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Spotting one week after ovulation

by Emily
(Oslo, Norway)

I had a miscarriage a year ago and have failed to fall pregnant since. After reading Wheat Belly, The Vitamin D Solution and Good Calories, Bad Calories, I have changed to a low-carbohydrate, high-fat diet for the last two months and I am spending time in the sun to increase my vitamin D level. I do feel better for it, but after reading this website I realise I'm more than likely suffering from estrogen dominance. For the past 5-6 cycles I have been spotting up to a week before my period starts and I have a host of other symptoms (scored 53 on the questionnaire).

This cycle I started using NatPro cream at approx. 250-300mg/day (I started applying the cream as soon as my fertility monitor registered a peak in fertility, so at least 24h prior to ovulation). A lot of my symptoms have cleared up and I'm feeling very calm, however, today I've started spotting, one week after ovulation. Since this is my first cycle using NatPro cream, should I just accept that pregnancy is unlikely this month? Would you recommend increasing the dose straight away or wait to increase it until my next cycle? I am more than willing to try 450mg/day, but am worried that since I'm already spotting, that implantation is unlikely to occur this cycle.

Please, any advice would be greatly appreciated.

Emily

Comments for Spotting one week after ovulation

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May 10, 2013
 Extra info
by: Emily

I forgot to mention that I'm turning 35 and that when I miscarried I was breast feeding my 5 month old daughter. I stopped breast feeding when she turned 12 months (4 and a half months ago), but have continued to produce milk. Since my miscarriage I have had regular 26-28 day cycles, however, like I said, I always spot up to a week before. Switching to a low carbohydrate diet 2 months ago (no grains, legumes, or refined sugar) has greatly improved both my mood and ability to concentrate and reduced my headaches, but I still suffer from a bloated stomach and I experience cramping almost immediately following ovulation. I can only assume I ovulate since I continue to have a rise in temperature from day 14 and my fertility monitor always indicates low followed by high followed by peak fertility. As much as I would like to conceive straight away, I am willing to use NatPro for 2-3 months straight without a break using at least 400mg/day.
May 10, 2013
 Spotting one week after ovulation
by: Wray

Hi Emily I'm delighted you've changed to a low carb/high fat diet. If you want more reading you might like to see our page on Nutrition, there's a link to the Paleo Diet. You might also like to look through the Basic Ketogenic Diet too. Please have a vitamin D test done, living in Oslo at nearly 60 degrees north, you won't have much chance of making vitamin D from the sun, except at the height of summer. The sun's rays are too oblique to have much affect, the best gauge is your shadow. If it's shorter than you then you are making it. Having read Holick's book you might like to see this amusing video he did. It's interesting you have these symptoms now, as many women find once they stop breast feeding adverse symptoms occur. After giving birth progesterone drops precipitously, causing some to go into PND, I was one. Normally the high level of oxytocin produced by the body helps. It's a feel good hormone, but needed to contract the nipple to let down the milk. The other hormone that increases is Prolactin which is needed to actually produce the milk. As you are no longer feeding, your oxytocin has dropped, but you are still secreting milk, which means your prolactin is high. Please read through the page I've given on this, it is an inflammatory hormone, having adverse side effects. Oestrogen stimulates it's production. Both progesterone and the amino acid tyrosine suppress prolactin, while the progesterone suppresses oestrogen too. Spotting does indicate your progesterone has dropped, so implantation is unlikely. It can take time to adjust the cycle, we do have more info about a defective luteal phase on our Pregnancy page. You might like to read this page here too. Starting the progesterone 24 to 48 hours prior to ovulation is perfect. A high initial rise in progesterone is essential for implantation. Continued below
May 10, 2013
 Spotting one week after ovulation Part 2
by: Wray

Hi Emily Before you increase the progesterone or change anything, please have a vitamin D test done. A lack of this reduces the benefits of progesterone. I'm beginning to think it's almost pointless using progesterone if vitamin D is not high enough, see here, here and here. There are two videos on vitamin D on the pregnancy page I've given you, it's vital for ovulation, conception, the growth of the foetus and for breastfeeding, please take a look at them. A lack of vitamin D also causes miscarriages, see here, here and here. Take care Wray
May 12, 2013
 Update
by: Emily

Interestingly, I was eating a paleo diet when I fell pregnant with my daughter (first month of trying) and when I fell pregnant for the second time while breast feeding (and subsequently miscarried). Unfortunately, at around the time I miscarried I had started eating a high carb diet again and I can't help but wonder whether I would have been able to successfully fall pregnant again if I had continued on the paleo diet.

