QuestionI am 30. I had been on the Pill for 12yr when I went off in mid Sept as I am starting to TTC. I have not had a period since then. My OBGYN gave me Provera on 12/29 (10 mg/10 days). I did not get a period. I called and they prescribed me another round which I started 1/25. On the Pill I had skipped maybe a total of 3 periods total over the last year, never consecutively. My BMI is 19 and I exercise regularly. My OB told me not to change anything at this point, but I have decreased my cardio.
My concern now is WHY I didnt respond to Provera, if there are other issues at work here. My concern has now shifted from TTC to TTfigure out what is wrong wih my body. How common is it to not respond to Provera the first time? And how likely is it that I will get a "regular" period/ovulate after the "witdrawal" period?
AnswerHello Mandy from the U.S.,
In general, provera is given as the first line medication to induce a period but when it does not work, that is an indication that there was no uterine lining to slough (which is what causes the bleeding in a period). The next step is to have the patient take the birth control pill two to three times per day for one pack and the period will usually start. This is proof that there is no anatomical cause preventing a period, and basically leads to a lack of estrogen stimulation. Tests will then need to be done to see what the base hormone levels are. Of course, all this assumes that you are not pregnant, and before even giving provera the first time, a blood pregnancy test should have been done. If it hasn't then that is the first step before any other medications.
With the shortened birth control cycle, there should be a period within 7 days of taking the last active pill. Once the period starts, a hormone panel (Estradiol, FSH, LH, TSH, Prolactin) should be done on the second or third day of the cycle. This will usually make the diagnosis as to where the defect is. An reproductive endocrinologist would be the person to see for this problem, even if it isn't strictly a fertility issue.
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
