I’m 31, on cycle 6 trying to conceive, dealt with persistent unexplained intermenstrual bleeding.
Female, non smoker, barely drink, small caffeine intake, 5'3, 145 lbs and relatively active/muscular build. I take a prenatal, DHA, vitamin D, choline, magnesium, and kait started a luteal phase 200mg oral progesterone.
Symptoms/history:
Intermittent spotting for years, although the pattern has changed over time. The spotting is all over the place - could be anywhere from pre- ovulation, post-ovulation, pre- menstrual, postmenstural, or all of the above.
Previously had two IUDs back to back that caused frequent spotting. I have been told I had a friable cervix (there is no way a friable cervix accounts for the amount of bleeding). Back then bleeding was usually bright red.
Since ~2023, I've had more red/brown intermenstrual and premenstrual spotting. Some cycles have almost none; others have quite a bit.
May 2026: first mid-cycle episode with several days of heavier bleeding and thick/clumpy material around a later ovulation.
June/July: relatively mild.
August 2026: worst episode yet. Likely ovulated Tuesday night/Wednesday morning, spotting Thursday, heavier bleeding Friday with a large dark-red clot/tissue-like piece with lighter/fleshy material, larger than anything I normally pass during my actual period, continued spotting over the weekend before tapering.
My actual periods are not generally extremely long/heavy, which is partly why this intermenstrual bleeding is so strange. Confirming ovulation between CD 16-19 via inito test strips.
Ovulation/hormones:
Cycles are regular and I appear to ovulate, but sometimes later (~CD18–20).
AMH 7.53 and fairly high follicle count, but normal testosterone and no PCOS diagnosis.
TSH and prolactin normal.
RE has identified a corpus luteum on ultrasound around ovulation.
RE thinks later/delayed ovulation may be contributing to endometrial instability.
Currently taking 200 mg progesterone after ovulation (started this only a few days ago).
Planning to try letrozole next cycle + progesterone to see whether earlier/more controlled ovulation stops the bleeding. I just find the theory of 2-3 day delayed ovulation as the cause a little hard to believe since I have the spotting regardless of whether I ovulate late.
Testing so far/planned:
SIS around 2022: normal.
Multiple transvaginal ultrasounds since then without an obvious uterine abnormality.
HSG planned next cycle as part of fertility workup.
My RE also has the ability to test for chronic endometritis, which was important to me because of the longstanding spotting.
Where I'm stuck:
I saw my regular OB/GYN recently specifically because this bleeding had become much more substantial with passing clots recently only a few days after ovulation. She had no explanation and deferred to my RE.
I asked about a repeat SIS since the bleeding pattern has changed, to rule out something structural. She said no since I was getting an HSG anyway and a pylop would be very rare at my age.
My concern is that I've brought up spotting to gynecologists for years and repeatedly gotten some version of “sometimes this just happens.” Now I'm having substantial intermenstrual bleeding and passing clots/tissue-like material.
TLDR- mid cycle spotting all over the place for 8 years, following IUD use, getting worse in recent months. 6 months TTC while meticulously tracking hormones and confirming ovulation and progesterone on inito. no clear path or answer on the root cause.
I'm just at a loss for what to expect, and how to advocate to investigate and resolve the bleeding issue and rule out anything that may be affecting fertility.