Bleeding throughout luteal phase

[pinacollama]

Hi everyone, posted this on the conception board yesterday but wondered if this might be a better place for it.

Does anyone have experience of this? I bleed every cycle from around 4/5 dpo, once as early as 3dpo. It’s light spotting, starting almost yellow, to pink and only when I wipe after bearing down (e.g after bowel movement). A couple of days before my period it gets marginally heavier and brown. I have had fertility investigations which have shown all is normal apart from polycystic ovaries. The consultant mentioned a possible hormone imbalance, but said “do you want to fix this or have a baby, we can’t do both”. The doctor I saw for my follow up said that they’re not concerned and don’t see that as a reason I’m not conceiving. They had to discharge us but have said come December, when we’ve been trying for 2 years, to request re-referral via the GP for IVF.

I don’t see how the spotting isn’t a problem and do feel it’s a likely hormone imbalance - isn’t it my lining starting to break down? How could implantation happen if it’s already shedding?

I had a chemical in January, apart from that nothing.

I’d be grateful for any similar stories/advice etc.

Hi @pinacollama

I'm responding because this is almost identical to my symptoms.

I get spotting in my luteal phase starting usually about 5dpo but anything from 3dpo onwards. It starts light - just a bit of colour on tissue, and gets gradually heavier towards my period. It tends to be pink or brown. I have been to the doctors about it in the past and it was investigated a bit but I was told it's not cancer and that's about it basically. When I started IVF last year my consultant said it's likely a progesterone issue - that my progesterone levels drop too low too quickly and so my lining starts shedding early. This made sense, but when I did my first IVF cycle I had the standard progesterone supplements and it made no difference, and then on my second cycle I had extra ones and it still didn't help. So that's not it.

I then went back to my GP and asked for further investigation and they referred me to a consultant gynae. He said it could be endometriosis and referred me for a hysteroscopy and laparoscopy. During those procedures they found a polyp, which they removed, and also diagnosed me with stage 4 endometriosis, which was quite a shock. I don't really have any symptoms and so thought if I did have it it would only be mild. I'm due to see a specialist in a couple of days to figure out what to do next (probably surgery), but it seems like the bleeding is almost definitely caused by the polyp / endo, so I'm hoping to see some improvements once I have some treatment. And after constantly being told we have unexplained infertility it now seems I have my explanation.

I just wanted to reply because if I were you, knowing what I now know, I would push your GP for a referral then push the gynae for a lap and hysteroscopy to investigate the bleeding. You never know what they might find. You may have to make a bit of a fuss to get one, but it's worth trying.

I also think you might find this link interesting about laparoscopies:
genesisresearchtrust.com/askrobert-questions-and-answers/laparoscopy-hysterosalpingogram/

I have pcos and nearly always got brown discharge around the same time in my cycle as you did. It can be a normal part of pcos as irregular ovulation can often thicken the lining - my consultant wasn’t worried but he had requested further testing. Has yours? Also laparoscopy’s for endo is only recommended when the endo is obvious in a hsg / other kind of test as the procedure itself carries an infertility risk - I know I have endo due to various bowel symptoms I have around my period but as my consultant couldn’t see it in an ultrasound he recommended against testing for it.

My endo had never been visible on an ultrasound at all - I've had loads. It's relatively silent. The only reason my consultant thought I may have it is slight tenderness when he examined me and the fact everything else has been investigated so by process of elimination that's what was left.

I've only had a diagnostic lap - no surgical treatment so far, so no risk to fertility. It's my understanding from research and speaking to my consultant that a lap only causes risk to fertility when any removal of endo is included and the removal is on or near the reproductive organs.

There is an infection risk associated with diagnostic laparoscopy which is why UK consultants tend to be wary about performing it for people ttc / undergoing IVF it it isn’t visible / no major symptoms. My consultant told me the infection itself can in some cases cause infertility. This is on top of the risks associated with removal.

