Fertile Ground
Drop in and explore Tempdrop’s fertile ground of science-backed insights covering a wide variety of women’s health and fertility-related topics, from menstruation and mental health to PMS, PCOS, and perimenopause.
Menstruation cycle4 Causes of Spotting Mid-Cycle (Ovulation, Between Periods, Etc)Spotting between periods is a common concern for women in their reproductive years. Below we'll share some common causes of mid-cycle spotting, however, some of the causes can be serious and require treatment. Always check with your medical provider to ensure you get a proper medical workup.
While there may be some variation in menstrual cycles, it is ideal for cycles to follow predictable patterns where we see regular periods followed by shifts in cervical fluid and BBT that indicate regular ovulation. However, about 5% of ovulating women experience bleeding in between periods, also known as mid-cycle spotting.
Intermenstrual bleeding is the medical term for bleeding or spotting mid-cycle, which simply refers to bleeding between regular periods (menses). Intermenstrual bleeding can occur early in the cycle, mid-cycle, and late in the cycle, and follow a predictable and cyclical pattern or have no pattern at all.
4 Common Causes of Mid-Cycle Spotting
1. Ovulation Spotting2. PCOS3. Sexual Intercourse4. Implantation Bleeding
What Causes Mid-Cycle Spotting?
Some women experience bleeding or spotting mid-cycle, which can be caused by a variety of reasons, including:
Ovulation or lack thereofAbnormalities of the cervix or uterusOvergrowth of tissuesCancerBleeding disordersHormonal or metabolic conditionsPregnancy or pregnancy-related concernsMedications (especially hormonal birth control)
How to Identify Spotting Between Periods?
Tracking your cycle with fertility awareness and confirming your ovulation with markers like cervical fluid and basal body temperature is the best way to know when, or if, you are ovulating. This way, you will have the most accurate data to know where you are in your cycle and if you should be bleeding, helping you determine if you are having mid-cycle spotting or spotting at another time in your cycle.
This is valuable data in your own journey and incredibly helpful information to have when or if you need to see a medical provider for a workup because this helps guide their decisions around what may need to be tested.
4 Causes of Mid-Cycle Spotting
1. Ovulation Spotting
During ovulation, your body goes through complex hormonal changes and spotting is thought to be related to the mid-cycle drop in estrogen that occurs around ovulation. Some women may experience spotting near ovulation. This discharge can be:
Brown discharge mid cycleBleeding mid-cycle that is bright redLight pink bleeding in the middle of the luteal phase*
*In a 28-day cycle, with ovulation on day 14, you may notice light pink bleeding on or around day 20 of the cycle.
Again, a great way to see if bleeding during ovulation is related to ovulation itself would be to track your cycles. Even though this can be normal and nothing to worry about, it's always best to speak with your medical provider about it and ensure you are up to date on routine testing to rule out more serious causes of spotting.
Track Your Cycle Accurately
Whether you want to increase your chances of conceiving or want to practice the fertility awareness method, Tempdrop offers the most convenient full fertility tracking solution.
Track your cycle with Tempdrop’s wearable sensor that continuously monitors your BBT while you sleep, and sync the data to the app whenever it's convenient, without having to wake up at the same time each day.
Why Tempdrop?
Accurately identifies fertility windowProvides continuous monitoringAccurately tracks personal BBT patternsIt's safe, non-invasive, and has zero radiationEasy-to-use wearable sensor and a charting app
2. PCOS
With PCOS, we often see long or irregular cycles with extended follicular phases, spotting during the follicular phase, and/or periods of anovulation (or lack of ovulation). If you're tracking your cycles, you'll be able to see if you're ovulating or not.
In a typical cycle, estrogen is the hormone dominant in the first part of our cycle (our follicular phase), which builds the endometrial/uterine lining.
Progesterone is the hormone dominant in the second part of our cycle, which stabilizes the endometrial lining. When we have long or extended cycles with ongoing or excess exposure to estrogen, this can make us more likely to have random spotting, especially if we are not ovulating and making progesterone available to stabilize the lining of the uterus.
If you are noticing irregular cycles or suspect you have PCOS working with a holistic or integrative provider can be a great way to get your symptoms and cycles in a healthier balance and prevent long-term, more serious risks.
» Check out these 5 tips for tracking your cycle when you have PCOS
3. Sexual Intercourse
Occasionally, sexual intercourse can cause irritation to the tissue in the vagina or can stimulate bleeding from tissue growths we may have on the cervix or inside the uterus. Bleeding with sex can also be a sign of an irritated cervix, vaginal imbalance, or a sexually transmitted infection.
If you are experiencing bleeding during or after sex during ovulation, or at other times in your cycle, always schedule a medical visit to make sure you rule out more serious causes and receive any necessary treatment.
