Let’s start at the beginning. Ovulation...
We’ve all heard of ovulation but it’s typically not something we give too much thought to until we’re trying to get pregnant. Quick reminder; Ovulation is when a mature egg bursts from its follicle and is released into the fallopian tubes to either be met by sperm and fertilized or, in most cases, where it breaks down and is later released from your body. Typically you ovulate once per cycle, but it is also possible to ovulate twice in the same cycle, though it always happens within the same 24 hour period (1). It’s also possible to not ovulate at all in a cycle. Though we haven’t been taught to think this way, being able to detect your ovulation pattern can be a pretty cool and empowering tool regardless if you are trying to get pregnant! And for some people, it’s impossible not to pay attention during ovulation as they actually experience physical symptoms. More on that below (dun dun dun)
How do I know when ovulation is going to happen?
It is a common misconception that ovulation occurs on the 14th day of each cycle. One study showed that a mere 10% of menstruaters actually ovulated on day 14 (2). Every body’s cycle is different, and in fact, ovulation can occur anywhere between days 6 and 21 of your cycle (1). And, it is definitely possible for you to ovulate on different days of different cycles thanks to changes in your sleep, stress, alcohol, diet, illness, antibiotics, and just shifting hormone levels overall. The truth is that there is no sure fire way to know exactly when you are going to ovulate. This is an important note when it comes to many fertility trackers and ovulation predictors! They may be able to give you somewhat of a sense of your fertile window (LINK) but they can’t actually confirm when you will ovulate or if you actually did.
Are there clues I can look for?
Yes! Say hello to your cervical fluid (LINK) and basal body temperature (LINK). The Fertility awareness method (FAM) teaches how to track both of these clues. But, FAM won’t be able to tell you when you will ovulate, only when you are in your fertile window (thanks to changes in cervical fluid consistency (LINK)) and if you have ovulated (thanks to changes to your basal body temperature (LINK)) When you are in your fertile window, your cervical fluid (LINK) will become stretchy and vicious- kinda like raw egg-whites. This type of fluid gives sperm protection from the acidity of the vagina, upping their chance of survival and aiding them in transport to the egg. After you have ovulated, your basal body temperature will rise due to increasing levels of progesterone (LINK) in the luteal phase (LINK) of your cycle (progesterone is warming). The specifics in temperature shifts here can get complicated, but basically you are looking for a temperature 2/10ths higher than your last six consecutive temps, signaling that ovulation has occurred (1). It is also possible to not detect a temp rise. If this is the case, it’s good information to know! Share with your practitioner to get a sense of what may be going on.
There are other physical and emotional signs that may indicate you are in your ovulatory phase like breast/chest tenderness, bloating, acne, and spotting. Because you have higher levels of testosterone during ovulation (3), you may feel like you have more energy and a stronger sex drive during this time. Tracking your emotional and physical changes over time can help you get a sense of where you are in your cycle.
Ok- so back to those who actually feel ovulation happening...
Everybody is different. Many people do not experience any physical sensations during ovulation, while others can actually feel that egg drop. For some, it can be painful. This is called Mittelschmerz, which is experienced by about 20% of menstruating people (4) and can last anywhere from a few seconds to a day or two (5). The sensation tends to be mild, but for some can feel dull and crampy or sharp and tingly. If you experience a lot of discomfort during ovulation, it can be a sign that your hormones need some tending to. Check out our practitioners here! (LINK)
What about bleeding during ovulation? How common is that?
One study showed that in 2.8% of menstruaters, spotting occurred during ovulation (6). Because there is a drop in estrogen following ovulation, sometimes you can get some partial endometrial shedding (that’s that blood!) before progesterone takes over (7). It can also be normal to have some slightly pink-tinged cervical fluid as a result of the egg bursting out of the surrounding follicle (7). While light spotting can be totally normal, it can also be due to some underlying anatomical or physiological issues, so always a good idea to check in with your care provider if you notice any bleeding outside of menstruation.
How much is normal to bleed? Will I need to use a period product?
Bleeding during ovulation is generally just a light spotting that lasts for a day or two. Every person is different, so depending on the amount of blood and your personal preference, you may choose to wear a thin panty-liner or period underwear. (LINK)
10 Things Ovulation Bleeding Might Be Telling You
Ovulation should be the time that you feel your best. It’s nature’s way of encouraging you to put yourself out there, and even though nature may have had a different motivation for this, we can use it to help us go after what we want. If you find yourself feeling crummy mid-cycle, it may be your body’s way of letting you know something is up, and it usually means you aren’t feeling so hot during your period, either. Here are some of the things your body might be trying to alert you to. Warning: some of these sound kinda scary. Remember, just because you experience bleeding during ovulation, doesn’t mean you have any of the following! It could be totally normal. This is simply a guide to arm you with more information to work with your practitioner to really know what is going on in your unique body.
Yep, you can add spotting to the never-ending list of things stress can do. When we’re stressed, we release more cortisol and if it becomes chronic, our bodies will focus on survival over reproduction. This means, while we’re pumping out all that cortisol, progesterone becomes lower on the list of priorities. This is referred to as the pregnenolone steal (8). Which brings me to the next cause.
Spotting anytime after ovulation can be due to low levels of progesterone and is usually accompanied by some spotting right before your period (7). This is generally not cause for much concern but there are dietary changes you can make to encourage more optimal progesterone production.
Disruptions in vaginal flora and STIs.
