137. What Causes Mid-Cycle Bleeding and When Should You Be Concerned?

Have you ever noticed a bit of pink or brown spotting right in the middle of your cycle and wondered what it means? You are not alone. Mid-cycle spotting is one of the most common concerns we hear from women who are paying close attention to their bodies — and it deserves a thoughtful answer.

In this episode of Cycle Wisdom, Dr. Monica Minjeur walks you through exactly what mid-cycle spotting can mean — from the most common and completely benign ovulation bleed, to hormone imbalances, cervical changes, and structural causes that may need attention. Through the story of Jenna, a 28-year-old planning for pregnancy, you will see how careful charting and a thorough evaluation can turn confusion into clarity.

You will learn:

• Why a brief pink or brown bleed at ovulation is often a healthy hormone signal
• How estrogen and progesterone shifts can trigger spotting — and what to do about it
• What cervical ectropion is and why it may be behind bleeding you have been worried about

If you are struggling with irregular cycles, unexplained spotting, or fertility concerns, you do not have to navigate this alone. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 0:00

Before we get into the episode today, I want to make sure you know about our free discovery calls to work with our clinic. If you are interested in learning how the medical services charting instruction or coaching programs we provide would be a good fit for you, go to our website radiant clinic.com and click on the link that says book free discovery. Call one of our team members will get back to you and get all your questions answered about our process towards healing your cycles. And restoring fertility. If you still have more questions after that, my team can arrange for a time to talk directly with one of our team members and make sure all your questions are answered and that we are the right fit for you. If we're not the right fit, we'll let you know and help to give you some guidance as far as where your next best steps should be. We are looking forward to visiting more with you soon and learning how we can walk this journey together, and now onto the episode.