Thank you both for your replies, they are really helpful. I had never considered that I might have endometriosis as I thought it would always have symptoms. Now I know otherwise, I think I will discuss further with my GP.

I'm pretty confused by it all if I'm honest. I was initially referred to both gynae and the fertility clinic. From the same scan, gynae said I do not have polycystic ovaries, and the fertility consultant said I do (and this was confirmed by another fertility doctor). The gynae said there was no reason for the bleeding and it was probably just stress . Having read the report from my pelvic ultrasound again, it is described as normal but mentions a cystic lesion which could be a collapsed haemorrhagic follicle or a small endometrioma - is this the same as endometriosis?!
It seems such a shame, and very costly option for the NHS, if I have to undergo IVF should there be treatable explanation for my infertility.

I've actually just sent a question to Robert Winston, what a great resource I'd never discovered before!

@Cariad82 - I hope your appointment with the specialist goes well and, if you have surgery, it helps. It really must have been a shock to find out that when you'd previously been told everything was normal.

@Teddybear45 I've never heard anything about an infection risk aside from the standard risk associated with any surgery. There's always something new to worry about isn't there?! Never ending. Luckily I seem to be fine. So far...

@pinacollama - it is all confusing. You just get overwhelmed with information and each new thing you find out about seems to open a can of worms.

I wouldn't be very happy with a 'probably stress' answer. That sounds like a load of fobbing off crap to me.

An endometrioma is a type of endometriosis yes - cysts on your ovaries. I think they also call them chocolate cysts because they are filled with old blood so it's dark brown colour. I don't have any endometriomas but I think they don't tend to touch them unless they're over 5mm. And removing them can cause damage to your ovaries and therefore egg reserve so they tend to avoid it if you're TTC unless it's desperately needed.

It seems crazy to me too that they send you for IVf without full investigations. They must have their reasons.

Yes the Robert Winston thing is awesome. Another mn user sent me a link. I wish he was our doctor!

Endometriomas are endometriosis. They also nearly always indicate that you have endometriosis elsewhere.

www.mdedge.com/obgyn/article/141398/surgery/endometriomas-classification-and-surgical-management/page/0/1

I developed the spotting you described this year, some time in the last six months. Definitely no PCOS, but I’ve just had surgery where they found Stage 3 endometriosis.

I had no symptoms either! My Mum had it, so I got it checked out privately.

I thought that spotting during luteal phase was caused by low progesterone causing the womb lining to break down earlier than it should, has this not been suggested?

@MajorFaffington That’s what I’ve thought was going on, and it’s still a possibility. I’ve mentioned it to the doctors and they just don’t seem to think it’s a problem. My day 21 progesterone level was 30, so they say that confirms ovulation, but then they don’t look at levels after that so who knows. So much to consider!

@jcurve thanks for your reply. This is interesting, I wonder why they didn’t let me know in the consultation about the possible endometrioma. I have been too anxious about it all recently so when the report came through last month I asked my husband to read it but then put it to one side, so hadn’t read through the details of the scan. I had been told it was normal so didn’t think it mattered I guess.

@Cariad82 I bet he’d be a fabulous doctor!

Interesting about the size of the endometrioma, my report says 30mm! I wonder if that’s a mistake.

Mine was 30mm and removed. I think Cariad82 might have missed a zero - 50mm is considered a large endometrioma which would be removed.

My consultant (who is better known for IVF but also does endo) strongly recommended a laparoscopy, so I’m not sure the infection/infertility risk is that high?

Just an update- my GP has agreed to refer me to the gynaecologist to investigate endometriosis. Hopefully they’ll take me seriously. He’s also ordered the relevant tests so we can be referred back to the fertility clinic for ivf.

I’m now stressing about my tsh levels which were classed as ‘normal’ at 3.39 but from what I’m reading they’re too high for conception?

Everything just feels a bit too much.

That's good that you have a referral. Hopefully they'll get to the bottom of things.

