What are the causes of intermenstrual bleeding during ovulation?

From the Guidelines

Mid cycle bleeding, also known as ovulation bleeding, is primarily caused by ovulatory dysfunction, which can be due to various factors such as adolescence, perimenopause, lactation, pregnancy, hyperandrogenic conditions, hypothalamic dysfunction, hyperprolactinemia, thyroid disease, primary pituitary disease, premature ovarian failure, iatrogenic, and medications, as stated in the guidelines by the American College of Obstetricians and Gynecologists (ACOG) 1. The causes of mid cycle bleeding can be categorized into structural and nonstructural causes, as described by the PALM-COEIN classification system, which includes polyp, adenomyosis, leiomyoma, and malignancy and hyperplasia as structural causes, and coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified as nonstructural causes 1. Some key factors to consider when evaluating mid cycle bleeding include:

• Hormonal changes, such as the rapid drop in estrogen levels just before ovulation, which can lead to temporary instability of the uterine lining and slight shedding
• Follicle rupture during ovulation, which can cause minor bleeding
• Hormonal contraceptives, such as birth control pills, which can contribute to breakthrough bleeding, especially during the first few months of use
• Other potential causes, such as sexually transmitted infections, pelvic inflammatory disease, endometriosis, uterine fibroids or polyps, and in rare cases, certain cancers It is essential to note that while ovulation bleeding is typically light (spotting) and lasts only 1-2 days, any bleeding that is heavy, prolonged, or accompanied by severe pain, fever, or unusual discharge should prompt medical attention, as stated in the guidelines by ACOG 1. Tracking your menstrual cycle can help determine if bleeding is truly related to ovulation, which typically occurs around day 14 of a 28-day cycle, and most mid-cycle bleeding is benign and resolves on its own, but persistent or concerning bleeding patterns warrant evaluation by a healthcare provider 1.