Speaker 2 1:01

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if that pink or brown bleeding right around ovulation isn't random, but a precise hormone clue? Today we're going to talk all about mid cycle spotting. When to discern if it's an ovulation bleed that is benign, when it can point to estrogen or progesterone imbalances or cervical issues, and most importantly, the exact cycle time steps to get answers without worrying. So let's start off as always with a patient story about Jenna. Now, Jenna came to us at 28 years old and she was not yet trying to conceive, but was planning to within the next year. However, she was a little bit worried because she noted that she was bleeding in the middle of her cycle all the time. She wondered if something was wrong and avoided intercourse during those fertile days. She started to notice a pattern light pink spotting for a day or two, right when her cervical mucus was the most fertile. A friend had told her this could be normal, but Jenna wanted to be sure. So she scheduled an appointment with us for a full evaluation. As we took a look at her charting, we revealed normal length cycles that were about 29 to 31 days. She did have a very clear and obvious ovulation cycle with clear stretchy peak type. And typically at least one, sometimes two days of pink spotting around cycle day 13 to 15. That was not associated with any pain or intercourse. She had a fairly good structure in her lifestyle as far as regular workouts, but she did have issues with sleeping not enough hours, only about six to six and a half on weeknights, and frequently noted that she was using caffeine in the afternoons to help keep her awake. Now anytime we have irregular bleeding, we always wanna make sure that we have done a complete evaluation with pelvic exam, ruling out infection, and oftentimes we also get an ultrasound. So Jenna's ultrasound showed that she had no problems with any fibroids or polyps. Her ovulation appeared to be normal, showing a dominant follicle at 19 millimeters and pelvic exam showed that she did have a cervical ectropion or aversion, and we'll talk more about that in a little bit, but it was easily bleeding when we took our culture samples with a Q-tip. We ruled out anything that was significantly problematic as far as any anatomic causes, checked her hormones and eventually gave her reassurance that her ovulation spotting was completely normal. We did find over time that once we treated her cervical ectropion, the bleeding actually significantly minimized and this further helped to provide reassurance to Jenna. So why can mid-cycle spotting happen? And again, as I mentioned with Jenna's case, there's lots of different reasons why the most common cause, though, is a completely benign situation of just some bleeding that happens at the time of ovulation. When you ovulate. There is a significant but very short window that your estrogen levels. Spike very quickly, and sometimes that estrogen rise when associated with the LH surge that causes the follicle to rupture can cause a painless and brief day of light pink or brown spotting right around the time of your ovulation. I have definitely seen this in some cases of some of my clients who do not have much fertile mucus at all, but they notice that a light bleed is actually the one sign that ovulation has occurred. Another cause that we may see mid-cycle spotting is the switch of estrogen dominance to progesterone. So progesterone typically will start to increase right after ovulation occurs. If the estrogen excess was prominent in the first place and the rise of progesterone lag a little bit, that shift can cause some problems with spotting. Now, this oftentimes will resolve once you have better overall cycle health and an adequate luteal phase. So again, important to assess and understand what's going on with these hormone changes as we go through each cycle. Cervical Ectropion is another common finding that we have, and as was mentioned in Jenna's case, cervical ectropion is just a normal situation that happens, but in many women, they have additional or increased glandular tissue on the outside part or the surface. Of their cervix itself. Oftentimes this is also accompanied by some increased blood vessels, and so many times women will notice that they have some bleeding or spotting that occurs if they have cervical ectropion. Now, this isn't always just related to the time of ovulation, but I oftentimes also find bleeding after intercourse. If you have a cervical ectropion. This can also be caused by other cervical issues like cervical polyps or infections, bacterial overgrowth, inflammation, yeast infections. We always wanna think about all of these factors that we talked about in episode number 1 34 when we discuss the microbiome, because again, infection, localized irritation can create additional bleeding, especially around those fertile days when you have more cervical mucus. Other reasons for having that mid-cycle spotting that are less common, but important to think about. Include things like uterine fibroids, chronic endometritis, which typically is not just mid-cycle bleeding, but bleeding at other times. And then also in our patients that are going through perimenopause, so that. 10 year timeframe leading up to menopause. There can be some significant estrogen variability and fluctuations. And so these are all things to consider when you have any mid cycle spotting. So again, most commonly it's going to be that benign ovulation bleed, but we always want to confirm that nothing else problematic is going on. So things that would trigger me to want to have additional evaluation is if your spotting is lasting more than two days. That can be concerning if you have actual, moderate, or heavy spotting or an actual menstrual flow around the time of ovulation, if you have pain associated with it or if it is recurrent, especially associated with any odor or irritation. If you have any issues as far as bleeding that is consistently happening after intercourse, not just during that ovulation window. All of these things require targeted evaluation to discern what is the underlying cause, because in many cases, that underlying cause can treated, corrected, and fixed, so you no longer have that concern as far as the mid-cycle bleeding. So again, the evaluation is going to be looking at charting your cycles, noting the exact day and amount of bleeding that you may be having, and then using that information in order to have a focused exam, focused testing, and to consider additional higher level testing like an ultrasound or chronic endometritis evaluation if necessary. So what do we do for treatment? Again, the treatment path is going