Wednesday, 18 June 2014

On ovulation spotting...

I haven't posted in a while because it's "break time" but something strange happened, and I felt the need to get an answer and share what I learned...

For the second month in a row I had "ovulation spotting" - mid-cycle bleeding to some of you. In the general sequence of cycle events, it was exactly the same both months, but after two years of steady charting, it came as a surprise. I know about the prevailing theory circulating online that it comes from the actual follicle rupture - but that theory just wasn't working for me because of the timing and because of my gummed up tubes. How would such a tiny amount of blood manage to get out through my cervix if larger quantities of fluids under pressure can't get in or out (sperm, imaging fluid from diagnostic tests, the much larger amount of blood that was found in my abdomen when my cyst ruptured two years ago). So I turned to my friend Pubmed and, eventually, found my answer:

259 women contributed data from 470 cycles to this study of menstrual bleeding patterns, and very few experienced mid-cycle bleeding. It was actually only 12 women, and for 11 of them it only happened on one of the two cycles recorded. So the chance of it happening twice in a row is roughly 0.4%. Lucky me, but still way more likely than winning the lotto.

They also took regular hormone levels from the women, and compared the hormone profiles of the spotters and non-spotters. I love numbers, so this was like candy to me, and I know it's hard to make a good prediction on the basis of only 12 women. But the data suggests that mid-cycle bleeding, what we call "ovulation spotting", coincides with higher estradiol levels, higher lutenizing hormone spikes, and higher progesterone levels. They aren't big differences though, and looking at the levels, it's nothing compared to the levels reached during ovarian hyper stimulation (40x higher). Just a subtle increase. But it also supports the lesser discussed theory I found during my googling, that it's a bit of leakage from a slightly enhanced uterine lining when the cervix opens up in the days leading up to ovulation. Some have taken this to mean "stronger ovulation" - I'm not sure that is completely accurate, or at the very least meaningful. Heightened estradiol may or may not reflect egg quality, and I don't know that a higher lutenizing hormone spike makes a difference, it's a threshold thing, and the increased progesterone doesn't look high enough to suggest multiple follicles or anything helpful.

Unfortunately I can't link directly to the figures, but click on the link, go to figure 3, and you'll see.

So that basically brings me back where so many websites started me off - it happens, but it may not mean anything when and if it does. But it's nice to know.

Happy ovulating ladies!