EP.333/ Is spotting at ovulation normal or a sign of endo problems?
In our last episode, we discussed spotting before your period and what’s normal and what could be a sign of low progesterone or even endo. Today I want to discuss spotting around ovulation and again, this is going to be a nice and easy to digest bite sized episode.
So, ovulation occurs roughly midway in your cycle, though that’s just the average. Statistically, the average ovulation day is around Day 14 but it can be a few days before or after, and maybe we can do an episode on what’s a healthy time frame for ovulation and what’s a sign of a problem, but until then, I actually have an episode on what’s a healthy cycle, so I’ll link to that in the show notes.
Now for those who are new to reproductive health, ovulation in the simplest terms is the eruption of a mature egg from your ovary. This egg works its way down the fallopian tube with the aim of being fertilised by a sperm in order to conceive.
Now, there are a number of things that occur around ovulation to kick this process off. But in relation to spotting, there is the release of prostaglandins, histamines and a surge followed by a drop in oestrogen.
Prostaglandins and histamines play several roles in ovulation from supporting blood flow to the ovaries, assisting the luteinising hormone surge and even breaking down the follicle that holds the mature egg, but one of the key roles is to aid the egg eruption process by triggering contractions.
People with endometriosis tend to have elevated levels of prostaglandins and histamines, and so times when prostaglandins and histamines peak, which is around ovulation and menstruation, we tend to struggle with excessive levels and the symptoms of these. We want prostaglandins and histamine to do their job of facilitating ovulation and the shedding of the uterine lining at menstruation, but if your levels are too high, these pro inflammatory chemicals will create excessive contractions, heavy bleeding, pain and swelling, to name just their core symptoms.
Now you can already see where I am going with this in relation to spotting, but let me now introduce the role of oestrogen here.
Oestrogen helps build your uterine lining. Once your uterine lining is nice and thick and fluffy, after ovulation, progesterone comes along and holds that uterine lining in place and keeps it healthy, to allow for possible implantation of a fertilised egg. Just before ovulation, your oestrogen levels surge, and this peak in oestrogen triggers the rise in luteinising hormone, and that is what really kicks off the ovulation show. Once oestrogen peaks, it begins to gradually fall but still says high until ovulation, and then right after ovulation, it sharply drops, before progesterone starts to rise and takes control of things.
This means your uterine lining is temporarily left to fend for itself, and for some, this can cause very normal temporary spotting, which can last for 1-3 days. When this occurs, the colour is normally red or pinkish, because it may be mixed with cervical fluid.
Now, as we just discussed, histamines and prostaglandins are involved in the rupture of the follicle, releasing the egg. They orchestrate this in various ways, from contractions to changes in our blood vessels. These changes can create small amounts of bleeding, either from the rupture itself, or from the uterine lining slightly shedding, with the impact of the contractions, the blood vessel changes and the dip in oestrogen.
If your levels of these two are excessively elevated, you may find that the spotting at this time is heavier than you would expect, or causes you cramping or an endo flare. If this occurs, it’s worth working on reducing your prostaglandin and histamine levels.
However, if you don’t get pain (a little twinge can sometimes occur with ovulation) and you only have light spotting that lasts 1-3 days around ovulation, this is usually not anything to worry about. You may find it improves if you start working on your prostaglandin and histamine levels, but if it doesn’t, and it’s not accompanied by other symptoms like endo pain, it’s normally typical and healthy.
However, if your bleeding continues into your luteal phase, this could indicate that your progesterone is not rising sufficiently, as we discussed last week. Additionally, if the bleeding is not just isolated to ovulation or pre-period spotting and happens at other times throughout your cycle, or is heavier than just spotting, it could indicate the presence of fibroids, or polyps, which are two conditions that we can often see in people with endometriosis. As we discussed last week, sometimes endo can occur on the cervix, but this is rare, though worth investigating if you tend to get bleeding after sex and/or at random points in your cycle.
Okay, so that wraps up today’s episode on spotting during ovulation. I hope that for some of you this has eased your mind, and for others, I hope this has given you some information so that you can go and seek the medical attention you need and deserve.
See you next week!
Show notes
https://www.ncbi.nlm.nih.gov/books/NBK279054/
https://www.mdpi.com/1422-0067/25/8/4499
https://www.sciencedirect.com/science/article/abs/pii/S030372071730504X
https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-fibroids
https://pubmed.ncbi.nlm.nih.gov/6838950/
https://pubmed.ncbi.nlm.nih.gov/12369286
https://pmc.ncbi.nlm.nih.gov/articles/PMC9916952/
https://www.sciencedirect.com/science/article/pii/S0015028211006807
https://pmc.ncbi.nlm.nih.gov/articles/PMC3136067
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