QuestionHello Dr. Ramirez,
First, thank you for taking the time to answer questions on this site. It is nice
to find a place to get extra advice. I know that women facing these issues
must be as thrilled as I am to find you.
As for my issue, I have spent the last 3 months taking my basal temperature
and I believe that I ovulate and I have a luteal phase defect since my luteal
phase is 8-9 days each month. This past week I had sex 2 days before the
increase in my basal temperature and saw my fertility doctor. She prescribed
100mg suppository progesterone, 1 per night. I started taking it on my 3rd
day of higher body temperatures. My doctor said that it should extend my
luteal phase. Today is my 9th day of my luteal phase and the 28th day of my
cycle. This afternoon I started bleeding/spotting, with cramps and backache.
After doing some web-browsing I can't decide if this is possibly implantation
bleeding or not. It feels like my cycle, but since I was expecting the
progesterone to extend my cycle I am unsure. One of my main questions is,
how can I tell the implantation bleeding apart from cycle bleeding and should
the progesterone have extended my cycle regardless of conception? Also, is it
normal to have cramps and backaches if you have conceived? If I have
possibly conceived, is it safe to take advil for the cramps?
Again, thank you so much for taking the time to help people like me.
Sincerely,
Julie
AnswerHello Julie,
It sound like you are correct with the diagnosis of LPD because of a shortened second half of the cycle. The progesterone is an appropriate treatment for this, and the dose given is adequate. The only difficulty is on progesterone it can sometime suppress onset of the full period since there is not drop in hormone like in a normal cycle. If you have ever taken the birth control pill, you will know that the last pills are placebo pills, so that there is a hormonal drop and the menses occurs.
However, the bleeding and cramping you are having may be from the period trying to start or "implantation bleeding". This is a phenomenon seen with fertility patients, especially IVF patients. I think that it is not "implantation" per say, because that occurred 7 days after ovulation, but probably bleeding from the progesterone suppositories. We see it very very commonly in our IVF patients. The only way to see if it is your period or not is to have a blood pregnancy test done.
Advil is not recommended in pregnancy. I would recommend Tylenol until you get the pregnancy test results.
Sincerely,
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.
