There are often young women who have a small amount of vaginal bleeding a week or so after a normal period. They are often very nervous because they are worried about whether there is a gynecological disease. Especially women who are expecting pregnancy are more worried that this abnormal vaginal bleeding will lead to infertility. This midmenstrual bleeding may be ovulatory bleeding. Ovulatory bleeding is the most common type of midmenstrual bleeding in women who experience spotting or a small amount of vaginal bleeding in the middle of their menstrual period, i.e. ovulation, and is classified as ovulatory dysfunctional uterine bleeding. For a 28-day menstrual cycle, ovulatory bleeding usually occurs on days 14-16 of menstruation and varies with the individual menstrual cycle. For many animals, ovulatory bleeding is a natural phenomenon and a sign of ovulation. Of course, for humans, ovulatory bleeding does not occur under normal physiological circumstances, but it is not uncommon and may be encountered by many women. If ovulatory bleeding occurs only occasionally, there is no need to pay too much attention to it, let alone worry and anxiety. However, if this happens repeatedly, for several months in a row, you should go to the hospital for consultation. What are the clinical manifestations of ovulatory bleeding? 1. Uterine bleeding: It occurs in the middle of menstruation, and the bleeding time varies from 2-3 hours to last 1-2 days, and can stop on its own. The amount is usually less than the normal menstrual volume and can be manifested as spotting or white with blood. The color varies from light red to red, and sometimes it is only coffee-colored discharge. If the amount of bleeding is high, the same as the amount of menstruation, or if the bleeding lasts for more than 3 days, it is necessary to go to the hospital for examination to exclude other diseases, such as lesions of the vagina, cervix, endometrium and ovaries. 2. Abdominal pain: It can be mild or severe, manifesting as pain or discomfort in the lower abdomen in the middle of the menstrual cycle, and in some cases, it can also radiate to the legs, which is called “ovulation pain” and usually lasts for several hours. If the bleeding is combined with ovulation pain, ovulatory bleeding should be considered. 3. Infertility: Aborting sexual life due to ovulatory bleeding and missing the time to conceive. What are the causes of ovulatory bleeding? The causes of ovulatory bleeding are still inconclusive and may be related to the following factors 1. Bleeding caused by a drop in estrogen: Under normal circumstances, the menstrual cycle is controlled by the growth and development of follicles, ovulation, and the formation and degeneration of the corpus luteum. The endometrium grows, develops and sheds under the action of estrogen and progesterone secreted by the follicles and corpus luteum to form menstruation. Typically, only one follicle grows and develops to maturity during a menstrual cycle. As the follicle grows, the estrogen secreted by the follicle gradually increases, forming a peak just before ovulation. As the mature follicle ruptures, i.e. after ovulation, the estrogen level drops sharply and cannot sustain the growth of the endometrium, causing the superficial layer of the endometrium to locally collapse and shed, and a small amount of breakthrough bleeding occurs. Later, with the formation of corpus luteum, sufficient amount of estrogen and progesterone is secreted, and the ulcerated endometrial surface layer can be repaired rapidly and the bleeding stops. 2. Individual researchers believe that ovulatory bleeding is due to the secretion of more estrogen by the mature follicles before ovulation, resulting in a high degree of endometrial congestion and bleeding due to leakage of some red blood cells. 3. Some data suggest that the umbilical part of the fallopian tube takes in the egg during ovulation and at the same time takes in the blood-containing follicular fluid into the fallopian tube, which is sent to the uterine cavity with the peristalsis of the fallopian tube and flows out from the vagina. How is ovulatory bleeding diagnosed? When intermenstrual bleeding occurs, you should first visit a hospital for gynecological examination and ultrasound observation to rule out various organic diseases that cause vaginal bleeding, such as cervical polyps, endometrial polyps, endometritis, uterine fibroids, etc. After organic diseases are excluded, ovulatory bleeding will be considered. 1. Menstrual cycle: It is not difficult to make the diagnosis of ovulatory bleeding based on the fact that the bleeding occurs in the middle of the menstrual period and is accompanied by mild lower abdominal pain. For women with regular menstruation, it is easy to identify ovulatory bleeding; if menstruation is irregular, it is difficult to distinguish whether it is ovulatory bleeding or menstruation. Since ovulation usually occurs about 14 days before the next menstrual period, women with irregular menstruation should also consider ovulatory bleeding if the bleeding occurs about 14 days before the next menstrual period. 