MID -CYCLE SPOTTING: WHEN SHOULD I WORRY?

By Dr. Kemi Ailoje

MID -CYCLE SPOTTING: WHEN SHOULD I WORRY?
You know it is not time for another period yet, but after a swipe at the loo you notice a spot of light pink or red blood around about middle of the menstrual cycle, it may be mid-cycle spotting.

What is mid-cycle spotting?
Mid-cycle spotting is bleeding that occurs outside of your menstrual cycle. It is also known as mid-cycle bleeding, abnormal uterine bleeding, intermenstrual bleeding, or metrorrhagia. The color of the blood may help to give a clue to help determine if it is mid-cycle spotting or a sign of an irregular period.

Menstrual period bleed will usually be bright to dark red, heavier than just light spotting, lasting for a few days ranging from three to seven days in most women of reproductive age while blood from the more common causes of mid-cycle spotting will be small in quantity, light pink or red, or even dark brown, with spotting lasting for as short as a few hours to one day.

WHEN DOES MID- CYCLE SPOTTING OCCUR?
It occurs when the follicle bursts open and releases the egg. Right before the mature egg is released, estrogen levels drop, which can cause the endometrium to shed and result in light spotting.

SPOTTING JUST BEFORE OVULATION
Spotting during ovulation lasts about a day or two. The drop in estrogen that signals a woman’s body to ovulate may result in ovulation spotting. It is estimated that about 5% of women experience mid-cycle spotting right in the middle of their menstrual cycles occurring during ovulation, a time when the body undergoes rapid, complex hormonal changes. For these women, ovulation spotting is generally of little cause of concern. Blood is typically pink or light red. Bleeding is light and lasts only a day or two. Some women who regularly spot during ovulation use this as an indicator to either become or avoid getting pregnant. Ovulation may also be accompanied by mild bloating or abdominal cramps.

SPOTTING AFTER OVULATION
Spotting after ovulation may indicate “implant bleeding”. This is when a fertilized egg implants and attaches to the lining in the uterus. Implantation bleeding may occur around the time mensural cycle is expected to start, but there are a couple of noticeable differences. Unlike regular period, blood clots or tissue will not be seen in the spotting.

This type of light spotting occurs after conception, usually a few days before the next scheduled period. Instead of the bright red of menstrual blood, this blood will be light pink or even dark brown. Also, implant bleeding is usually pinkish or light brown in color. Up to a third of women experience this symptom of early pregnancy. It is common and doesn’t pose a danger to the developing embryo.

Other common causes of mid-cycle spotting include:
Hormonal imbalances
The menstrual cycle is regulated by a complex network of hormones. This is known as the hypothalamic-pituitary-ovarian (HPO) axis. Any disruption to your HPO caused by medical conditions such as Endometriosis, Polycystic ovary syndrome (PCOS),Thyroid disorder, Luteal phase defects, Uterine fibroids ,Ovarian cysts may trigger mid-cycle spotting.

Endometriosis
Endometriosis is a disorder in which the tissue (endometrium) that lines the uterus is found growing elsewhere, endometriosis usually can cause pelvic pain associated with menstrual period, painful period, mid cycle spotting.

Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome is a condition that affects mostly women of reproductive age, women who are polycystic have more male hormones (androgen) and a polycystic ovary can cause mid cycle spotting, irregularities in menstrual cycle, developing follicles which refuse to release eggs.

Thyroid disorder
Thyroid hormone stores and produces hormone that affect the function of virtually all the organ in the body. When there is a disorder in the thyroid function whether high thyroid hormone or low thyroid hormone, disturbances in menstrual cycle is expected either irregular period, spotting mid cycle or even having a prolonged menstrual flow.

Luteal Phase defect
Luteal phase defect occurs when a person menstruates less than ten days after ovulation, this can result into low progesterone level which could lead to menstruating a lot sooner than expected.

Tumors in the Reproductive System
Tumors whether benign or malignant can cause make the hormones to be unstable, which can result into bleeding when you are less expecting your menstrual flow

Fibroids/Polyps
Benign growths that form in the uterus such as Uterine fibroid and polyps are more likely to cause irregular bleeding if they grow into the uterine lining or on the cervix.

Ovarian Cyst Rupture
If you experience a sharp pain on either side of your lower abdomen, followed by slight bleeding around the time you should be ovulating, if you have excruciating pain, nausea, vomiting, or bleeding from the vagina during any point in your cycle, you may have a ruptured ovarian cyst

Anovulation
Bleeding during ovulation is not an unusual thing as some may even experience light spotting during ovulation but when cycle is anovulatory it may trigger bleeding before menstruation because this is as a result of hormonal imbalance. A way to confirm if one’s cycle is anovulatory is to do ultrasound scan, check the basal body temperature every morning and if there is no increase in temperature and no dry, sticky cervical mucus then one may be said to have anovulatory cycle.………..TO BE CONTINUED NEXT WEEK