Spotting and other Variations in Bleeding
Spotting.
Really frustrating. Where does it come from? We first look for an anatomical reason (a problem due to some sort of growth that we can see usually with the ultrasound). The most common reason is that there is a polyp inside the uterus. A polyp is a benign growth inside the uterus, kind of like a skin tag on the inside. They are easily removed via hysteroscopy. If you have had polyps removed and still have spotting, you need to have a sono hysterogram to be sure that the polyps were completely removed. Or maybe they grew back. If the lining is pristine, you we have to look for other causes. Adenomyosis is another reason for spotting. Usually there is evidence of adenomyosis on ultrasound. If not, an MRI will make the diagnosis.
Women with endometriosis are more likely to have spotting, and this may be may be due to a few causes. With endometriosis, the glands of the uterus grow in areas they shouldn’t. The most common abnormal areas are around the ovary and tubes, but there can also be spots of endometriosis on the surface of the cervix. Because the glands don’t always behave as the normal endometrium, they can bleed anytime, causing spotting.
Another source of spotting in women with endometriosis is a hydrosalpinx. A hydroslapinx is a big scarred fallopian tube that is blocked on the part away from the uterus, near the ovary. If the hydro is caused by the chronic inflammation of endometriosis, blood can slowly built up inside the tube. This blood can sometimes back up from the tube into the uterus and then out the cervix, causing spotting. It’s usually not red, but more of a chocolate brown.
Occasionally no reason for the spotting is discovered. So we blame in on being “hormonal”, but we really don’t know what the specific hormonal abnormality is. Could spotting a few days before the period be due to a luteal phase defect and low progesterone levels? There may be one rare woman who has this issue, but for most women with pre-period spotting, their hormones are just fine. I have found that persistent spotting stops when moving to injectables, which do increase both of those hormones.
Post ovulation spotting can in many cases be controlled with progesterone and estradiol in the luteal phase. I remember one patient from years past who had the spotting mid cycle, had a negative hysteroscopy, and got pregnant on her own a few months later. So even though she had monthly spotting it had little effect on her ability to conceive. Maybe the spotting was normal for her and it stopped once she became pregnant.
If you are anovulatory due to PCO and you have frequent spotting, you may need to have a biopsy of the endometrium. PCO women who rarely get a period are at higher risk for endometrial hyperplasia or even cancer. This usually causes heavy irregular periods, but sometimes it’s just spotting. An office biopsy can usually make that diagnosis.
Other Variations in Bleeding
“I don’t bleed for a long as I used to”. I hear this a lot. Typically someone will say they used to bleed for 4-5 days and now they are finished after 3. There is no evidence that this means anything bad. Certainly after a delivery such changes are more common. But even without pregnancy, some women have changes that are hard to explain. I don’t think this means there is a change in fertility.
Heavier bleeding is more of a problem because it is more likely to signify a change that may be important. Remember that fibroid the doctor told you you had, but said it’s not a problem because it’s small? Unfortunately they can grow and become a problem with time. Increased estrogen levels associated with repeated drug cycles can accelerate their growth. Adenomyosis can also progress, leading to increased bleeding.
Consistent heavy bleeding in the setting of normal anatomy may require a consultation with a hematologist. Many of us are born with blood abnormalities that don’t’ allow for proper blood clotting. These issues are usually discovered in adolescence after the first periods are found to be abnormally heavy.
And of course, unexplained heavy bleeding may also require an office biopsy or hysteroscopy to rule out pre-cancerous or cancerous cells.
Thanks for reading and please see disclaimer 5/17/06.
Dr. Licciardi
Really frustrating. Where does it come from? We first look for an anatomical reason (a problem due to some sort of growth that we can see usually with the ultrasound). The most common reason is that there is a polyp inside the uterus. A polyp is a benign growth inside the uterus, kind of like a skin tag on the inside. They are easily removed via hysteroscopy. If you have had polyps removed and still have spotting, you need to have a sono hysterogram to be sure that the polyps were completely removed. Or maybe they grew back. If the lining is pristine, you we have to look for other causes. Adenomyosis is another reason for spotting. Usually there is evidence of adenomyosis on ultrasound. If not, an MRI will make the diagnosis.
Women with endometriosis are more likely to have spotting, and this may be may be due to a few causes. With endometriosis, the glands of the uterus grow in areas they shouldn’t. The most common abnormal areas are around the ovary and tubes, but there can also be spots of endometriosis on the surface of the cervix. Because the glands don’t always behave as the normal endometrium, they can bleed anytime, causing spotting.