2. Measure the basal body temperature. If it is a biphasic body temperature and the bleeding occurs during the transition from low to high body temperature, that is, during ovulation, ovulatory bleeding should also be considered. 3. Ask your doctor to monitor follicle development as well as detect changes in hormone levels in the blood to analyze whether the bleeding occurs during ovulation. If the vaginal bleeding is prolonged and the amount of bleeding is also high, it may not necessarily be a problem of ovulatory bleeding. You are advised to pay attention to the amount, nature and duration of bleeding. If the bleeding is severe or lasts for a long time, more than 3 days, or even if there are other symptoms such as severe abdominal pain, suggesting gynecological diseases, you should go should go to the hospital early. In addition to routine examination, hysteroscopy is performed to determine the cause of abnormal bleeding if necessary. It has been found that even for people with no organic diseases of the reproductive organs on physical examination and ultrasound, about 40% or more of them are found to have endometrial polyps on hysteroscopy. Hysteroscopy not only provides a clear diagnosis, but also removes polyps for the purpose of treatment. Does ovulatory bleeding affect conception? Bleeding during ovulation is a sign of ovulation. If the bleeding is very little, like a drip, you can wash your genitals and have intercourse to catch the chance of conception. If the bleeding is heavy, sexual intercourse should be suspended to prevent the occurrence of infection, which will undoubtedly reduce the chance of conception. Early studies at Concord Hospital found that some people with ovulatory bleeding may have combined follicular dysplasia and luteal insufficiency, all of which can affect conception. Treatment of ovulatory bleeding Ovulatory bleeding is usually of low volume and short duration, occurring occasionally once or twice, and is not a health hazard. During the bleeding period, attention should be paid to rest and avoid overexertion; keep the vulva clean to prevent infection; apply heat to the abdomen when the abdominal pain is severe; prohibit the consumption of stimulating foods such as spicy, hot and dry foods during the bleeding period to avoid increasing the bleeding and prolonging it. It is important to realize that this is a common phenomenon, do not overstress and maintain emotional stability. You should strengthen your physical exercise to prevent ovulatory bleeding. If ovulatory bleeding is frequent and heavy, causing inconvenience to life and affecting sexual life and conception, treatment is needed. If there is no clear cause, a low dose of natural estrogen, such as Tegretol, can be started 3 days before ovulation until the usual bleeding period is exceeded. For those with a clear cause, aggressive removal of the cause is required, such as removal of the cervix and endometrial polyps. For follicular dysplasia and luteal insufficiency, ovulation promotion therapy is feasible to promote the development of follicles. Chinese herbal medicine is also very effective, and depending on the results of the identification, treatments such as Jia Wei Yi Yao Wan and Er Zhi Di Huang Tang are used. In addition, for ovulatory bleeding, some therapeutic diets are also effective. The following are commonly used. 1. Celery and golden needle soup – 30 grams of dried celery and 15 grams of golden needle. Add the right amount of water and take the decoction. It has the function of clearing heat and cooling blood. 2, celery and lotus root soup – fresh celery, fresh lotus root slices of 120 grams each, 15 grams of raw oil, a pinch of salt. Wash the celery, lotus root, celery cut into shreds, lotus root slices. Put the pot on a high fire, boil the oil, add the celery and lotus root slices, add the right amount of salt, stir-fry for 5 minutes, add the right amount of water to cook, season the essence and eat. Can clear heat, cool the blood. 3, yam wolfberry porridge – yam, wolfberry 20 grams each, 60 grams of rice. Wash, boil porridge for consumption. Has the function of nourishing Yin and stopping bleeding. 4, raw earth porridge – 30 grams of raw earth, 60 grams of round-grained rice. Wash and slice the raw earth, decoct it twice with water, take 100 ml of juice, wash the rice and add water to cook the porridge, pour in the juice and cook for 10 minutes. It has the function of nourishing the kidney, cooling the blood and stopping bleeding. In conclusion, every woman may experience ovulatory bleeding. If the bleeding is minimal, it can mostly heal on its own and no treatment is needed. From another point of view, ovulatory bleeding is a “signal” that ovulation is imminent or has already taken place, and if properly controlled, it can also be used for safe period contraception. If ovulatory bleeding is frequent and heavy, it will cause inconvenience to your life and needs active treatment.