What is normal hormonal breakthrough bleeding versus concerning bleeding?

[Anonymous]

Prefacing to say I am being treated for health anxiety and am on medication and trying to work through this. But peri has thrown me for a loop with the variety of new symptoms. One of these, for me, was mid-cycle ovulation spotting. When it first began on Thanksgiving 2022, I was given a TVUS and pelvic ultrasound. Nothing was wrong. The midcycle spotting continued and I just dealt with it even though it unnerved me. I subsequently (for a different reason) had a normal CT scan where my ovaries were normal size and the uterus was normal. I also had a normal Pap smear and pelvic exam, but the midcycle stuff continued. My doctor suggested that I didn't need to repeat the ultrasound (although the nurse initially offered it when I called); instead he said I could go on low-dose estrogen/progesterone birth control pill and to take it continuously. I began it three months ago.

Since then, the midcycle bleeding pattern stopped. However, now into my fourth month on the Pill, I now continue to spot very lightly (as in, only when I wipe, not enough to show up on a pad), though at unpredictable times in my cycle - very dark, tissue-like pieces, not even really blood, much darker.
Today is now my third day of this tissue-y stuff.

Sigh. I can't tell if my health anxiety is making me worry, or if this is something to worry about. I did text a close friend who is a women's health practitioner who just said I need a higher hormone dose and that bleeding is poorly controlled on low-dose pills. But when you look this up, it says not to ignore such bleeding. I'd hate to mask an issue with birth control. Has anyone BTDT? Peri has made me very anxious and moody which is not helping.

[Anonymous]

I know there's a women's health NP here who can possibly help.

[Anonymous]

Anyone?

[Anonymous]

Anyone?

[Anonymous]

Anonymous wrote:I know there's a women's health NP here who can possibly help.

Hi, that’s me, at least I’m one of them. A couple of things. Abnormal bleeding should also be evaluated by endometrial biopsy ( in anddition to the ultrasound you had) and it doesn’t sound like you’ve had that done yet. If everything is normal totally reasonable to manage with birth control but I agree with the poster above that said low-dose is less effective at controlling bleeding. Also continuous cycling is often associated with spotting at random times so I would suggest at at least “giving” yourself a period every three months by taking the sugar pills and seeing if that manages it better. Good luck!

[Anonymous]

Hi NP,
I'm the OP. A biopsy wasn't even suggested because the uterine wall was normal/homogenous and the bleeding was at the same time monthly. Do I reach out to my GYN and insist on a biopsy?

[Anonymous]

I had near constant spotting when I took the low dose BPC. I did much better (no breakthrough spotting) on a regular dose BCPs. This was years ago, but I think my doctor at the time said my experience wasn’t uncommon. Now I have an IUD and no periods at all - is that an option for you?

[Anonymous]

Anonymous wrote:Hi NP,
I'm the OP. A biopsy wasn't even suggested because the uterine wall was normal/homogenous and the bleeding was at the same time monthly. Do I reach out to my GYN and insist on a biopsy?

Without knowing your full clinical history I'd be reluctant to say you should insist on it, but it's certainly a conversation to have. In my world it really is the standard of care to do both but there are certainly some scenarios where an ultrasound may be enough to prompt a plan like "let's see what happens with this birth control and if that helps manage bleeding". That said, it is good news that the endometrial stripe is normal.

[Anonymous]

You again! Stop trying to get women to talk about their midcycle spotting. It's literally the nastiest fetish I've ever run across online.

[Anonymous]

Anonymous wrote:You again! Stop trying to get women to talk about their midcycle spotting. It's literally the nastiest fetish I've ever run across online.

Seriously? Do you know how many peri threads there are here? Many of us have asked Jeff to create a peri forum. I'm sorry you think a very normal part of women's bodies is a "nasty fetish."

[Anonymous]

Anonymous wrote:

Anonymous wrote:You again! Stop trying to get women to talk about their midcycle spotting. It's literally the nastiest fetish I've ever run across online.

Seriously? Do you know how many peri threads there are here? Many of us have asked Jeff to create a peri forum. I'm sorry you think a very normal part of women's bodies is a "nasty fetish."

There's a poster who posts constantly about midcycle spotting. Women aren't this ignorant about their bodies - it's clearly a man with a fetish trying to get women to respond to him.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You again! Stop trying to get women to talk about their midcycle spotting. It's literally the nastiest fetish I've ever run across online.

Seriously? Do you know how many peri threads there are here? Many of us have asked Jeff to create a peri forum. I'm sorry you think a very normal part of women's bodies is a "nasty fetish."

There's a poster who posts constantly about midcycle spotting. Women aren't this ignorant about their bodies - it's clearly a man with a fetish trying to get women to respond to him.

Um. I'm the OP of this thread and last I checked, I was a middle aged woman. But...OK!