Another source of spotting in women with endometriosis is a hydrosalpinx. A hydroslapinx is a big scarred fallopian tube that is blocked on the part away from the uterus, near the ovary. If the hydro is caused by the chronic inflammation of endometriosis, blood can slowly built up inside the tube. This blood can sometimes back up from the tube into the uterus and then out the cervix, causing spotting. It’s usually not red, but more of a chocolate brown.
Occasionally no reason for the spotting is discovered. So we blame in on being “hormonal”, but we really don’t know what the specific hormonal abnormality is. Could spotting a few days before the period be due to a luteal phase defect and low progesterone levels? There may be one rare woman who has this issue, but for most women with pre-period spotting, their hormones are just fine. I have found that persistent spotting stops when moving to injectables, which do increase both of those hormones.
Post ovulation spotting can in many cases be controlled with progesterone and estradiol in the luteal phase. I remember one patient from years past who had the spotting mid cycle, had a negative hysteroscopy, and got pregnant on her own a few months later. So even though she had monthly spotting it had little effect on her ability to conceive. Maybe the spotting was normal for her and it stopped once she became pregnant.
If you are anovulatory due to PCO and you have frequent spotting, you may need to have a biopsy of the endometrium. PCO women who rarely get a period are at higher risk for endometrial hyperplasia or even cancer. This usually causes heavy irregular periods, but sometimes it’s just spotting. An office biopsy can usually make that diagnosis.
Other Variations in Bleeding
“I don’t bleed for a long as I used to”. I hear this a lot. Typically someone will say they used to bleed for 4-5 days and now they are finished after 3. There is no evidence that this means anything bad. Certainly after a delivery such changes are more common. But even without pregnancy, some women have changes that are hard to explain. I don’t think this means there is a change in fertility.
Heavier bleeding is more of a problem because it is more likely to signify a change that may be important. Remember that fibroid the doctor told you you had, but said it’s not a problem because it’s small? Unfortunately they can grow and become a problem with time. Increased estrogen levels associated with repeated drug cycles can accelerate their growth. Adenomyosis can also progress, leading to increased bleeding.
Consistent heavy bleeding in the setting of normal anatomy may require a consultation with a hematologist. Many of us are born with blood abnormalities that don’t’ allow for proper blood clotting. These issues are usually discovered in adolescence after the first periods are found to be abnormally heavy.
And of course, unexplained heavy bleeding may also require an office biopsy or hysteroscopy to rule out pre-cancerous or cancerous cells.
Thanks for reading and please see disclaimer 5/17/06.
Dr. Licciardi
posted by Dr. Licciardi at 7:59 AM
14 Comments:
Thank you for your very informative post, especially the reference to andometriosis, which I was diagnosed with last year. I would be really interested to know what you thought about very large blood clots; occasionally I get a "rubbery" clot the size of my palm (sorry TMI!) and it freaks me out! My gynae doesn't seem unduly worried about them but I have always wondered what causes them, especially as they seem very similar to the miscarriage I had.
Thank you for taking the time to share your experiences with us.
Thank you so much for sharing your expertise with us. you are truly amazing and selfless. I want to ask you about unexplained infertility. It's probably the most frustrating thing in the world. Can you write a post about this? Maybe you and your colleagues have conversations about this topic? Has the medical field made advances in technology to find out more than the current testing allows? Thank you again!
Your blog has been so helpful through all of my desperation lately. THANK YOU!!! I am 32, ttc for 7 years, 7 failed IUI's, 2 failed IVF's, ONLY possible reason for infertility per my RE is severe endometriosis. 8 eggs retrieved, 5 fertlized, 2 blasts transferred, none left to freeze; 16 eggs retrieved, 10 fertilized, 1 blast and 1 morula transferred, none to freeze. I love my clinic/doctor but everyone is telling me to go somewhere else. I really want success. Should we see a genetic counselor? How does embryo adoption work? What way should I go?! Thanks for all you do.
Thanks for your great posts. I have done 4 IUIs, one took but I miscarried due to Trisomy 16. We are doing our first IVF and I am on 2 vials of Gonal and one of Menoour and not responding well. I will only have 3 mature eggs by my estimated ET. I am 37 (almost 38) my FSH is 4.08 and I have responded well to Clomid in the past. My E@ has risen and my RE doesn't know why I am not responding. I am on the non-lupron protocol. What should I change next time around? Thanks
Thank you for this blog! I would love for you to do a post about poor responders. How does one with all hormone levels and AFC within normal range and all possible tests come back fine turn into a poor responder? Is estrogen priming the best protocol for us? Also is there anything that can be done about dominant follicle produced early on? I'm afraid of birth control and Lupron as it might suppress me too much.
