QuestionQUESTION: Hello,
I am 25 years old and have been working with an endocrinologist to try and figure out a menstrual issue that I have been dealing with. He is stumped and said that if he ever does figure it out that he will write a book about me!
First of all, I initially decided to see an endocrinologist because I had been experiencing light spotting 7 days before my menstrual period every month for the last two years-minimally. As a result of this, and upon his recommendation, I had an ultrasound, a saline induced ultrasound, an HSG, a uterine biopsy, several blood hormone tests, a test for Von Willebrand's Syndrome, and my husband's semen analysis. There have been no abnormalities found in any of these screenings.
It is also important to note that my husband and I have been actively trying to get pregnant for the last 8 months or so. Prior to the last 8 months we were only using the withdrawal method for about 1 year. No pregnancies resulted from any of this.
The endocrinologist decided to put me on Clomid. I asked about the possibility of having endometriosis as I was willing to undergo the laparoscopy to finally diagnose whatever is causing the spotting/infertility. He decided that we should wait to see if I could get pregnant first as I wouldn't want to know as badly if I was able to go ahead and get pregnant.
So, I took Clomid for the first time this past cycle and was surprised when I started a full period a week early when I would normally only be spotting. I will be scheduling a follow-up consultation with my doctor soon but I wanted to see if you knew any helpful information regarding all of my issues. Namely, I would like to find out information as to why I spot one week before my period. I would also like to know any reasons for having a full, normal period one week earlier than anticipated. Sorry for such a long winded question! I just thought I would try and fill you in as much as possible! Thank you.
Catherine
ANSWER: Hello Catherine from the U.S.,
Having spotting prior to the onset of a period is actually quite common. I am not sure what your Endocrinologist is referring to. It occurs because the hormones are dropping in your system if you are not pregnant. Clomid caused a shorter cycle because it influences your ovarian function and often will shorten the cycle. That is not unusual either.
The testing that you had was a basic infertility evaluation, so it sounds like you were trying to get pregnant. In terms of using Clomid or Clomid ovulation induction cycles, I refer you to a recent blog that I posted on my site explaning exactly how I recommend clomid cycles to be done. That should help your understanding.
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 follow me on Facebook at http://bit.ly/9Iw9oV
---------- FOLLOW-UP ----------
QUESTION: Dr. Ramirez,
I found your blog post describing how to properly be treated with Clomid very informative and helpful as my endocrinologist was not taking any additional steps other than prescribing the medication and telling me to use an OPK. I will bring some of these points you made to his attention.
Also, the only issue that I am still unclear about is the spotting before my period. I have read some conflicting information. I keep finding that having spotting for 1-3 days is completely normal. However, I have spotting for a full week. I think that this is interfering with my fertility because my luteal phase is so short as a result of the bleeding. How would the embryo even have time to implant? I have read that having spotting for a full week right before your period is a tell tale sign of Endometriosis. From your experience, do you find that 7 days of spotting is characteristic of a normal cycle or, if all other abnormalities described from the previous post have been tested and ruled out, do you have any other inking as to what can be causing it? Fourteen consecutive days of bleeding is not ideal for any woman, and I am just concerned that it really can't be normal.
I do appreciate your professional opinion, and I hope that you will be able to shed some light on this issue.
Thanks!
Catherine
AnswerHello Again,
I'm sorry that my answer was not clear. I didn't realize that your premenstrual spotting was for so many days prior. Yes, you are correct that an inadequate luteal phase support can cause the endometrium to prematurely start to breakdown. In a normal 14 day luteal phase, the embryo has already implanted by 7 days after implantation, so the spotting may not necessarily affect implantation. But if the luteal phase is too short, then it can interfere with implantation as blood in the uterus is toxic to the embryo. We call this a "luteal phase defect." The luteal phase should always be 14 days from implantation to the start of your menses. Luteal phase defect is usually caused by inadequate progesterone stimulation. That is why I ALWAYS use progesterone supplementation with my infertility treatments. I don't want a pregnancy to fail due to a simple thing like lack of adequate progesterone. Clomid can correct a luteal phase defect is some cases because it forces the ovaries to work properly. That is why my ovulation induction cycles are so regimented. I am leaving as little to chance as possible, although OI cycles are "natural" cycles and most of it is not under my control. In any case, if your RE decides to continue with the "hands off" approach (as opposed to my more aggressive/programmed approach, then you should as him for progesterone supplementation. It should begin after ovulation has occurred, or 3-4 days after your positive OPK.
I hope that clarifies it for you.
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 follow me on Facebook at http://bit.ly/9Iw9oV