4. Implantation Bleeding
Some women will experience some spotting when a fertilized egg implants or burrows into the uterine wall. This typically occurs 6-10 days after ovulation because the fertilized egg has to have time to travel the length of the uterus and into the uterus.
If you track your cycle, you will see this in the mid to late luteal phase. Keep in mind, this bleeding can happen in both pregnancy and non-pregnancy cycles.
If you are concerned you are pregnant or concerned about a potential miscarriage, please seek medical care.
Closing the Gap on Mid-Cycle Spotting
While mid-cycle spotting can be a cyclical, regular, and even normal experience for some people, the safest thing to do is to track your patterns. Be sure to check with your medical provider and get appropriate testing to rule out more serious causes of mid-cycle bleeding that may require treatment or intervention.
Menstruation cycleDoes PID Affect the Menstrual Cycle? An Expert DiscussionPelvic Inflammatory Disease (PID) is a complex condition that involves inflammation of the pelvic area, including the upper genital tract, such as the uterus, fallopian tubes, and ovaries. It's characterized by swelling, heat, and redness, although these signs are internal. In 85% of cases, this infection is caused by sexually transmitted pathogens and bacteria, but only about 10-15% developed PID from gonorrhea and chlamydia. Numerous other bacteria may also lead to PID, such as streptococcus or certain influenza strains.
Due to the location PID affects, menstrual cycle awareness is crucial. Overall, PID can impact the cycle in negative ways, particularly causing chronic pain and irregularity. This, in turn, affects fertility and conception. To better understand the true correlation between PID and the menstrual cycle, we spoke to Natasha Hogan—an experienced healthcare professional, infertility expert, and author of Pregnancy After Infertility: A Guide to What’s Next & What’s Different. She shares her wisdom on the effects and treatment options women should know when dealing with PID.
PID: In-Depth
Though the incidence of clinically diagnosed acute PID has decreased, the condition remains complex and requires careful consideration in both diagnosis and treatment strategies.
What Causes PID?
Various factors could increase susceptibility to PID, such as:
Multiple sex partnersSexual practices, including oral sexPleasure toys, especially if not kept properly cleanDouching, which alters the vagina's microbiological environment, potentially flushing bacteria into the uterusProcedures like IUD insertion or dilation and curettage (D&C), sometimes performed after an abortion or miscarriageLower concentrations of protective chlamydial antibodiesLarger cervical ectopy in younger age groups (this is when the cells inside the cervix are visible outside of it)Smoking increases the chance of developing PID
Tip: To guard against getting the infection repeatedly, it's advised to abstain from sex until your partner or partners have had treatment for any STDs or if PID has been previously diagnosed. Make sure you take precautions when conducting any oral, physical sexual pleasure. It's always recommended to consult with a healthcare provider to understand personal risks and to take appropriate precautions and treatments tailored to individual needs and medical history.
PID Symptoms
The symptoms of PID can vary but generally include:
Deep discomfort or pain during sex, felt inside the pelvisBleeding between periods and after sexHeavy and painful periodsUnusual vaginal discharge, particularly if yellow, green, or smellyFever and pain during urination
Connected Issues
Some other issues highlight how PID and infections are connected:
Tubo-ovarian abscess (TOA): This condition can be polymicrobial, meaning it is caused by multiple and various pathogens. And this study shows that 13.9% of those in hospital for PID have TOA, which is more prevalent among those with chlamydia too.Dyspareunia: This primarily concerns insufficient lubrication. "If you don't have what you would consider natural feelings when being sexually aroused or going into the motion of having intercourse, everything can pull and hurt," explains Hogan. PID can become an irritation because of constant infection, making sex painful. This pain is not limited to initial intrusion; it can be felt in various ways, even hindering full orgasms since there may be no fluid in the area.Endometriosis: While there are similarities pathogenically, the two conditions occur in different locations, so they are not likely to increase the risk of each other. "From the standpoint that PID is related to intrusion within the uterus and endometriosis occurs on the outside of it, they are two distinct things," says Hogan.
Detection Methods
Current knowledge on PID detection emphasizes broader screening and diagnostic approaches. Early diagnosis and treatment are crucial to avoid chronic concerns, and a broad spectrum of testing methods is available, such as:
BiopsiesSwab culturesPelvic examsImaging (ultrasound)Laparoscopy
Note: Negative results from testing don't necessarily exclude a PID diagnosis.
PID and the Menstrual Cycle
PID can significantly affect the reproductive system, including changes to menstrual cycles, hormone levels, and physical structures within the system. Let's look at the different aspects of menstruation and the reproductive system and how PID can impact them:
Cycle Length
It can sometimes increase the length of a period due to the inflammation that irritates the reproductive organs. In some extreme cases, PID can make it nearly impossible to conceive because irregular ovulation or anovulation are harder to track. "This underscores the importance of not adhering too rigidly to textbook expectations about menstrual cycles. Variations can occur, and something unusual, like a cycle lasting up to 62 days, might indicate a problem," explains Hogan.
