It is more common when the pelvic organs are congested with blood.
- Some researchers believe that the bleeding may come from the cervix, the glands of which also proliferate in the oestrogenic phase.
- Another view is that the bleeding may come from the ovary at the time of ovulation.
Oral Contraceptives:Oral contraceptives may cause withdrawal bleeding in the middle of the cycle similar to that of ovulation bleeding. This is due to the fact that many oral contraceptive pills are prepared so that the hormonal levels imitate the fluctuations of the normal hormonal levels. So, there may be a decreasing level of estrogen in the middle of the cycle causing withdrawal bleeding.
Midcycle bleeding is more common in the first few months after starting oral contraceptives and if the pills are not taken at the same time each day.
- threatened abortion if the woman is not aware that she is in early pregnancy.
If pregnancy occurs, a woman may confuse implantation bleeding with her period and may not realise that she is pregnant. In this case, if abortion starts with bleeding and pain in the abdomen, she may believe that she is actually going through ovulation bleeding.
- IUCDs are more likely to cause irregular bleeding throughout the cycle rather than a single episode of midcycle bleeding.
Other Hormones:A low thyroid hormone or a a high insulin level may cause irregular bleeding durng the periods by interfering with the normal hormonal levels of estrogen and progesterone.
Other Conditions:Conditions like cervical polyps, infection of the cervix, vagina or uterus, ovarian cysts, cervical erosion, stress, foreign body in the vagina like a tampon, tumors and cancers etc. cause irregular bleeding throughout the cycle.
But sometimes one or the other may cause bleeding in the middle of the cycle and this may be confused with ovulation bleeding.
These conditions are usually benign and easily treatable, but abortion needs early treatment.
Treatment : Treatment is as per the cause.
If there is no infection, tumors, IUCDs or other causes of the midcycle bleeding, assurance and an explanation of the phenomenon of ovulation bleeding is all that is necessary.
But if the woman finds the bleeding very uncomfortable, a minimal dose of oestrogen or progesterone may be prescribed for 2-3 days at the time.