Question
Spotting
Dear Doctor
I have a wierd problem. Here is the history:
KEY: CD: Cycle day, BBT: Basal Body Temp, OPK: Ovulation
predictor kit.
March 1: CD 1
March 14th : - ve OPK
March 15th: +Ve OPK
March 16th: BBT raised and -ve OPK. STARTED spotting in the
evening. (pinkish color)
March 17th: BBT raised, started PROMETRIUM,spotted brown
March 18th: BBT raised, Took prometrium, spotted brown
March 19th: BBT raised, Fertility Friend confirms Ovulation
on 15th, prometrium, spotted red
March 20th: BBT dropped, prometrium, Spotted yellow
March 21st: BBT remained constant, prometrium, spotted red.
Took Day 21 progesterone test - Level was at 55 ( Very good
according to my OB/GYN).
March 22nd: BBT raised, prometrium, spotted brown
March 23rd: BBT raised, prometrium, spotted red in the
morning.
March 24th: BBT Raised, Prometrium, Spotted red
March 25th: BBT down little bit, Prometrium, Spotted red.
Is this normal to have so many days spotting after
ovulation. I can't put the blame on Prometrium because I
started spotting the day before I started prometrium. I
have been having light cramps for couple of minutes every
day. I mean every single day along with my spotting. Except
for March 21st and 22nd, I see it only when I wipe but not
on my underwear. On March 21st and 22nd, I saw this creamy
and sticky CM filled brownish spotting on my underwear
also.
I got my day 21 progesterone tested and It was 55 (well
above normal ranges)
I called my doctor and she said its o.k to spot after
ovulation...but these many days????? I don't understand.
When I say spotting - it is usually when I go to toilet - I
notice some stretchy red thing hanging from my vagina. When
I wipe, it is brown reddish and sticky (Just like egg white
cervical mucus - Just in red color though!). I see this
almost every time I go to toilet.
I am heterozygous to A1298C mutation and therefore on 1
baby aspirin a day since January and started prometrium
this cycle (after Ovulation).
I had a short Luteal Phase last month (i.e, February) and
my doctor has put me on prometrium to help my uterus get
some time for implantation.
Here is my chart:
http://www.fertilityfriend.com/home/25d9b2
AnswerHello,
That is quite a l-o-n-g question but thanks for the detailed information.
First of all, taking prometrium (progesterone) will elevate your serum progesterone level so your CD21 test is invalid. (your doctor should know that!). Also, it will prolong your luteal phase (that is the reason to take it if you have a shortened luteal phase).
Secondly, the spotting you are experiencing is certainly not normal, but is not caused by the Prometrium. The only other hormone that plays a role in this is estrogen. It is possible that your estrogen level is inadequate, hence he breakdown of the endometrium causing the spotting. An estrogen level blood test does not give that information. I would just add estrogen to your regimen via cream, vaginal suppository or patch.
Thirdly, if you have a luteal phase deficiency, then it is possible that you have an ovarian dysfunction to go along with that, which is causing the LPD. So, the better treatment is to do ovulation induction with either Clomid or Femara (Letrozole). That corrects the ovary and will treat the LPD as well.
I hope this helps,
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.
