I am 35 years and currently breastfeeding my 16-month-old. My period came back and lasts about 28 days. I bleed scantly at day 23 or 24 for one day and at day 28 the real bleeding starts. What causes the bleeding at day 23? Also, I took a ovulation test last month, from day 11 to day 15, without any result. Can it be that I am not ovulating at all?
The cause of the bleeding can be only surmised without a complete history and physical exam. The usual causes of abnormal vaginal bleeding are ovulation, infection, trauma, pregnancy or hormonal imbalance.
If infections such as vaginitis, chlamydia and cervicitis have been ruled out, then the most logical explanation in your case might be hormonal changes.
If you are not ovulating, which is a definite possibility, the typical rise in estrogen followed by the post-ovulatory peak of progesterone would not occur. You may have the initial FSH and estrogen increase but not in sufficient quantities to induce ovulation. Estrogen stimulation of the lining of the uterus is insufficient to stabilize the endometrium, making it fragile and easily disturbed. Then any decrease in estrogen levels will cause spotting.
The fact that you are having regular 28-day cycles, however, generally indicates ovulation, especially if associated with typical premenstrual symptoms. Taking your waking temperature (basal body temperature) every morning is a good idea to detect if you are ovulating.
Your age and the addition of the breastfeeding could be working together to cause hormonal fluctuations and could be causing the failure to ovulate.
A book called "Taking Charge of Your Fertility," by Toni Weschler, would be an excellent resource for you. She explains all the interpretations of the BBT and helps determine if ovulation is occurring.
Your care provider could also do an ultrasound and or endometrial biopsy, which would detect ovulation and its effect upon the lining of the uterus. Although very rare, bleeding could be a sign of a malignancy, which endometrial biopsy could diagnose.
I would recommend that if you are thinking about another pregnancy in the near future, that you consider weaning your baby (sad as this may be), start taking your basal body temperatures and, if the spotting continues, see your provider for a diagnostic workup.
I wish you the very best and hope all works out.
[Editor's note: "Taking Charge of Your Fertility" can be ordered online at Taking Charge of Your Fertility Use the search button to locate the book. If the book is not listed in the database, it can be special ordered.]