I am due for a doctors appointment tomorrow and I will request a vitamin D test. I have, however, followed Holick's advice and since February I have been regularly visiting the solarium and from his Sensible Sun Tables I have calculated that I receive at least 20,000 to 30,000 IU of vitamin D per week and understand that this is the equivalent of 40,000-50,000 IU of vitamin D in a supplement since the vitamin D from the sun lasts twice as long in the body.

Regarding my spotting, it only happened that one time and it was a very small amount of blood and was not followed by any more. Also, for the first time in 5 months, I have not experienced any cramps! I do find, however, that my hands and feet are very cold right now and unless I'm using the cream every couple of hours, my arms and legs are incredibly itchy. Unless I have some sort of liver malfunction I'm presuming that I may not be using enough cream. When my NatPro arrives in the post I will experiment using around 400mg per day.

Assuming I am not pregnant this month, do you suggest I use the cream daily for a few months without a break or do you think I should continue to use it from just before ovulation and for the entire length of my luteal phase? Also, I did not test positive with my daughter until I was 5 weeks pregnant. After reading another lady's comment, I understand that continued use of NatPro at my current dose may suppress menstruation completely? Is that correct? If I'm not pregnant, when do I stop using the cream?

Following the advice on your website, if I ever do fall pregnant again, I plan on continuing using NatPro cream throughout the entire pregnancy and after I give birth. Do I understand correctly that using NatPro cream after delivery does not adversely affect milk production?
May 13, 2013
 Update
by: Wray

Hi Emily Well that first para of yours I find very interesting. This paper here has just come in. Although the study was on IVF, the implications are the same. Less carbs and more protein result in a far greater chance for a successful implantation. I didn't realise you had been visiting a solarium, I thought it was only from the sun you were getting the vitamin D. I hadn't read about the sun versus oral vitamin D being so different. Holick has discovered so much about vitamin D I tend to believe what he says! I misunderstood about the spotting, I thought it was a regular feature of your cycles now because you said "For the past 5-6 cycles I have been spotting". I'm delighted the cramps have stopped. The itching can be a symptom of oestrogen dominance, it occurs naturally in some women the few days before they bleed. This is when oestrogen levels are higher than progesterone, which has begun dropping sharply. I only recommend using progesterone daily if symptoms are severe, or if they come back in strength when taking a break. I'll have to leave it to you to decide on whether this is the best route to take, or to continue to follow your cycle. If you continue to follow it, then when you next bleed stop using the progesterone. I've found 400mg/day will stop bleeding in most women, and of course using it daily will prevent ovulation. Even 200mg/day will, please bear this in mind. I'm really pleased you want to continue using progesterone throughout your pregnancy, it does make for a more intelligent child! We've not found, nor has Dr Dalton, that using progesterone after pregnancy stops milk production. There don't appear to be any studies on it having looked for them. Unless you get PND, you could continue to use 100-200mg/day successfully. With the drop in progesterone at birth, both oxytocin and prolactin rise. Large amounts of progesterone will suppress these, as it does while we're pregnant. Take care Wray
May 18, 2013
 Still waiting on results
by: Emily

Hi Wray,

Thank you so much for all the information you've provided so far (although the link to the recent paper regarding low carb and IVF has a password restriction). I am still waiting for my recent blood test results for my vitamin D level, but I would like to update you with my progress since I last wrote to you.

As I mentioned before, I initially started using 250-300mg NatPro per day from the first day that my fertility monitor registered a peak. At 7 dpo I had a one-off spotting and this is when I originally wrote to you. What you originally understood is correct, for the previous 5-6 cycles I have spotted up to a week before my period arrives. At the time of writing to you I presumed this cycle was a repeat of my previous cycles. However, I was pleasantly surprised that the spotting on 7 dpo was an isolated incident, NO spotting has occurred since.

