Abnormal Uterine Bleeding, Infertility And The Role Of Assisted Reproductive Technology
Imagine waking up one morning to find unexpected bleeding, just days after your last menstrual cycle ended. Confusion quickly turns to concern, your next period is not due for weeks, yet here you are, facing blood again.
For countless women, this unsettling experience is more than a minor disruption; it is a symptom of abnormal uterine bleeding, a condition that can signal deeper reproductive health challenges.
Left unaddressed, it often intersects with infertility, forcing many to confront not only the physical toll but also the emotional weight of struggling to conceive.
In an era where assisted reproductive technology offers hope to millions, the conversation around abnormal uterine bleeding is no longer just about irregular cycles, it is about the broader journey of women navigating complex medical realities, societal expectations, and the promise of science to restore possibility where nature falters.
When unexpected bleeding otherwise known as mid-cycle spotting, or abnormal uterine bleeding occurs outside of your normal menstrual period, this can often be frightening. It brings up a range of emotions and questions you likely don’t know how to answer. Am I pregnant? Do I have a hormone imbalance? What is wrong with my body?
Abnormal Uterine Bleeding: Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Bleeding may be heavier or lighter than usual and occurs often or randomly.
AUB can occur: As spotting or bleeding between your periods. It can also occur at different times in the menstrual cycle, such as between periods or after sex.
AUB can also be described as vaginal bleeding that is irregular, heavy, or lasts longer than normal.
Mid-cycle spotting: Mid-cycle spotting is one of the most asked-about fertility concerns women approach us with. The concern is valid. As far as most of us learned growing up, you are only supposed to bleed during your period, not randomly throughout your cycle.
There is some truth to this, but there are also a few exceptions. I hope to help you understand the different causes of mid-cycle spotting, and learn to recognise what is normal and when it may be a sign that something is not quite right, which may warrant a trip to consult with your gynecologist.
Can Abnormal Uterine Bleeding Resolve On Its Own?
Such irregular bleeding usually resolves without treatment when the girl’s hormonal cycle and ovulation normalises. If irregular bleeding persists beyond this time, or if the bleeding is heavy, further evaluation is needed.
Causes Of Mid-Cycle Spotting
Abnormalities of the Cervix – Though rare, conditions of the cervix such as HPV or cervical fibroids may cause some slight bleeding mid-cycle. If the mid-cycle bleeding is accompanied by pain in the cervical region, it would be best to have your gynecologist check this out. Very rarely, abnormalities of the cervix may be cancerous.
Endometriosis – Some, but not all women with endometriosis report mid-cycle spotting. The cause is not completely understood, but it is speculated that a disruption in hormone signaling may be the culprit. Excess endometrial tissue under the influence of hormones may be given disrupted signals, leading to breakthrough bleeding.
Implantation Bleeding – Implantation bleeding can be the most confusing of all, particularly for women currently trying to conceive. The hope is that the spotting they are experiencing is a sign of pregnancy, and not simply another period.
Up to 1/3 of women who conceive will experience implantation bleeding. This occurs at about six to 12 days post-conception. The scant discharge, tinted a light pink to brown, is the result of the trophoblast (tissue that forms around the fertilised egg) implanting itself in the uterine lining.
The implantation may damage some of the blood vessels in the uterus, which may cause slight bleeding. Because the bleeding can come as late as 12 days post-ovulation, many women mistake this bleeding for menstruation.
Implantation bleeding is typically light and lasts anywhere from a one-time occurrence, to very light bleeding over the course of two days, at most. It doesn’t become heavier like menstruation bleeding does.
If you think you may be pregnant, take a pregnancy test. You can begin to test for early pregnancy with an at-home early pregnancy test at seven to 10 days past ovulation.
Ovarian Cyst Rupture – If you experience sharp pain on either side of your lower abdomen, followed by slight bleeding around the time ovulation should occur in your cycle, it may be a ruptured ovarian cyst. Ovarian cysts are a sign of disrupted ovulation, which may cause difficulties in achieving pregnancy.
Abnormal Uterine Bleeding Management
In general, medical options are preferred as initial treatment for AUB. For acute abnormal uterine bleeding, hormonal methods are the first line of medical management. Intravenous (IV) conjugated equine estrogen, combined oral contraceptive pills (OCPs), and oral progestins are all options for treating acute AUB.
Can One Get Pregnant With Abnormal Uterine Bleeding?
AUB can complicate the journey to parenthood by disrupting the regular menstrual cycle, which is vital for ovulation and conception. Women with irregular or absent periods may struggle to predict their fertile windows, making conception more challenging.
Note: See a doctor immediately if you have excruciating pain, nausea, vomiting, and/or bleeding from the vagina during any point in your cycle.
Dr Taiwo Orebamjo is an experienced Consultant Obstetrician and a medical administration expert from the Kingston Academy of Learning and Career College Canada. He is a post-graduate of the Royal College of Obstetricians and Gynaecologists, London. The Research Fellow in assisted conception at the St. George’s Teaching Hospital in Tooting London is also the Consultant Obstetrician &Gynaecologist, Medical Director, at Parklande Specialist Hospital & Lifeshore Fertility and IVF Clinic.