Mid-cycle Spotting: What you can do about bleeding between periods…

Mid-cycle spotting Causes & what you can do

6 May 2021 Update: women have been reporting that they are having spotting after getting a Covid vaccine. If this is the case for you, you can report this to the Medicine Board or Medicine Regulating Authority in your country as this can only be verified as a side effect if they collect enough data.
Are you having to wear a panty liner every day because you spot between periods? Mid cycle bleeding can be annoying and at worse worrying. Read on to help unravel the mystery of mid cycle spotting and understand what could be happening and what you can do.

What is Mid-Cycle Spotting?

Mid-Cycle Spotting is bleeding between periods (spotting between periods) and can be referred to as Mid-Cycle Bleeding, Breakthrough Bleeding or Abnormal Uterine Bleeding. The bleeding does not have to be exactly in the middle of your menstrual cycle to fall under this category of mid-cycle bleeding.
You can have spotting a week after your period, but it can happen any time after your period stops, just after ovulation or even the time after ovulation up until the time full flow of your next period starts. Knowing when in your cycle the bleeding occurs helps to determine the possible causes which then leads to what you can do about it.

So, the first thing to do is to determine when in your cycle the bleeding happens:
It can be quite unsettling to see blood well after your period has ended and/or well before it is due to start. The bleeding/spotting can be light bleeding between periods or heavy bleeding between periods. Mid cycle bleeding can be any colour from brown spotting to bright red spotting. You should always consult your doctor to be on the safe side and rule out anything sinister. Usually though mid-cycle bleeding is not due to something sinister and can be rectified. Mid-Cycle Spotting is a very common complaint & area of concern that we see in our Fertility Acupuncture Clinic. The reasons for spotting are varied:

Causes of Mid-Cycle Spotting

What can cause bleeding between periods?

⦁ Menopause / peri menopause-As we age our hormone production diminishes which affects ovulation and our reproductive cycle. Menstruation is governed by the ebb and flow of reproductive hormones such as Oestrogen, FSH (Follicle Stimulating Hormone), LH (Luteinising Hormone), AMH & Progesterone. When these hormones wane, the menstrual cycle changes: The cycle length can get shorter or longer and eventually it stops. Symptoms like mid-cycle spotting, insomnia and hot flashes may occur. Day 3 Blood Tests and Day 21 Bloods Tests can determine your hormone levels and if you are starting to enter menopause / peri menopause. Hormone levels usually start to change at around age 40, but some women may experience early onset menopause.
⦁ Implantation Bleeding-this is when conception has happened and an embryo implants into the lining of your womb and bit of the lining comes away as it embeds into your lining (note that this implantation bleeding does not happen every time a woman gets pregnant). This can be bright red spotting.
⦁ Low Progesterone– When your level of progesterone falls in the normal course of your menstrual cycle, this triggers your menstrual bleed to begin. If your progesterone dips too soon you may experience mid-cycle bleeding. There are different reasons for spotting due to your progesterone level being low or falling prematurely. You can get a progesterone level blood test, usually referred to as Day 21 Bloods, but having the test performed on day 21 may not be an accurate reflection of the information you need, click through to the Day 21 Bloods link to discover why. It is best to talk to your doctor about this and let them know what day in your cycle you are ovulating or whether you don’t even know if you are ovulating, so you and your doctor can determine the best day to test your progesterone level.
⦁ Fibroids-these are (non-cancerous) growths of the uterus (uterine fibroids). There can be one or more in number present and they can range in size from tiny, almost undetectable to so large that they can distort the shape of the uterus. They can located on the inside of the uterus or on the outside. In addition to bleeding between periods, uterine fibroids can cause the feeling of pelvic pressure, discomfort & pain, heavy menstrual bleeding, constipation & painful urination. If they are large enough you can feel them if you press around the area of your uterus. Getting a pelvic ultrasound or a vaginal ultrasound can confirm if you have them, how many, the location and what size the fibroids are. They can be removed surgically if necessary.
⦁ Endometriosis-Women with endometriosis sometimes report mid-cycle spotting. With Endometriosis there is an excess of endometrial tissue lining that builds up in the womb & some of the lining may slough off mid-cycle & cause spotting. Other symptoms of endometriosis are painful periods, very heavy menstrual flow, clots in the menstrual flow (note that not every woman with endometriosis has these symptoms).
⦁ Polycystic Ovary Syndrome (PCOS) -this is when there is a hormonal imbalance due to elevated levels of Androgen hormones (these are often referred to as “male hormones” even though it is normal for women to have androgens as well, just not as high a level as with PCOS). Some, but not all, women’s ovaries form small cysts on the surface area (the cysts are not harmful). Other symptoms of PCOS include acne, facial hair, being overweight & a long time between periods. The period can be very light and thus mislead you to think it is not your period at all, but just light spotting between periods.
⦁ Hormonal Imbalance-There is a sequence & balance of hormones released throughout the menstrual cycle that regulates your fertility. This is called the hypothalamic-pituitary-ovarian (HPO) axis. The many & varied reproductive hormones regulate everything from growing the womb lining & maturing eggs in your follicles to sparking ovulation & the implantation of an embryo. Any type of disruption in this system may trigger mid-cycle spotting. Stress & other factors may disrupt the delicate balance of reproductive hormones in your body. Day 3 Blood tests can help determine if some of your reproductive hormones are at normal levels (Note: This test can also be performed on Day 2 or 4 as well, so sometimes it can also be referred to as “Day 2 Bloods” or “Day 4 Bloods”, but they are all the same hormone test, looking for the same thing). Also, a dip in the hormone progesterone after ovulation can cause spotting & be a factor contributing to embryo implantation failure.
⦁ Ovulation spotting-Sometimes mid-cycle spotting happens just after ovulation has occurred. The Ovulation bleeding theory is that the bleeding is due to an early drop in oestrogen just prior to ovulation, which means that there is a bit of lag time before progesterone levels rise. As a result, a small amount of the womb lining may shed.
⦁ Failure to Ovulate-When mid-cycle bleeding occurs in a cycle where there is no ovulation, the bleeding is due to a withdrawal of estrogen. Low estrogen levels means that a surge of LH doesn’t happen (LH triggers ovulation), thus ovulation does not happen. When ovulation does not occur then progesterone cannot be secreted because progesterone is secreted from a follicle that has ovulated. It is this progesterone that is secreted after ovulation for two weeks that keeps your period at bay. When no pregnancy occurs in the 2 weeks following ovulation then the levels of progesterone drop, thus signaling your body that you should get your period & start the menstrual cycle all over again. So, as a result of not ovulating, a lighter or shorter period may be experienced sooner than your period is due, which may appear as spotting mid-cycle. Basal Body Temperature charting (BBT) is one way that can help you determine if you are ovulating.
⦁ Rupture of an Ovarian Cyst-Symptoms of a ruptured ovarian cyst usually occur around the time that ovulation should happen. Symptoms are: a sharp pain on either side of your lower abdomen &/or slight bleeding around the time ovulation. You should see a doctor immediately if you experience excruciating pain, nausea, vomiting and/or bleeding during any point in your cycle.
⦁ Sexual Intercourse-Around the time of ovulation, the cervix becomes more sensitive. Sexual intercourse may cause some slight damage to the cervix, producing light bleeding as a result. Experiencing mucous tinged with bright red blood after sexual intercourse around the time of ovulation is common enough as well.
⦁ Abnormalities of the Cervix-The first thing to note here is that cervical abnormalities are rare. Cervical conditions such as HPV or cervical fibroids may cause some slight bleeding mid-cycle. Mid-cycle bleeding that is accompanied by pain in the cervical region, should be investigated by your doctor. Again, very rarely, abnormalities of the cervix may be cancerous & you want to err on the side of caution to rule that out if you are experiencing pain in the cervical region.

