Mid-cycle bleeding & fertility

Dear Professor Winston,
I would just like to follow up on a previous message sent querying if mid cycle spotting can be problematic for fertility. I have heard lots of conflicting advice on this issue, with mainly the medical profession advising it’s not problematic and the alternative therapies advising it can be quite problematic. And when a couple has been tested for everything and in that unexplained box, this is something that we would be interested in hearing your thoughts on. Any advice would be much appreciated. Kind regards, C

Dear C,

There are various reasons for mid-cycle bleeding and many may be associated with failure to conceive..

  1. Inadequate hormonal support of the endometrium usually associated with problems associated with ovulation
    2. An intrauterine polyp possibly arising from the endometrium.
    3. A fibroid polyp growing from the uterine muscle.
    4. A foreign body in the uterus, for example a piece of a contraceptive coil that wasn’t fully removed.
    5. Endometriosis or adenomyosis of the wall of the uterus.
    6. Tuberculosis.
    7. Fluid leaking from a partially blocked fallopian tube.
    8. Very uncommonly, cancer of the uterine lining and on even more rarely, cancer of a fallopian tube. Very rarely indeed, cancers of the uterine muscle.
    9. Blood tracking down from the peritoneal cavity at the time of ovulation – not associated with infertility.
    10. Disease of the cervix – abnormal cells, abnormalities of cervical opening, cervical cancer.

I’ve probably forgotten something………

Nearly all these conditions can be easily diagnosed by a competent gynaecologist and most of the time they are not at all serious. A cancer smear test, a hysteroscopy and appropriate hormone tests, possibly with ovarian scanning, are the usual investigations that may be needed. Endometrial biopsy may be useful possibly to see if there is some inflammation, or more usually whether the uterine lining is developing synchronously with the stage of the menstrual cycle. Having said that, many perfectly fertile women do have so-called breakthrough bleeding during the menstrual cycle from time to time.

Robert Winston