Thank you for your time!
Hi, I have been spotting for 51 days straight now, I have been to my gyno, and she said everything was normal. I am not pregnant. Has any one ever experienced this before? I am 28 yrs old and have a 3 yr old son. I am really starting to stress about it. I can't seem to find any answers.
Thanks
Our IVF cycle was performed with the assitance of ICSI. We transferred one fresh embryo that did not take. We have twelve frozen embryos, four in great shape, the rest of average quality (at least so far). We were hoping to thaw and grow four embryos so that we can have two blastocysts for transfer in December.
Is is unwise to bring frozen embryos (frozen at day 3) to blastocyst stage if they were formed with ICSI? Should we simply transfer embryos instead of growing them to blast?
I've read some literature that says ICSI embryos are more vulnerable and that fewer make it to blast when thawed.
My retrieval was performed when I was 37. I will be 39 on the date of transfer.
Thanks in advance for your advice.
I have only just started seeing a doctor re. infertility. He thinks I may have mild PCOS even though since having an implanin removed 12 months ago my cycles are regular 27 to 28 days (they were 35 to 38 when on implanon)u/s showed some cysts. my doctor has percribed clomid. I havn't found anything re. PCOS with regular periods could this diadnosis be wrong?
Thank you for this post. I asked you about spotting a few months ago. I was one that had it like clockwork 9 DPO. I did do IVF to conceive my first child, and was recently trying for #2 and was concerned about the spotting. I convinced my RE to just let me do vaginal Progeserone for a few months before we move back to IVF. He like you is convinced that for most women a luteal phase defect is not the issue ( all my hormones were normal). Well, I am so excited to say that after the second month on the progesterone, I am 5 weeks pregnant! It could be complete coincidence, or maybe I really was one of those rare women with a luteal phase defect. Regardless, I am glad that my doctor was willing to take MY suggestions and concerns seriously, as maybe sometimes women just really know what is wrong with their bodies. Thank you for all your information!
Hi Dr Licciardi,
Thank you so much for all your work! After being dx with MFI (low counts and 3% WHO morph), we did IVF ICSI, transferred 2 fresh embryos (BFN) and later, a FET with 3 embryos, also BFN. I was able to get pregnant 3 years ago with twins, but sadly it did end up in a m/c at 8 weeks. I'm almost 36.
All others tests are fine, except that I have a paraovarian cyst, which my doctor say it doesn't matter (I manage to get 14 eggs for IVF, 6 on that side).
We are doing another IVF cycle at the end of the summer, same protocole since I reacted very well, slighty higher dosage for the meds. Implantation seems to be the problem... Unlucky or....? If you have any comments or tests I should undergo, I would really appreciate your input.
(I'm in Montréal, so there's no SART equivalent. We go to Procrea, but McGill would be our other choice)
Thank you so much!
Laura
Your blog is very helpful during a helpless time....thanks for putting in the effort!
Thanks so much for this post--I wish I had read it three years ago, when I was struggling to get answers about my spotting which was indeed caused by polyps (and not the five things five different doctors insisted it was). After a hysteroscopy, the spotting never returned.
I am really enjoying your blog and thank you for all the information you've shared. I am trying to decide what the next step is for me and would love to know if you have any ideas. I'm 32 and have been trying for my first child for 20 months. This spring I did 2 clomid iuis and got pregnant on the 2nd try. Unfortunately I miscarried at 6 weeks. I started trying iuis again and have had 2 unsuccessful tries since the miscarriage.
My doctor is recommending a move to IVF soon. My HSG and hormone testing has been normal and my husband's sperm count is fine. My doctor is not sure what is causing the infertility though has some suspicion that endometriosis is the problem since I have a strong history of the issue in my maternal family. However, I do not have any symptoms other than cramps (sometimes severe) on the first day of my cycle and my ultrasounds have been normal.
I am open to IVF but am a little worried about doing it without first addressing any possible endometriosis. My doctor is very open to a laparoscopy but feels it won't impact my success chances at IVF. Is this correct? Does it make sense to go straight to IVF?
There has never been a real reason identified for my spotting. I've had and HSG, a lap and hysteroscopy. I was getting an infertility work-up at the time. The reason for my infertility was not found either. I did get pregnant after 3 years and and had a baby. I still spot.
http://www.your-infertility-answer.com/
Post a Comment
<< Home