What causes spotting in the luteal phase of menstruation?
Patient's Query
Hi doctor,
I suffer from spotting in the luteal phase, sometimes 10 days or more before my period. However, I have noticed that it does not happen when I take a combination of progesterone and estrogen (from my previous experiences with the fertility process).
My gynecologist told me to take Dydrogesterone 10 mg twice a day from cycle day 17, but today I woke up to urinate and found pink blood, and today is the 21st day of my cycle. I had mild camping, like the one that happened before my period yesterday night. What could be the problem?
Since the morning, there has been no spotting yet. But I am afraid that it will worsen, as this is what happens every cycle. But this time it is a little late (cycle day 21). My period started towards the end of two months ago and ended at the beginning of the last month.
After renal transplant, it has been in my life to sport before periods, usually 10 days before. Taking Dydrogesterone 10 mg alone did not stop it before, as I tried it. It gets worse. Would I need to take estrogen to stabilize my uterine lining or take a higher dose of progesterone to stop spotting if it worsens? I am taking Azathioprine, Tacrolimus extended release, and Prednisolone 5 mg previously. Please help.
Thank you.
Hi,
Welcome to icliniq.com.
Thank you for writing and I understand your concern.
Spotting, especially in the luteal phase (the second half of your menstrual cycle), is mainly due to hormonal drops (either estrogen or progesterone) after ovulation. It may occasionally be due to structural abnormalities like cervical or endometrial polyps. Ultrasound scans can help in the diagnosis of the latter.
For you, the spotting most likely is due to a drop in your estrogen post-ovulation. That is why complementary progesterone did not stop the spotting. The drugs you are presently taking post-renal transplant would have over time affected estrogen production in the body.
For now, provided you do not have any contraindications to combining pills (estrogen and progesterone), you should take it for six months. It will help regulate your hormone levels and subsequently stop the spotting. Also, you would need to do an ultrasound scan to confirm you do not have a polyp.
I hope that you get your answer.
Please let me know if you want more help.
Thank you.
The Probable causes
Investigations to be done
Patient's Query
Hi doctor,
Thank you for the detailed answer.
Everyone used to tell me that I have low progesterone, while I knew inside me that it was not the problem since it did not stop while taking progesterone alone. Instead, it worsened. I tried taking estrogen alone as well, but it did not stop until I started taking the two pills together.
Concerning polyps, I did multiple check-ups, especially transvaginal ultrasound, and there was nothing suspicious. So can I take Estradiol 2 mg and Dydrogesterone 10 mg, both twice a day at the same time? Please advise.
Thank you.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Estrofem (estradiol) is mainly used for hormone replacement therapy in postmenopausal women because it has a higher dose of estrogen when compared with regular combination contraceptive use in women who are not postmenopausal.
Why not start with YAZ PRO (Drospirenone and Ethinyl estradiol)? If you use it for two months, and you are still having spotting, then we will increase the dose of estrogen and progesterone.
I hope that you get your answer.
Please let me know if you want more help.
Thank you.
Patient's Query
Hi doctor,
Thank you for your advice.
Just to make sure, does this not affect the fact I am trying for pregnancy?
For this cycle, I took clomid on cycle day five to nine and did an Exem Foam (a procedure to assess fallopian tube patency in women with known or suspected infertility) procedure on cycle day 10 to make sure that my tubes were fine. I had a good amount of eggs, and one was mature.
The doctor advised intercourse the day after the check-up, and the day after. I felt ovulation pain throughout the cycle and was sexually active during the fertile days. All was good until cycle day 21 when I woke up and had pink blood during urination and today as well (cycle day 22).
The previous day, cycle day 20, I had slight abdominal cramps at night. I am not sure if there is any chance I could be pregnant, so I want to stop those spotting, and not lose that chance if there is. By the way, I took one tablet of Estradiol 2 mg yesterday night to act fast.
Thank you.
Hi,
Welcome back to icliniq.com.
I understand your concern.
The drugs will affect ovulation, as it is meant to prevent ovulation.
If you are trying to get pregnant, just stick to the Dydrogesterone alone after ovulation. It will increase your chances of getting pregnant.
After you get pregnant, the spotting will stop. The situation is we concentrate on getting pregnant for now as that is the one of more importance for now. I hope that you get your answer.
Please let me know if you want more help.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply. I will make sure to do that.
Thank you.
Hi,
Welcome back to icliniq.com.
Take the tablet Dydrogesterone, which is the most viable option as you are trying to conceive. Even without the spotting, Dydrogesterone is given 24 hours after ovulation in a Letrozole (aromatase inhibitor) influenced cycle. It is taken 10 mg morning and evening until pregnancy is up to 12 weeks, or if the period starts again. The spotting will gradually stop with each cycle.
I hope that you get your answer.
Please let me know if you want more help.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
Related Questions
Could altered menstrual cycle be related to intimacy?
Spotting due to Microgestin Fe is making me very uncomfortable. Please help.
Can spotting after 10 days of taking emergency contraceptive mean pregnancy?
Are irregular menstrual cycle, brown vaginal discharge, and bleeding after sex signs of pregnancy?
Should not my progesterone level be much higher in case of chemical pregnancy?
Could vaginal brown discharge be a sign of cervical cancer?
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.