On 10 dpo I increased my dose of NatPro to 400mg per day and at this dose all itchy skin symptoms stopped and I have felt great. However, at 14 dpo I took a pregnancy test and it was negative. At 15 dpo I reduced NatPro to 333mg and today (16 dpo) I will reduce it by a further 1 ml (to 300mg). I plan on reducing my dose by 33mg/day until I'm using 200mg/day. I am still testing negative for pregnancy.

So now I need some words of wisdom to help understand why my period has not started. I understand from what you've said that 400mg per day is enough to stop all bleeding and I presume by this that you mean menstruation as well as spotting. What I need to know is, HOW does this dose stop menstruation? If the luteal phase is 12-14 days (max 16 days) and the corpus luteum can only be saved by hCG produced by a fertilized egg following implantation, how does progesterone delay the onset of a period? I need to understand from a cellular level what is going on.

Under the section Pregnancy Problems, it has been advised that for a defective luteal phase, 400mg/day from ovulation may be needed to extend the luteal phase (I am assuming to 12-14 days), depending on symptoms. It then follows, that if bleeding occurs, to stop using progesterone, as either fertilisation or implantation has not occurred. Contrarily, if bleeding has not started 14 days following ovulation, to continue using progesterone on the chance that pregnancy has occurred.
May 18, 2013
 Continued
by: Emily

So my question is, why is it necessary to stop using progesterone beyond the 14 days if pregnancy has not occurred in order to bring on menstruation? Since its not possible to lengthen the luteal phase beyond 14 days, what in fact, is delaying menstruation? I understand in theory that I could be pregnant regardless of my negative tests so far, but what's the explanation if I'm not? So far, the only thing I can deduct is that ovulation failed to occur, regardless of my fertility monitor results and my rise in BBT. Perhaps that's why I haven't been able to fall pregnant again in the last 12 months? Please help me resolve some questions if possible. I don't want to stop taking NatPro cold turkey in case I am pregnant. Should I continue dropping the dose down to 200mg/day and stay on that dose until my period arrives? If I still have negative pregnancy tests in a weeks time, I'm assuming I hadn't ovulated this cycle and I will stop using the progesterone.

Also (I'm sorry, you must be tired of this long narrative so far), I'm experiencing ovary pain, which started at 14 dpo. First it was my right ovary and the pain radiates down my right leg and today I'm also feeling tenderness on my left side. I hopefully have an appointment with a gynaecologist at the beginning of June, so I will be mentioning my ovary pain then.

Thank you Wray! So sorry for all my questions! But I so desperately want to fall pregnant again!
May 21, 2013
 Blood test results
by: Emily

Once I dropped my dose of NatPro down to 330mg/day, I started spotting and stopped using the cream completely. My period arrived two days later and it's full of clots and thick, dark blood. I also had black clots when I switched to low carb three months ago, so I'm guessing that my uterus was in desperate need of a flushing.

My blood test results from 11 dpo are as follows, unfortunately, no parameters were provided.

S-Vitamin D: 75
Vitamin D3: 75
S-Progesterone: 85
S-Estradiol- 17beta: 0.26
S-Testosterone: 0.8
S-Prolactin: 109

This cycle I plan on using 300mg/day NatPro from ovulation, which I look forward too.
May 24, 2013
 Blood test results
by: Wray

Hi Emily Sorry about the password restriction. It is possible to join Medscape for free if you look on their site, then you'll be given access. I'm delighted the spotting was a once off occurrence. I have found 400mg/day does stop excessive bleeding in most women, it can also stop the normal period occurring. Oestrogen builds the lining each month during the follicular phase. At the end of the cycle, the corpus luteum regresses, progesterone withdraws and levels begin dropping. This allows the MMPs to break down the lining. These are proteolytic enzymes which degrade tissue, in excess they cause inflammation and excessive bleeding and/or spotting. Progesterone inhibits both oestrogen, and the MMPs, hence the degradation of the lining once it withdraws. There's more info and papers on our Menstruation page. But if oestrogen is high, the MMPs will be too, as it stimulates their production. So low progesterone, but high oestrogen and high MMPs will mean the lining will continue to build up and be broken down at the same time. So using 400mg/day or more will inhibit oestrogen building up the lining, and of course the MMPs too. If you continued with the high amount and you weren't pregnant, it will stop ovulation in your next cycle, it acts as a contraceptive, see here. And you are correct in how to use progesterone if bleeding occurs or if fertilisation has taken place. It's most unusual to have pain in both ovaries at once. Pain does occur in 20% of women each month at ovulation, but the ovaries normally alternate, maybe in your case they don't! The Germans have a word for it 'Mittelschmerz' or middle pain, see here, here and here. You are right about the clots and dark blood, evidently your lining was not shedding fully each month. This could well explain your failure to fall pregnant. You could have been conceiving each month, but once the embryo hits the uterus the old lining is preventing it implanting. If there is still old lining in the uterus, it would be essential to make sure it's all out before attempting conceiving. So I suggest next cycle you use the high amount of progesterone and round about when you should bleed, stop using it. This should cause bleeding as it did this last cycle. You'll probably find more clots etc will come out. You might need to do it a third cycle, the thing to look for is fresh blood and no clots. Continued below
May 24, 2013
 Blood test results Part 2
by: Wray

