QuestionQUESTION: Hi Dr Ramirez I am Jane from Australia. I am 37 years old and my partner and
I have been TTC for a couple of months. I had an abdominal myomectomy in
January 2010 where my surgeon removed 14 fibroids, some of them were
quite large. Since then I have recovered well and my period returned one
month after the operation and is a lot lighter than it was prior to getting the
fibroids removed. I also maintained a regular cycle of about 24-25 days which
was what I have always had prior to taking the oral contraceptive for
contraception and heavy bloodflow.
Once I had recovered from the operation my partner and I decided we wanted
to try and conceive. I went in May to see my gyn and he suggested I have a
tubal patency test to see that everything was ok prior to ttc (along with a
sperm count test for my partner). I had the procedure in mid-June at an
ultrasound clinic on day 8 of my cycle and everything was fine. My tubes are
clear and my uterus is in good working order! At the time the dr could see
that I was just about to ovulate. I then got a period right on track 15 days
later. The problem is I haven't had a period since! Therefore I have affectively
skipped 2 cycles. I am not pregnant as I have done several home tests and
have had a blood test. Do you think the tubal patency test could have caused
ovulation to stop? I have done several ovulation tests over the past couple of
months and they never seem to indicate that I am ovulating. Or do you think I
could be entering peri-menopause? My mum had her last period in her early
40s and we both got our period at 11 years old so could this be possible? Any
light you can shed on my sudden lack of periods/ovulation would be greatly
appreciated! I understand that we have just started trying but I thought I'd
start the process now of looking into reasons. I also don't feel as though I am
stressed so I don't think that is the cause either. Thank you.
ANSWER: Hello Jane from Australia,
It is highly unusual for you to all of a sudden skip periods. It is not related to the myomectomy or the HSG. Something else is going on and an evaluation needs to be done to find the reason. That is where you need to start at this point. Your Gyn doc should be able to help you with this. An ultrasound will need to be repeated to check for an ovarian cyst, that could be keeping you from ovulating, I would repeat the blood pregnancy test again, I would give you a medication called Provera for five days to start a bleed (artificial period), then draw blood on cycle day #2 or 3 for a hormone panel (FSH, LH, TSH, Prolactin, Estradiol). If you have a period from the Provera, then that is all that may be required to get you back to normal, assuming that everything else is okay. If no period starts after the provera, then a short course of the birth control pill will need to be given (1 tablet 3 times per day for 7 days) and this indicates that the uterine lining did not get primed by estrogen. Anyways, there is a series of steps that we normally take to evaluate this situation. Make sure your doctors does it.
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
---------- FOLLOW-UP ----------
QUESTION: Thanks for getting back to me doctor. I forgot to mention that I did have some light brown spotting about 2 weeks ago that lasted a few days but all the reading I have done says that this is not classified as a period and in the past the light brown spotting has always been followed by fresh blood. Is that correct? Am I being paranoid when I ask about peri-menopause? Thanks :)
AnswerHello Again,
Light brown discharge is old blood, so there was some bleeding that occurred from the uterus. That could mean several things. It could just be breakthrough or abnormal bleeding due to anovulation, it could mean that the menstrual bleeding is getting trapped inside due to scar tissue formation or it could mean that the uterine lining is not being formed so there is minimal tissue to slough.
As I mentioned previously, you need to undergo an evaluation to determine exactly what is going on. I would recommend hormonal testing, pelvic ultrasound and diagnostic hysteroscopy.
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
