Spotting before period

  My wife had an early miscarriage 10 weeks ago (without any bleeding!).
  She is now charting her basal temps as we try again.  She appears to have ovulated (predicted and
  consistent rise in temps) approximately 2 weeks ago.  Approx one week ago
  she began spotting and light bleeding.  We thought that this might be
  implantation bleeding.  Her temps remained in the high post-ovulation
  range.  Yesterday her temperature dropped and she began bleeding more
  heavily so we assume this is her period and she is not pregnant.
  The question is, what might have caused the early spotting/bleeding?  We
  are concerned that it might indicate a progesterone deficiency but
  thought that temps do not usually remain high when there is a prog.
  deficiency.  What do you think happened?
Dear Tom:
Premenstrual spotting in a single cycle is very hard to explain. You have touched on two common issues: implantation bleeding and luteal phase defect. The former is suspected when pregnancy occurs. The only proof would be an ultrasound study that showed small amounts of old blood near the implantation site. Most often, it is a speculation.
Luteal phase detect (progesterone deficiency) cannot be diagnosed from a temperature record. One must either measure the progesterone level in blood or sample the endometrium to assess its histologic (appearance under a microscope) development. In studies done in the 1960s by the late Dr. Israel in Philadelphia, 19% of women studied in single, random cycles had a luteal phase defect.  When observed in a second cycle, only 1/38 of these women demonstrated a luteal phase problem twice in a row.
Thus, the odds are in my favor to guess that this was a random, progesterone-deficient cycle.
Keyword: premenstrual spotting
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