Can PID cause a missed period?Some people may find that their cycle length gets a bit shorter. However, PID usually leads to longer cycles. Because of this, your period can sometimes be delayed and irregular, not necessarily skipped.
Ovulation
Some ways your ovulation may be impacted are:
PID can affect hormones such as the luteinizing hormone (LH) and thyroid-stimulating hormone (TSH), throwing the entire system out of balance. This hormonal disruption can cause irregular ovulation or even no ovulation.The inflammation associated with PID can irritate the reproductive organs, leading to disruptions in the normal ovulatory cycle. The general illness caused by PID, including symptoms like increased white blood cell count and lethargy, can interfere with the body's normal processes, including ovulation.
Bleeding
With PID, bleeding may be heavier during periods, and the blood may even appear darker as white blood cells try to combat the infection. This could be because the body is trying to rid itself of the bacteria present. Some may report their menstrual blood as more "stringy" or "gummy." Understanding your bleeding patterns can help you identify when there's a change that could be symptomatic of an infection, which you can address with your doctor.
Reproductive System and Fertility
PID can disrupt the entire reproductive system, potentially even leading to infertility. There may be less chance of getting pregnant due to:
Fallopian tube damage: PID can lead to scarred or blocked tubes, which can prevent the egg from meeting the sperm for fertilization in the uterus.Abscesses: If these are in the reproductive tract, they can obstruct the normal fertilization process.Lowered sexual desire: Pain and discomfort can lead to a reduced interest in sexual activity, lowering the chances of conception. Also, any infection will raise white blood cell count and affect other markers, such as the erythrocyte sedimentation rate (ESR), draining energy from the body and potentially leading to lethargy.Implantation disruption: Sometimes, PID's effect on the reproductive system's internal environment can potentially interfere with egg fertilization in the uterus. But this is a complex issue with less research on it in relation to PID.
Tip: If you're trying to conceive and are concerned about PID, it's essential to work with healthcare providers who specialize in fertility and reproductive health. They'll be able to guide you based on your specific situation. Some options they might discuss with you are in vitro fertilization (IVF), surgery, fertility medications, intrauterine insemination (IUI), lifestyle changes and supportive care, and surrogacy or adoption.
» Check out these 5 steps to repairing your period
How Is PID Treated?
PID is usually treated with a combination of approaches, and early treatment is essential to prevent complications. Unrecognized or "silent" PID may still lead to tubal factor infertility, so seeking treatment within 3 days of noticing lower abdominal pain can reduce risks. However, any treatments should only be implemented under the guidance and monitoring of your healthcare professional.
Here's a general outline of how it's treated:
Antibiotics
Since PID is often caused by bacterial infections, antibiotics are the primary treatment. The specific antibiotics prescribed may depend on the suspected bacteria causing the infection. Sometimes a combination of antibiotics is used to cover a broader range of bacteria. This approach is most effective when implemented early on.
Hospitalization
In more severe cases or when complications are present, hospitalization may be required. Intravenous (IV) antibiotics might be administered, and close monitoring will ensure the best possible care.
Surgical Options
Surgeons may offer procedures to address abscesses or adhesions, but these come with added dangers and can result in trauma. "You have to weigh the risks with the benefits, particularly if you're keen on having a natural birth and want to explore different surgical interventions," advises Hogan. Each time surgery is performed, the risk to the uterine wall increases, and it may become so thin that it could rupture.
» Are you having irregular periods? Find out some surprising causes of this here
Decode Your Body's Rhythms With Cycle Tracking
While PID has a clear impact on numerous stages of the menstrual cycle, from length to fertility, there are different options you can explore to help treat the infection under medical professionals' care. Ensuring your knowledge of the condition is up-to-date and comprehensive can help prepare you should you get PID, as well as help you take precautionary lifestyle changes that can lower your chances of the infection. Then, easiest of all, you can take your cycle and fertility tracking into your own hands with tools like Tempdrop's wearable tracker. This device monitors your basal body temperature (BBT) while you sleep and the app enables you to track additional fertility symptoms which will help you notice patterns, better understand your body, and be a crucial first data-gathering step should you wish to try and conceive.
Menstruation cycle4 Surprising Causes of Irregular Periods in Your 20's & OnwardsWhile irregular periods can be expected and are considered to be normal for the first few years of menstruating, after this point, if you are still experiencing irregular cycles, you should consider a visit to your medical provider to discuss things further.