to match the underlying reason. So again, for most women, it's going to be normal ovulation spotting, and so we just provide reassurance that this can be a normal variant. We optimize basics of lifestyle, like seven to eight hours of sleep a night, a protein, heavy breakfast, hydration, avoiding any internal washes or scented products altogether. If we find that there is a cervical contribution to this, so especially if we find that you have something like cervical ectropion or that inflammation where you have more of the glandular tissue or blood vessels present on the surface of the cervix, we don't always have to treat, but in some cases, we will treat with some topical silver nitrate. This creates an artificial barrier, almost like a gentle. Scab that helps to heal that area and can help to stop any of the bleeding from those small blood vessels. We oftentimes will treat with this if the bleeding is disruptive, persistent, or if you're unable to discern a specific fertile window, because it is oftentimes also accompanied by excessive or continuous, or in some cases, daily and persistent cervical mucus. If there are any issues with infection, we would always treat that if there is an imbalance of hormones, we focus on stabilizing your luteal phase, helping to promote an optimal ovulation, and if there are any anatomic causes like polyps or fibroids, we're oftentimes referring to a surgeon or a gynecologist for removal of those polyps or fibroids because they can also cause additional issues with fertility. Or persistent blood loss if they're hanging out over time. So some of the common questions we get asked in regards to mid-cycle spotting. First and foremost, is mid-cycle spotting dangerous? Again, typically not especially if it's light and brief, but if it's persistent, especially if it's accompanied by any pain or any concerns for infection or fertility concerns, we always recommend getting it checked out to discern if there is anything else that is causing those problems. Am I still able to conceive even if I'm spotting during ovulation? Yes. Many patients do still spot during ovulation and they can still conceive as long as it is brief spotting and painless. It generally does not negatively impact your chance of successful pregnancy on any given cycle. So how do I know? If my bleeding happens, if it's not implantation bleeding. So implantation bleeding, if it happens, is typically around six to 10 days after ovulation, not at the time of your LH surge or after your temperature shift. So this is why it's so important, why we talk to women all the time about the importance of charting your cycles to understand when am I ovulating? When is my fertile window? Because if you don't know when you've ovulated the bleeding that happens randomly in the middle of your cycle could be during the time of ovulation or it could be implantation bleeding. So it's so critical to understand when are you ovulating to help us know what was the bleeding associated with and what do we expect to see? That is normal. Another common question we get asked is, could my bleeding be from endometriosis? Now, typically endometriosis is going to cause cycle related plane and bleeding changes during the menstrual cycle, but simple, brief, mid-cycle spotting, especially if it's only one or two days. Typically it's going to be more related to ovulation or the cervix, and in some cases the endometrial lining. So the internal part of the uterus, not the external uterus, which is where endometriosis is present outside of the uterus. So it can be anywhere in the pelvis, it can be anywhere in any of the other organs, throughout your abdomen and pelvis and even beyond that. But typically endometriosis, if it is just that mid cycle spotting, that's not going to be one of the high risk factors that we see with a single day of spotting. And then probably the most important question or concern that I get from patients is asking, do I need hormones? If I'm having mid cycle spotting? And again, typically not if it's a benign variant. However, there are cases where we find that ovulation dysfunction is also present. And you may need hormones for another reason. Again, we typically don't just treat with hormones in order to eliminate that mid cycle spotting, but oftentimes there are concurrent or multiple other things that could be going on that may be playing a role when it comes to your exact cycles. So what can you do right now this month if you notice mid cycle spotting. So first of all, start charting your cycles. If you're not already doing so, make sure that you're able to clearly identify ovulation fertile window and then note any days of bleeding or spotting that you have if you have not already done so. I would recommend working with a trained fertility charting instructor because they are able to help you identify the nuances, not only of bleeding. But of ovulation, fertile window, and especially if you're trying to conceive all of those pieces are so important to understand. Another thing you could try is really focusing on that sleep rest cycle, so making sure you're getting at least seven to eight hours of sleep per night, avoiding any caffeine afternoon, and really focusing on getting that good quality sleep back because that can help with your hormone balance as well. Focus on strength training twice a week or three times a week if possible, but avoiding high intensity workouts, especially around the time of ovulation because this can add extra stress to your body, which can then also lead to increased bleeding. If your spotting is recurrent or you've never had an ultrasound done, as I mentioned, we oftentimes will also check an ultrasound mid cycle to look and see what's going on with your follicle or kind of that shell that develops around the egg, as well as to look at the lining of the uterus, make sure there's not anything else concerning that could be going. And certainly always making sure to follow up over the course of a couple of cycles if you have gotten any sort of treatment to make sure that that treatment has worked or to see might I need to adjust my treatment to further improve that mid-cycle spotting. Imagine if mid-cycle spotting shifted from a scary mystery. To a clear explainable pattern because you were tracking your cycles precisely. You had ruled out any cervical or anatomic causes, and you were supporting the handoff of estrogen to progesterone to an optimal level for your hormones. Over the course of a few months, intimacy can feel easier to time. Your charts can be more clear and your confidence can return to improve your health and promote fertility.

Speaker 3 15:36

If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.