There are plenty of cures and remedies for some of the the above listed conditions. Some your doctor can help with and some you can find help from other health practitioners such as Nutritionists, Acupuncturists or Herbalists, we always advise you to consult your doctor for advice.

What to do about Mid-Cycle Spotting -Take Action

1. Keep track of when the Mid-Cycle Spotting happens. There are a lot of great APPS out there that can help you keep track of your menstrual cycle. The Clue APP is very popular, but it seems you have to pay for that one now. I also like (& personally use) the free version of Period Tracker Lite APP & the free Pink Pad APP. Keep notes of what days in your cycle the spotting occurs. Note the colour (is it bright red spotting, dark red, brown spotting, pink, etc.), the amount of bleeding. Is there any pain at the same time the bleeding occurs? Pay attention & write down any other symptoms that coincide with the bleeding so you can take this information to your Doctor or Acupuncturist. Period Tracking APPS Article
2. Consult your doctor. Always consult your doctor for medical advice. If you notice irregular bleeding in your menstrual cycle you should consult your doctor to help determine the cause. You should at least have blood tests for your various reproductive hormone levels performed such as Day 3 Bloods & for your progesterone levels. You might possibly need scans of your uterus & ovaries as well. If your doctor can determine the possible cause,then consider any medical options suggested by your doctor. If you need a quick refresher to understand your menstrual cycle better, read the Article Menstrual Cycle Explained.
3. Take action:
   1. Get Acupuncture. Mid-cycle bleeding is the most common question we get asked about & Acupuncture is great at rectifying it, especially when doctor’s don’t have a diagnosis or a cure.
   2. Herbal therapy also yields great results as well.
   3. Try Progesterone creams.
   4. Another effective therapy is Abdominal massage (click here for a worldwide directory of Maya Abdominal Massage therapists).
4. Educate yourself, there are many natural cures. Recommended reading for:
   1. PCOS: “8 Steps to Reverse Your PCOS”, by Dr. Fiona McCulloch.
   2. ENDOMETRIOSIS: “The Doctor Will See You Now: Recognising and Treating Endometriosis”, by Tamer Seckin.
   3. FIBROIDS: “Healing Fibroids: A Doctor’s Cure”.