QuestionDear Dr Ramirez,
Thank you for taking your time to respond to infertility questions. I find your responses incredibly helpful.
I wrote to you a month ago about follicular phase spotting during a Femara cycle. This happened to me for the first time 2 months ago during a natural cycle (after 18 months of TTC). So, my RE and I decided to try Clomid 100mg d 3-7 for my current cycle because I've completed 5 Clomid cycles and none have had follicular phase spotting. I started spotting yesterday (CD7) and I am currently experiencing a light, bright red flow. This is after my period stopped on CD5.
Can estrogen therapy help with this type of spotting? If so, how and when is estrogen therapy usually given during the follicular phase? If I move on to injectable FSH, would this spotting persist?
My HSG and pelvic U/S were both normal. Would a hysteroscopy and/or a laparoscopy be helpful to diagnose the cause of this type of spotting? My RE has suggested a laparoscopy before moving on to superovulation.
Thank-you!
Happy Easter!
Laura from BC, Canada
AnswerHello Laura from Canada,
Estrogen would probably help reduce the spotting, as it has effects directly on the uterine lining and helps to build it up and cover the vessels there. However, if you are responding to Clomid appropriately, that means that follicles are being recruited and increasing follicles incerases the estrogen levels. So, you should naturally be increasing your estrogen. I don't think that additional estrogen would be required. If you are not responding to the clomid well, i.e. not recruiting 2-3 ovulatory follicles, then the dose of the clomid is too low and your doctor might want to try increasing it.
If you go on injectables, the same mechanism occurs whereby estrogen levels increase with formation and growth of the ovulatory follicles.
If you have not had a hysteroscopy, that would be helpful to make sure that there is no endometrial pathology causing this breakthrough bleeding. One potential cause would be endometrial polyps. Another would be submucous fibroids. I don't think that a laparoscopy has any use with this problem, but would benefit you if it were to help diagnose other pelvic diseases that might be impeding your fertility such as endometriosis or scar tissue (adhesions).
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