I know it's a lot to take in, but there are some really good resources on Fertility Friends. Have a look at this link and section 21.3 - all to do with thyroid. You might find it a helpful starting point.

www.fertilityfriends.co.uk/forum/index.php?topic=242395.20

Thanks @Iwouldbecomplex for the link, I’ll have a look through that this evening.

Hi all- just wanted to update and say thanks for your input a few months ago. You encouraged me to push to see a gynae, and I had a laparoscopy/hysteroscopy and dye test on Monday. Turns out I do have endometriosis - endometriomas on my right ovary and it was also stuck to my pelvic wall. No idea what stage that is, but the consultant said they didn’t see anything else. Thankfully my tubes were clear and uterine lining looked good.

Hi there, hope you are well and saw this old thread which says all my symptoms! I started spotting in luteal phase since march 2020, ranges from 3-7 dpo, Def 1 week before period came. Did blood tests, HyCoSy, hysteroscopy (polyps removed), day 21 progesterone test, all normall maybe endometrium a bit thick 12mm on day 12. Only didnt do laparoscopy as doctor said there was no evidence or symptoms suggest it. Wanted to see if you had any other symptoms apart from spotting? And will endometriosis impact fertility? Sorry for so many questions! Thanks 😊

@pinacollama will this affect conception?

I too have the issue you describe and got fobbed off back in 2019. They did pelvic scans and blood tests and found nothing. Said it must be hormonal and to go back on the pill. However I had come off that for ttc.
Fast forward to now and I've been referred for infertility. They are hoping to do IUI and she said they'll support me with progesterone because of the spotting. I queried that my day 21 test was ok so would it be that? She said it doesn't necessarily mean it's OK because of the blood test.

The reason I think it's not - i can sometimes spot from ovulation. So this makes no sense? I have tracked ovulation in the past with opks and bbt and my cycles are regular. I don't need to even do this now because I know I've ovulated as soon as I spot. Happened this month. Often it stops for a bit and then I get more later, but if unlucky I can spot the whole 14 days!
I've an internal scan booked next month. So- it'll be interesting if that shows anything.

Hello just saw your message. Wanted to check when you spotting and went back to pill then came off the pill, did the spotting come back? I.e. no spotting when on pill but as soon as you came off you back to spotting again? My doctors said it's hormonal and I was thinking whether to take pills for 2-3 months then see if this would stop when off the pill. Thanks!

@GQXX I didn't take the pill again, so I've no idea. However, I never spotted when I was on the pill. But I started as soon as I came off it and continued to do so. So actually- I would guess that it would stop it if I took the pill. But it would return if I stopped.

@GQXX I probably should point out i was on the progesterone only pill. So didn't have periods or any bleeding at all.
Prior to that I was on the combined one but it was a long time ago. No spotting though.

Hi, I also have spotting from about 7dpo and was diagnosed with endometriosis about 10 years ago by a laparoscopy. It couldnt be seen on ultrasound either.
I had fertility treatment 3 years ago and was put on clomid. The doctor seemed to think the spotting was related to me not ovulating. I still spotted with the clomid but I also got pregnant with my now 20 month old dd so possibly the spotting doesn't matter?
I'm now ttc dc2 and have the same spotting issue thought the bleeding is heavier, maybe because my cervix is more open?
Trying not to be concerned but it's hard not to be. I've been having private fertility treatment this time round and they have also dismissed it being a progesterone issue.
Sorry I don't really have any answers but hopefully it gives everyone a bit of hope!

@starfishy thank you for your information, sounds very positive sorry for my question but when you were diagnosed with endometriosis did you have any procedure to remove it? And would endometriosis impact fertility if not removed? I suspected it but doctor said no evidence suggests it but my mum had it so I was thinking if there is a thing in the family.

When you got pregnant with DD were you spotting at the beginning of the pregnant and then assume stopped at some point?

I have seen 4 different doctors all private now and all think spotting won't impact fertility, though I'm a bit doubtful of that.

Also my cycle is short, I would normally have ovulated by day11/12, I wonder whether this suggest poor egg quality