As you age, your period will change because of hormonal changes and experiences like pregnancy or breastfeeding, but once we are two years into our cycles and until we begin to enter peri-menopause, we should expect to see fairly regular cycle patterns with only a few shifts here and there.
Irregular Menstrual Cycle Length
The length of a normal menstrual cycle varies from person to person and can range from 21-35 days in length, according to the American College of Gynecology. They define an irregular cycle as a cycle length that varies by more than 7 to 9 days from cycle to cycle. There are variations in what is considered an irregular period or normal based on which organization you look at and the training of the provider involved.
From a holistic hormone health perspective, I personally like to see cycle lengths of 24-36 days that do not vary by more than 2-3 days per cycle.
When we are talking about irregular cycles, the concerns come when it is something that is happening consistently. If you have just one sudden irregular period but this is not a pattern for you, this can be normal and is likely nothing to worry about. However, if it continues to be a regular pattern, then check with your medical team.
Below I'll share some common symptoms and possible causes of irregular periods. But first, here are some additional symptoms that would be considered abnormal when it comes to bleeding and things that should prompt you to see your medical team:
Bleeding or spotting between periodsBleeding that lasts longer than 7 daysHeavy bleeding during your periodBleeding that soaks through one or more tampons or pads every hourBleeding more heavily than usual during your periodBleeding or spotting after sexBleeding or spotting between periodsMenstrual cycles that are longer than 35 days or shorter than 21 days“Irregular” periods in which cycle length varies by more than 7 to 9 daysNot having a period for 3 to 6 monthsBleeding after menopause
4 Possible Causes of Irregular Periods
1. Stress2. Medications3. Changes in Weight or Diet4. Medical Conditions
1. Stress
Stress (emotional, nutritional, and physical) affects your hormones. There is just no way around this, and whether it is good or bad stress, it doesn't matter.
Stress increases our cortisol levels which can have negative downstream effects on our menstrual cycles, affecting ovulation and when your period comes.
Prolonged stress can delay ovulation or cause you to skip it for long periods of time, which means your period will be delayed or skipped for long periods. In fact, chronic stress can sometimes cause the lack of a period for months (amenorrhea).
High levels of stress can also trigger inflammation and more painful periods in the body. Overall, the more we can remove and properly support good stress management techniques, the more our cycles and hormones will thank us.
2. Medications
If you find yourself asking why your menstrual cycle is getting longer or why your periods are getting heavier or longer, it can be worth looking at your medications and discussing this with your medical provider. Commonly used medications that can affect your menstrual cycle include:
Hormonal birth control: this is one of the most common causes of irregular cycles. Though often, it is also suppressing ovulation as part of how it works to prevent pregnancy.Antidepressants: anti-depressants can lead to absent or infrequent periods with a longer cycle.Steroids: long-term use of steroid medications can make periods heavier and longer.Chemotherapy: certain cancer treatments can significantly affect the body, stress, and hormones or even lead to premature menopause and no periods (though this is not always a long-term effect). This is an in-depth discussion that should be had with your medical provider prior to starting chemotherapy.
3. Changes in Weight or Diet
Our diet and weight are deeply tied to our hormonal health and our cycles. Strict or limited diets or those lacking in nutrients or calories can lead to PMS, painful periods, or non-ideal cycles. Not getting adequate calories or over-exercising are some of the main causes of amenorrhea because our body is under stress or not getting enough cholesterol or other nutrients necessary as the building blocks for healthy hormones.
Similarly, taking diet pills or eating disorders such as anorexia, bulimia, or binge eating can cause irregular or missed periods or other menstrual cycle disturbances.
4. Medical Conditions
Some medical conditions can disrupt your hormones and menstrual cycles, and may have irregular menstruation as a symptom. For example:
PCOS (polycystic ovary syndrome): is a complex endocrine and hormonal disorder that often includes excess androgen (typically thought of as a male-related hormone) and/or insulin resistance, both of which affect the ovaries and adrenals and can lead to irregular periods.Thyroid disorder: hypothyroidism (not enough thyroid hormone) and hyperthyroidism (too much thyroid hormone) can both affect your period, causing them to become irregular or infrequent.Diabetes: similar to PCOS, because insulin is not working properly, we can see longer or irregular cycles.
Know Your Cycles + Know Your Hormones
The beauty of tracking our cycles and seeing if they are regular or not is that we can see the health of our hormones and know when we may need to seek further support. I personally love using Tempdrop for myself and my clients when looking to understand cycles and hormonal health because:
It helps to show if cycles (ovulation, followed by a period) are regular.It gives us insight into other symptoms, which is helpful in addition to cycle data, especially when we are talking about PCOS or stress.It helps give us vital information about the health of our cycle phases so we can see if it would benefit us to have some additional holistic support or medical workup.