A year ttc, clear pelvic exam but still spotting

[Fifii]

my partner and I have been ttc for full year (came off the pill October 2022 and immediately started trying) with no luck, no bfp, nothing.

for the last 5 months or so I’ve started spotting six days before my period arrives - not heavy, usually brown but sometimes red. The first few times this happened I obviously got my hopes up thinking it was implantation bleeding, which of course it wasn’t.

ive since had a day 21 test, which came back normal at 33.5. Last week I had a pelvic exam (external and internal) and although I have a catch up with my doctor tomorrow, I’ve already been told that they found nothing and it was all fine.

so, I guess my question is, has this happened to anyone else and did you manage to conceive? I’m going to push for fertility treatment tomorrow but I just feel so hopeless. I know I should be relieved that it’s all clear but I typically start spotting less than a week after I ovulate so in my mind, there’s surely no time for implantation before my body starts shedding.

I’ve read about low progesterone - does anyone have experience of that?

bumping up - I realise this is quite niche but I feel mad ☹️

Hopefully someone else will come along with a more positive story, but this was exactly my experience and ended up going for IVF after 2 years of no luck. I was also told that my day 21 progesterone was fine and was diagnosed with unexplained infertility, but when I took progesterone for both my IVF rounds I didn't spot at all. Second round worked for us so didn't need to go further but we were considering trying to get a private prescription for progesterone and trying naturally again for a bit.

I gather it’s much more common to be prescribed progesterone in the US. However as you had it tested and it was a good number, it doesn’t sound like low progesterone is the issue?

Thank you both for your replies!
@Msrivia thats really interesting. I keep wondering if my progesterone is initially fine but then dramatically drops, causing the spotting. Am I right in understanding that the second round of IVF worked and you’re now pregnant/have a baby? If so that’s lovely!

@CurlyWurly1991 yeah I did wonder this too 🙁 I do wonder if my progesterone levels drop too quickly post ovulation though - so the day 21 test is fine but maybe by day 22 it’s really low, if that makes sense.

@Fifii you could try the proov pdg urine tests? Afaik they take a sample over a period of days.

Hey OP this used to happen to me every month, I had several threads on here about it. I started down the infertility road with chats with my GP and checks for infection but then I did manage to get a BFP and I’m 12 weeks now. That month the spotting did start as usual but then it stopped about 8dpo and didn’t start again, which is why I tested! I’ve had a fairly uneventful pregnancy so far with no bleeding. I didn’t do much differently when we did conceive although I’d I’m honest our dtd had become a bit focused around ovulation day, when we dtd every other day for the two weeks after AF that’s when I conceived. Appreciate this doesn’t give you a lot of help but hopefully offers some hope.

Another thing to note is it took almost a year after stopping the pill for my periods to become regular, and they still were varying between 4 and 5 weeks when I got my BFP. When I first stopped I would wait up to 10 weeks for AF. I’m not sure if this is the case with you, but I definitely believe it can take our bodies much longer than we would like to get back to normal after the pill.

Thank you guys for your reply. I just finished speaking to my doctor and now I’m worried - the receptionist told me everything was fine but doctor just told me they found an endometrial cyst!!! It’s very small still thankfully. I have wondered for some time if I have endometriosis so I wonder if this is further clarification.

I feel really worried now ☹️

Hi @Fifii - just wondering how they found the endometrial cyst? Do you know what your next steps are? I’m in almost the exact same position as you - been trying to conceive my first for a year now, all blood tests and scans seem ‘normal’, but I also have the dreaded pre-period spotting. Had also assumed this might be low progesterone but doc says my progesterone levels are fine and they seem unconcerned, although I’m not convinced, and like you am wondering if they are dropping off too quickly? Have tried acupuncture for the last couple of months but that hasn’t unfortunately made any difference. Finding it all very frustrating as every month I get my hopes up it is implantation bleeding! anyway would be very interested to know what advice you have been given too…

Hey @Goldendoodlelover, sorry to hear you’re in a similar position, it’s really tough ☹️
doctors have been relatively useless - they tell me the cyst alone wouldn’t cause the spotting or affect fertility, but if the cyst is caused by endo, then of course the endo will affect those things. My doctor was lovely but she was very adamant that if we keep trying we’ll be fine - which stresses me out beyond belief. hoping to get a private referral for gynaecology through my work but even they’re slow and useless so far.

they found the cyst on the ultrasound scan (an internal one, I believe - I had both external and internal at the same appointment so it’s hard to say for sure). it’s not even 3mm in size so still not very big but it’s making me so anxious. after that was found, the doctor did her own pelvic exam but she said everything looked fine.

have you requested a referral for fertility treatment? Or maybe a gynae referral for the spotting? My doctors are also pursuing fertility referrals, but they’re unsure whether I’d need to deal with the cyst before fertility specialists would see me. Yours might be a little more straightforward. Have you ever had any other hormone tests other than progesterone?

sorry for the long reply!

