QuestionHi, my name is Morgan and I am from Houston. I stopped taking combination birth control back in August of last year. I got the withdrawal bleed like normal as soon as I stopped it, and then had a normal period in September. After that, nothing. So, in January I went on provera for 10 days, and I got the withdrawal bleeding after about 7 days of completing it. But, come February, nothing. So what happens now? Do I need to just keep trying with the provera for another round and hope my normal ovulation kicks back up, or do I need to try clomid? I know clomid is used to induce ovulation, so is it more likely that your body would start doing it on its own after taking the clomid than just provera by itself? Before I started on birth control I had my period every single month like clock work, I had been on birth control for about 2 1/2 years before stopping it. thank you so much for your help!!
AnswerHello Morgan from the U.S.,
You are manifesting and ovulatory dysfunction. I cannot tell you exactly what is going on without doing some tests, but by now, your ovaries should have returned to normal. The provera is artificially causing a withdrawal bleed ie causing your uterine lining to slough, but is not correcting the basic problem. If it had only been a month or two, even up to three, I would recommend that you just wait, but since it has been over 6 months, it is time to do something productive. If you are trying for pregnancy, Clomid is an option, but before progressing to that treatment, you need to find out what is causing the ovaries to not functioning correctly. There are several possibilities like hypothalamic problems, pituitary problems, thyroid problems, in addition to, ovarian problems. An investigation needs to be done. If your gynecologist is comfortable with evaluating and treating hormonal disorders such as yours, then he/she would be appropriate to do the evaluation. You can know this by asking if your doctor uses injectable gonadotropins. This would be used with hypothalamic, pituitary and some ovarian disorders. If your doctor only does Clomid, then I would be worried that you are not getting a sufficient evaluation or treatment plan. In that case, you should go see a sub-specialist called a reproductive endocrinologist. This specialist has additional training and expertise in reproductive (women's) hormonal disorders, as well as, can provide advanced fertility treatments.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
