Women's Health Community

Dear An: If your spotting begins about cycle day 14 (cycle day 1 being the first day of your last period), the most likely cause would be bleeding with ovulation. Right before ovulation there is a brief spike of estrogen. When this level drops back down to normal, the sharp decline can destabilize the lining of the uterus leading to spotting/bleeding. Some women have this sign of ovulation every month; others only rarely. Fortunately the amount is usually scant and brief in duration.

Some other possible causes of erratic spotting can include a new chlamydia infection (unlikely if you are both monogamous). polyps of the lining of the uterus (way more common in midlife women), or missed/erratic ovulations (usually there will be a history of missed/irregular periods). Given your prior use of DepoProvera your MIGHT be having missed ovulations and/or the lining of the uterus is less stable because it is still thinned out from lingering Depo effects.

Certainly if you were started on some other form of hormonal birth control (pill/patch/ring/Mirena) the most likely explanation would be "normal" breakthrough bleeding/spotting due to the hormones in the birth control.

If your erratic spotting persists, or you develop other symptoms (eg pelvic pain from an infection or ovarian cyst) see your GYN or local family planning clinic. They can give you the most "for sure" answer.

Yours,
Jane