@Fifii it’s tough isn’t it! My doctor has said just to keep trying, which is understandable but psychologically is almost harder - at least if I had a diagnosis there would be something to ‘fix’ and focus on! I know a year isn’t that long in the grand scheme of things but two of my best friends and my sister in law have all announced their pregnancies in the last six months after only a month or two of trying so I think it has really skewed my perception of things! It’s good the cyst was small and your doctor said it shouldn’t be a problem, although like I said it’s not always easy just waiting…

My doctor seems to suggest that there is no ‘treatment’ they can offer other than IVF (which seems premature) because I am apparently ovulating fine on my own? Think I’ve had all the normal hormone profiles - AMH, FSH, LH, testosterone, prolactin etc and all within normal levels. Only thing the ultrasound did show was polycystic ovaries, but apparently I don’t qualify for PCOS because I have regular(ish) periods and normal androgen levels - guessing the polycystic ovaries may be a hangover from when I was on the pill and so not properly ovulating?

My acupuncturist though definitely said the spotting isn’t ideal because it suggests the lining is breaking away prematurely which is obviously not great for implantation, which seems to make sense, but doctor doesn’t seem to want to investigate it any further.

Sorry for the long reply in return! 😂

@Goldendoodlelover I know exactly what you mean. So many people I know got pregnant SO quickly - one of my friends started ttc a few months after me and she’s due next week. It sounds horrible; I am so happy for them, but so sad for me :(

That’s great news that all your levels were normal. I’d be curious to know exactly what type of cysts you have - it seems there are sooo many different types! Some seem to affect periods and fertility and others less so.

Unfortunately the type I have is clearly linked to fertility problems and yet the doctors don’t seem to know what to do with me. The last time I was there, the doctor kept telling me stories about women who had come to her with fertility concerns and then almost immediately got pregnant. I don’t know if she hoped that would reassure me? It definitely didn’t.

I’ve just started my typical pre-period spotting (7dpo today - not due on until Wednesday/Thursday next week). I just feel so broken ☹️

hope you’ve had some positive/better news xx

@Fifii it’s so hard isn’t it - I completely know what you mean: I’ve been so happy for everyone who has announced their pregnancies but it’s also so gutting and hard to stay positive and is a horrible reminder that things aren’t working yet, but I don’t want to tell my friends how upset ttc is making me cause I don’t want them walking on eggshells or that they can’t talk to me about their own journeys if that makes sense?

So apparently the ‘cysts’ in polycystic ovaries aren’t actually cysts (rather confusingly) but follicles that never properly made it to development / ovulation (hence they are apparently quite common in women coming off the pill). Apparently they are quite harmless and as long as I am having regular periods my doctor doesn’t seem concerned.

Afraid same story again this month so far. Had a tiny, tiny bit of spotting 6dpo (again hoped this might be implantation bleeding, but probably too early). Tested 11dpo, negative, and am now 13dpo and had a bit more spotting this evening - I didn’t think my period is actually due until Wednesday but my luteal phase length can vary a bit, but I think I’m basically out again for this month.

Do you think your doctors will investigate endometriosis for you? Hope you get some answers soon 🤞 it’s really hard to stay positive but I try and see a period as a good thing as it’s a new month/new cycle/new opportunity to start again, but the wait for af is always the absolute worst!

@Fifii I was also told during an internal scan 'everything looks ok as it should be' to be told by my Dr I have a fibroid and adenomyosis. That was about 3 months ago.

I was already waiting to see a consultant for my ttc issues and was put on letrozole which I have taken this cycle for the first time.
I have now been spotting 3 days which I thought was implantation (excitedly) however doing lots of reading it looks like it's period spotting.

Keep pushing for your answers and help.