Hi Emily We do have a page on Hormone Testing you could look through. Living in Norway they probably use nmol/L or pmol/L for measuring them, including the vitamin D. What I find puzzling is that all your hormones are on the low side, except for the progesterone, which is understandable as you're using it. Although the test was done 11 days after ovulation when all hormones are dropping. It should be done ±7 days after, or mid-luteal phase, so this might account for it. Your vitamin D is very low at 75nmol/L, the minimum should be 125nmol/L, better still if it's in the 175-250nmol/L range. Mine is currently 230nmol/L. Please consider taking at least 10,000iu per day to get it up quickly, the 5000iu is only a maintenance dose and won't raise levels fast. I would suggest you take about 2000mg/day taurine too, not only is this essential for a successful pregnancy, the growth of the foetus and for breast feeding, but low levels are found in any dysfunctional uterine problem, see here. These on pregnancy, see here, here, here, here, here and here. Take care Wray
May 30, 2013
 Need some reassurance
by: Emily

Hello Wray,

Thank you for your last feedback. I know you are a very busy lady and I really do appreciate the time you take to help answer my questions. After reading how to use progesterone on your website, on my last cycle I started using 200mg/day NatPro during the 50 hour preovulatory surge, i.e. on the first peak day registered with my fertility monitor. I understand that this is optimal if trying to conceive since the brain naturally releases progesterone during this time. Is it possible, however, that using this amount or more (300mg/day) during this preovulatory surge, could, in fact prevent ovulation? I understand that BBT normally spikes following ovulation due to the release of progesterone from the corpus luteum, but is it possible that I could detect a rise in BBT in an anovulatory cycle if I have been applying NatPro a day or two prior to when ovulation should occur?

This cycle I have been so nervous at the thought that I could prevent ovulation from occurring by using NatPro too early. Yesterday was my first peak on the fertility monitor and I also had complete ferning using the mini microscope. This morning I started using NatPro 300mg/day and I will be splitting the dose in order to use it three times a day. I need some reassurance that it will not stop me from ovulating! I would have waited until tomorrow for a (hopeful) BBT spike, but I felt like I needed to use NatPro today. So my question is, can progesterone cream prevent ovulation from occurring once the LH surge has already been detected?

Thank you Wray
Jun 01, 2013
 Need some reassurance
by: Wray

Hi Emily You could possibly detect a rise in temps when using progesterone during an anovulatory cycle, it depends on how much is used. I haven't found any study which has followed this line, and I doubt one will ever be done. They know progesterone is thermogenic from studying the luteal phase, but it matters not which form it comes in. I wish I could give you the link to the full paper I bought which shows the graphs of the changing hormones over that 5 day period. All I can do is give you the abstract, see J Clin Endocrinol Metab, 2011, Vol. 57 (4): 792-796 It says "The onset of LH and FSH surges was found to occur abruptly (LH doubled within 2 h). They were temporally associated with the attainment of peak E2 levels and occurred 12 h after the initiation of a rapid rise of P4." It's the "occurred 12 h after the initiation of a rapid rise of P4" which is interesting, suggesting it's actually progesterone and not oestrogen which causes the LH surge, which then initiate's ovulation. Without that progesterone surge, there won't be an LH surge, so ovulation won't take place. So I don't think you need have any worries. For contraceptive purposes it must be used at least 5 days prior to ovulation, to inhibit oestrogen's affect on the maturation of an egg. Take care Wray

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