The dreaded yeast infection or bacterial vaginosis (BV) LINK! Most of us have been here...and it’s no fun. Yeast infections or BV can cause spotting due to inflammation. Some STIs (LINK) can also cause spotting so if your vagina is feeling or smelling a bit funky, get checked out by your care provider.
Hormonal birth control.
It’s important to know that when you’re on hormonal contraceptives like the pill, implant, or shot, ovulation can be suppressed, so this may not technically be ovulation bleeding. If you have the hormonal IUD, ovulation is partially suppressed (9), meaning you may or may not be ovulating. Every body reacts to them differently. The non-hormonal IUD can also cause spotting/bleeding as your body adjusts to it. Basically, if you are on any form of contraceptives, hormonal or not, there can be an adjustment period that looks different for each person. If it becomes bothersome or lasts longer than normal (your provider can tell you what to expect for your specific type of contraception), talk to your provider about maybe making some adjustments.
If you’re spotting around ovulation and it’s more of a dark brown color, this can be a result of disruptions in hormones and thyroid function. Brown spotting is often associated with higher levels of estrogen and low thyroid function (7). You can see your healthcare provider and request a thyroid panel and estradiol test to rule this out. (LINK TO DUTCH TEST?)
Fibroids are uterine growths that can cause a range of uncomfortable menstrual issues, including ovulation bleeding. Many people with fibroids don’t experience symptoms, however, they are commonly associated with heavy and long periods, pain in the pelvic area, frequent urination and difficulty urinating, constipation, and can cause pain in the back and legs (10).
Overgrowths of endometrium can cause the formation of growths, known as polyps, on the inside of the uterus. They can be tiny or as big as a golf ball, and they have a hormonal component, as well. Polyps are sensitive to estrogen so imbalances in estrogen can play a role. Irregular and heavy periods, as well as spotting or bleeding between periods, can be a result of these growths. While polyps are more common post-menopause, they can occur in younger people as well (11).
Endometriosis is when the endometrium that normally lies on the inside of the uterus, grows outside of it. It can be on the ovaries, fallopian tubes and pelvic tissue, and in more extreme cases, spread beyond the pelvic region (12). One in ten menstruators experience endometriosis (13) and it can be difficult to get the right support, due to a pretty serious lack of understanding of how to treat it. Unfortunately, endometriosis can be incredibly painful, causing intense cramping during menstruation and heavy bleeding. Many people with endometriosis report mid-cycle bleeding, so if accompanied by other symptoms, it could be a possible indication (14).
While rare, it is possible for HPV to be the cause of bleeding.
If you’re experiencing spotting mid-cycle every month, then this one probably isn’t it. However, when fertilization occurs, one-third of people experience what is called implantation bleeding (14) (LINK). It happens about 6-12 days after fertilization and is triggered by the fertilized egg burrowing into the uterine lining.
Contributed by: Paige Green, reproductive health educator and full spectrum doula
(1) Weschler, Toni. 2015. Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health. New York: William Morrow, an Imprint of HarperCollins.
(2) Wilcox, A. J., Dunson, D. D., Blaird, D. D. 2000. “The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study.” BMJ (Clinical research ed.) vol. 321 (7271), 1259-62. https://doi.org/10.1136/bmj.321.7271.1259
(3) Vitti, Alisa. 2016. "The Easiest Way to Track Your Ovulation Signs." Flo Living. Last modified April 28, 2016. https://www.floliving.com/ovulation-signs/
(4) “Mittelschmerz.” Pub Med Health. April 12, 2009. https://web.archive.org/web/20110219124244/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002472/
(5) "Mittelschmerz." Mayo Clinic. May 09, 2018. Accessed March 04, 2019. https://www.mayoclinic.org/diseases-conditions/mittelschmerz/symptoms-causes/syc-20375122.
(6) Dasharathy, S. S., Mumford, S. L., Pollack, A. Z., Perkins, N. J., Mattison, D. R., Wactawski-Wende, J., and Schisterman, E. F. 2012. “Menstrual Bleeding Patterns Among Regularly Menstruating Women.” American Journal of Epidemiology, vol. 175(6), 536-45. https://doi.org/10.1093/aje/kwr356
(7) Jardim, Nicole. 2018. “Help! Why Am I Spotting?” Last modified October 21, 2018. https://nicolejardim.com/help-why-am-i-spotting/
(8) Jardim, Nicole. 2019. “Pregnenolone Steal: The Great Hormonal Heist.” Last modified January 22, 2019. https://nicolejardim.com/pregnenolone-steal-great-hormonal-heist/
(9) “Mirena (hormonal IUD).” Mayo Clinic. January 11, 2016. https://www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354
(10) "Uterine Fibroids." Mayo Clinic. March 06, 2018. https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288.
(11) "Uterine Polyps." Mayo Clinic. July 24, 2018. https://www.mayoclinic.org/diseases-conditions/uterine-polyps/symptoms-causes/syc-20378709.
(12) "Endometriosis." Mayo Clinic. July 24, 2018. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656.
(13) “The Facts about Endometriosis.” Planned Parenthood of Indiana and Kentucky, Inc. March 19, 2015. https://www.plannedparenthood.org/planned-parenthood-indiana-kentucky/newsroom/press-releases/the-facts-about-endometriosis
(14) Barton-Schuster, Dalene. 2018. “Mid-Cycle Spotting -- Should You Be Concerned?” Last modified December 10, 2018. https://natural-fertility-info.com/mid-cycle-spotting.html