Mid-Cycle Spotting: Bleeding Before Period or During Ovulation

Learn About the Female Menstrual Cycle and What Types of Bleeding Are Normal

Whether you’ve always had regular menstrual cycles or never had a regular menstrual cycle in your life, the sudden appearance of mid-cycle spotting can be startling. Spotting is when a small amount of blood is passed, just enough to "spot" your underwear or toilet tissue.  The blood spots can be many different colors, from brown to red to pinkish, so don't be too concerned about the color of mid-cycle spotting.  Fortunately, mid-cycle spotting is usually nothing to worry about.  Here is some information to better understand mid-cycle spotting:

  • Changes in Hormonal Balance. All of the changes in a woman’s menstrual cycle are due to alterations in the progesterone/estrogen balance.  Changes in a woman’s hormonal balance are especially common in perimenopause.
  • Timing. If you have spotting that occurs around the time of ovulation (ten to fourteen days after the start of your last period), it is likely due to the increased estrogen in your system at this time. Spotting can also occur upon implantation of a fertilized egg into the uterine lining.  Spotting that occurs several days to one week before one's menstrual cycle can be due to low levels of progesterone, which while not a problem in and of itself, can cause infertility or early miscarriage in the event that one is trying to become pregnant. Spotting that shows up at other times in your cycle is more likely to be abnormal spotting.
  • Mittelschmerz. Mittelschmerz is German for "middle pain," and it is a word that describes the mid-cycle pain that can accompany ovulation.  You will experience mittelschmerz on one side of your lower abdomen around the time of ovulation, from 10-14 days after the first day of your last period.  If you experience mittelschmerz around the same time as spotting, you are almost certainly ovulating.   Mittelschmerz is nothing to worry about; I see it as a convenient way of knowing exactly where I am in my cycle.
  • Other Potential Influences. A woman's hormonal balance can also be affected by the following conditions:
    • Weight loss or gainAnorexia or bulimia
    • A change in diet (especially poor nutrition)
    • Excessive caffeine or alcohol consumption
    • Excessive exercise
    • Smoking or drug use
    • Stress (work-related, personal, environmental)
    • Illness
    • Childbirth, breastfeeding, miscarriage or dilation and curettage (D&C)
    • Cysts, polyps, endometriosis, fibroids or other reproductive system abnormalities
    • Perimenopause
    • Beginning or changing medications
    • Chemotherapy

    If any of these events have occurred in your recent history, chances are that your hormones are temporarily out of balance, and mid-cycle spotting is the result.

  • Cortisol. The effect of stress deserves special note.  Cortisol is released by our adrenal glands when we are under stress and cortisol directly affects estrogen, progesterone and DHEA.  If you are under a lot of stress, try to find ways to create a respite for yourself via yoga, meditation, exercise or whatever means you can.
  • Amount. Another way to assess spotting is to observe the amount.  Spotting is called "spotting" for a reason--the amount of blood does not begin to approach that of a menstrual cycle.  Abnormal spotting tends to last longer than run-of-the-mill spotting--for many days rather than a day or two.
  • The Pill. Spotting is common when a woman begins her first cycle of birth control pills or if pills are either missed or taken late.  Spotting usually improves by the end of the third cycle of birth control pills.  "Breakthrough bleeding," bleeding that is quite a bit heavier than spotting, may indicate that your pill does not have enough hormone for your particular system.  In this case, don't assume that your pill is providing birth control protection and be sure to follow up with your doctor.
  • Polycystic Ovarian Syndrome. Excessive spotting can sometimes be a symptom of Polycystic Ovarian Syndrome.  Between 5-10% of women of childbearing age suffer from Polycystic Ovarian Syndrome; you can learn more about it at Polycystic Ovarian Syndrome Association.

It is always a good idea to check out any changes in your menstrual cycle with your physician.  Spotting may be a symptom of some female reproductive cancers or sexually transmitted diseases.


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