MID -CYCLE SPOTTING: WHEN SHOULD I WORRY? Part 2

By Dr. Kemi Ailoje

Last week we started the discussion on common causes of mid cycle spotting, this week we will be concluding on causes and management.

Other common causes of mid-cycle spotting include

Sexual intercourse

The cervix becomes more sensitive around the time of ovulation because it is preparing for pregnancy. Sexual intercourse at this time may cause some slight bruises to the cervix producing light bright red blood-tinged mucus.

Much more rarely, post-sex spotting may be a sign of cervical cancer. A sample of cells from cervix; the opening of the uterus, should be taken to test for STIs and abnormal precancerous or cancerous cells. A Pap smear, also called a Pap test, is a screening procedure for cervical cancer.

Sexually Transmitted Infections

In some rare cases, bleeding after intercourse can also signal a sexually-transmitted infection (STI), such as chlamydia or gonorrhea. Untreated STIs can also lead to pelvic inflammatory disease (PID), which is another cause of mid-cycle spotting. It is advisable to do STI testing to rule out this possibility. Pelvic Inflammatory Disease (PID): Pelvic inflammatory disease (PID) causes inflammation or infection of the uterus, fallopian tubes, or ovaries, which can cause abnormal bleeding.

Birth Control Methods

Use of Hormonal Contraceptive: Women taking hormonal contraceptives may be more likely to experience bleeding if they miss a pill, take one at a different time or switch to a new medication. Recently inserted Intrauterine Device (IUD): Some IUD such as Mirena IUD contains progesterone like hormone called levonorgestrel. This hormone has the effect of preventing pregnancy and reduces the heaviness of period and may cause mid-cycle bleeding/ spotting in some women.

Lifestyle

Excessive exercise: Regular exercise may cause changes in the hormone levels which in turn affects the buildup and shedding of the uterine lining. The body may respond to these mixed hormonal signals by randomly shedding. This is known as ‘breakthrough bleeding’. This is however not a common cause.

Poor nutrition: High fiber diets, excessive alcohol consumption, diets too low in fats and unbalanced diets can affect the production and normal functioning of hormones, thus cause irregular menstrual bleeding. Excessive exercise or a very poor diet lacking in necessary nutrients dietary disorders may be the reason some women experience mid-cycle spotting

Abnormalities of the Reproductive Tract

Abnormal growths such as polyps and cysts, infections, inflammations can cause the cervix to bleed.

Cervical fibroids and entropion can also lead to mid-cycle bleeding

The cervix is fragile and can bleed very easily. This could indicate sexually transmitted infection (STI), such as Chlamydia or gonorrhea that should be treated immediately.

A scratch in the vagina will always bleed more than a scratch in the regular skin would because the vagina and the cervix are highly vascular, that is, they have lots of blood vessels.

Endometrial hyperplasia, in which the lining of the uterus grows too thick, can also cause abnormal bleeding occurring around the mid cycle.

What to do for mid-cycle spotting

Spotting can mean different things at different stages of your menstrual cycle. Unless your bleeding is excessively heavy, severe, or prolonged, it is usually not a problem.

If you are experiencing mid-cycle spotting, the best thing to do is to keep track of it. Many health apps on your smartphone make this easy.

Take note of the day in your menstrual cycle the spotting occurs, how long it lasts, the color and consistency, amount of blood, any other related symptoms.

If you are experiencing mid-cycle spotting along with irregular periods, talk to your gynecologist or fertility specialist. Blood tests will be run to determine if the imbalance in your hormone levels may be the cause of your mid-cycle bleeding.

Both fibroids and polyps can be removed surgically if your doctor deems it necessary.

In some rare cases, post-sex spotting can also be a sign of cervical cancer. A sample of cells from your cervix to test for STIs along with abnormal precancerous or cancerous cells called Pap smear will be taken for analysis.

It can be hard to tell what’s normal and what’s not, though, so it’s always best to check with your fertility specialist/gynecologist, who will ensure it is not a sign of a serious health condition. Inform the doctor about any unexpected vaginal bleeding

Spotting can mean different things at different stages of the menstrual cycle If you are trying to get pregnant, the specialist will check to ascertain mid cycle does not interfere with your chances of starting or enlarging your family.

References: lifelinkfertility.com, Emma Gunther:helloclue.com