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Cause of spotting during ovulation and free fluid in cul de sac?

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Practicing since : 1999
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Hi, I had a transvaginal ultrasound. Everything looks normal except free fluid in cul de sac. No findings. It is small amount of blood. I am 33 years old. No children. Married for 6 years. Not sexually active in the past 2 months. I went to the doctor because I have spotting during ovulation. The doctor is trying to find out the causes. I am going to see a obgyn this afternoon. Very nervous, I hope I don't have cancer.
Posted Mon, 10 Mar 2014 in Women's Health
Answered by Dr. Timothy Raichle 1 hour later
Brief Answer: Hello, I would be happy to help... Detailed Answer: First of all, the chance of cancer is extremely unlikely. Do not go in with the assumption that this might be cancer - it is not high on the list at all given your young age. Second, consider this: leading up to ovulation, there is a steady rise in estrogen levels. This peaks with ovulation and then there is a brief, abrupt drop in estrogen that is sometimes associated with a small amount of breakthrough bleeding just as you have described. So, in the setting of a 33 year old, not on birth control pills (meaning you are not suppressing ovulation), with a normal ultrasound and mid-cycle spotting, then this all might just be normal and nothing to really worry about. Third, other common causes of spotting that is unrelated to your cycle includes uterine polyps. This is best evaluated with a followup ultrasound called a "sonohysterogram". This is where a small amount of fluid is put into the uterus and the presence of small polyps is easily determined. If they are present, then they can easily be removed with a procedure called a hysteroscopy. I often see patients who see a doctor for your complaint and they offer an IUD as an option. This is a great idea, BUT you really should have the sonohysterogram first. If there are polyps present, then the IUD will only make things worse. Do not be nervous. This is a common complaint. If your doctor is not clear on their explanation, or if their plan just does not make sense, then consider re-asking me about the plan after the visit and/or seek a second opinion. Good luck today!
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