With shaking fingers, I carefully unfurled a period pad and placed it into my underwear. It was the day of my grandfather’s funeral last August, and the pad was a precaution against any potential bloodstains – but I wasn’t on my period. Nowhere close, in fact. I was ovulating.
“Ovulation is the process by which a mature egg is released from one of the ovaries and becomes available for fertilisation by sperm,” says Cesar Diaz-Garcia, IVI London Medical Director. “The egg is released from a structure called a follicle, which essentially is a small liquid bag measuring around 2 cm. During ovulation the follicle bursts, releasing the egg.”
Diaz-Garcia outlines symptoms of ovulation as including mild pelvic pain; cervical mucus changes, with mucus becoming “clear, slippery, and stretchy, resembling raw egg whites”; increased basal body temperature; breast tenderness; and heightened libido.
I experience most of these ovulation symptoms each month. What I also get, though – during times of increased stress or anxiety – is blood. Sometimes, it appears as streaks of brown or small, stringy lumps of black mixed in with the discharge; other times, as spots of bright red.
I first noticed strings of brown that quickly turned to (what felt like) torrents back in mid-2021, when I was very stressed at work – constantly behind on deadlines and perpetually terrified I was about to be fired. I noticed some bright red blood again towards the end of that year, when I was ovulating while getting a long-haul flight; I’m a very nervous flyer and it was my first flight in two years.
“Ovulation bleeding is said to occur in about 5% [of] people,” says Dr Shazia Malik, Consultant Gynaecologist and Obstetrician at The Portland Hospital, part of HCA Healthcare UK.
“Also known as mid-cycle bleeding or ovulatory spotting, [it’s] where a person experiences light vaginal bleeding or spotting during the time of ovulation. It occurs around the time of ovulation [typically 12 to 16 days before the start of the next menstrual period] and can last for a day or two.”
She adds that the bleeding can manifest as “light pink or brown spotting, watery or mucus-like discharge with streaks of blood or a few drops of blood on toilet paper”.
Malik goes on to explain that, while exact causes of ovulation bleeding aren’t fully understood, theories include: Hormonal fluctuations (more on this below); follicle rupture, when “the release of the mature egg from the follicle may cause minor trauma to the ovarian tissue or the lining of the uterus, leading to slight bleeding”; or cervical changes: “Changes in cervical discharge and cervix position around ovulation can sometimes cause minor irritation and spotting.”
Fluctuating hormones is the theory favoured by Dr. Claudia Pastorelli Mosca, Gynecologist and Obstetrician [and] Medical Advisor at Flo Health, who says: “Typically, ovulation bleeding is caused by the natural and expected changes in hormone levels throughout the menstrual cycle, specifically the shift from high oestrogen levels to low levels that happen around ovulation, and that may cause the endometrium – the inner lining of the uterus – to shed slightly.”
But there could be an underlying cause, too, and this is crucial to acknowledge.
“Some types of ovarian cysts, such as functional cysts, can cause bleeding when they rupture, which might coincide with ovulation,” Malik explains. “Conditions like cervical polyps or infections can [also] cause bleeding [and] certain medications, such as blood thinners or hormonal contraceptives, can lead to spotting.”
It’s vital to get any possible underlying cause investigated immediately. I had a scan back in 2021, which indicated a ‘normal womb’ and ovaries that are also ‘completely normal’.
My most recent cervical smear was last year and that came back all-clear, too. No cause of my ovulation bleeding has ever been confirmed, though – which left me to assume that it must, in some way, be down to stress.
While we prepared for my grandad’s funeral last August, my anxiety levels were skyrocketing. The previous day, I’d struggled not to cry any time I attempted to speak; that morning, I’d felt the tears and panic hovering behind my face, straining my throat. I’d come to expect the ovulation bleeding during times of stress by then; but it got so pronounced during this time that I didn’t want to risk standing up to deliver my funeral reading without a period pad securely in place.
But there’s no evidence to indicate that my period pad was necessary that day because of my high stress levels. “There is no evidence to suggest a link between ovulation bleeding and stress,” Pastorelli Mosca confirms.
“While stress can impact the menstrual cycle, there isn’t strong evidence to suggest that it directly causes ovulation bleeding,” agrees Malik (in fact, one way that chronic stress can – ironically – impact the cycle as a whole is through anovulation, where “ovulation doesn’t occur”).
She concludes that ovulation bleeding is more likely associated with hormonal and physiological changes related to the ovulatory process itself – reiterating that “variations in oestrogen and progesterone levels can affect the uterine lining and lead to spotting.”
I then told the experts about my own experience of ovulation bleeding, and the inescapable fact of it tending to occur during times of high stress or anxiety. In reply, Diaz-Garcia emphasised “the complexity of providing specific insights without the benefit of a comprehensive consultation and physical examination”; and added: “It is crucial to bear in mind the delicate nature of the external portion of the cervix, which can render certain individuals more susceptible to ovulation-related bleeding.”
That said, he posited: “Based on the recurrent pattern of bleeding coinciding with your menstrual cycle, it is reasonable to hypothesise a hormone-related connection.”
And on that theme: “Cortisol is a stress hormone released via the adrenal glands – and it goes up at times of increased stress,” Malik, in turn, replied. “This can reduce levels of oestrogen and testosterone – which in turn can then affect the womb lining and cause spotting.”
It’s something – this hormonal link could explain why I was sitting in a toilet cubicle fumbling with an Always-Ultra pad just before I was escorted into a funeral car.
Ultimately, though, there still isn’t enough evidence to establish whether stress could be a direct cause of ovulation bleeding. I suspect, but I don’t know – and it’s vital that nobody ever self-diagnoses.
“Light spotting can be absolutely normal, but any bleeding should get checked by a doctor to rule out any other causes,” says Pastorelli Mosca. “Particularly if the bleeding during ovulation [lasts] longer than a day or two or is particularly heavy, or followed by severe pain.”
Diaz-Garcia agrees – adding that the pap-smear is of paramount importance –and Malik, too, says the same, emphasising that you should always consult your GP if: You’re experiencing new or regular mid-cycle bleeding; the bleeding is heavy, persistent or accompanied by pain; you’re trying to conceive and experiencing fertility issues; or if you have other unusual symptoms, like fever, chills or foul-smelling discharge.
For me, Diaz-Garcia recommended considering the following course of action if the issue persists or occurs frequently: “An examination of your cervix, a potential Pap smear (if your last one was conducted over two years ago), an ultrasound scan, and hormonal assessments, specifically around the time of ovulation” – some of which I’ve done, and some I haven’t.
At first, I was disappointed that none of the experts I interviewed for this piece said ovulation bleeding could be down to stress. Then I realised I shouldn’t be disappointed, I should be thrilled – because women’s health issues are too often dismissed as ‘stress-related’. In a world in which medical gaslighting is all too common, how brilliant is it to hear from experts who are adamant that – while likely harmless – this bleeding shouldn’t be dismissed as stress and always requires thorough examination?
So please, don’t put ovulation bleeding (or any bleeding at all) down to stress without getting it properly checked out. And if anyone tries to dismiss it outright as stress- or anxiety-related – well, if we’ve learned one thing, we’ve learned that it’s far more complicated than that. Tell that healthcare professional to try again, and to do better.