Provera and Irregular Periods: Understanding Mid-Cycle Bleeding & Ovulation

Question
Hi Dr. Ramirez,

I was put on 10 MG Provera by my doctor b/c I have irregular periods. Before I started the medicine I hadn't had one in about 4 months. I have now been on it for about 3 months, taking it as instructed. Although I didn't the first month on it, I now tend to have mid-cycle bleeding. I have been traking my BBT. On the two cycles without mid-cycle bleeding it showed that I did ovulate. However when I do have the mid-cycle bleeding it doesn't show ovulation since based on the information it starts a new cycle. I guess my questions are 1.) Is it normal to experience this while on Provera? 2.) Is it being caused by some other problem that the medicine is not addressing?

Thanks.

Answer
Dear Whitney,

Thank you for your question.  Where are you writing from?

I presume that you are on the Provera to regular your cycles and use it for the last 10 days of the month.  You should know that Provera does not induce ovulation.  It only causes the endometrial llining to shed when it is withdrawn.  It would not cause mid-cycle bleeding.  Rather, that is being caused by an abnormal hormonal state in your body.

From your menstrual history, it sound like you have an ovarian dysfunction, and that is why you do not have regular periods.  This also indicates that you are not ovulating on a regular basis.  The most likely diagnosis is PCOD (polycystic ovarian disease).  In order for you to become pregnant, it is likely that you will need to use a fertility medication to get you to ovulate.  However, because you have periodic menses, you are probably ovulating every once in a while.  It is hard to predict and time, however, and also causes the rest of the cycle to be out of sync.  PCOD patients do occassionally become pregnant spontaneously.

If you are not seeing an OB/GYN or Fertility specialist, I would recommend that you see one.  You need to go through a complete hormonal evaluation to make sure there are no other problems, like Thyroid or Pituitary problems.

I hope this helps.

Sincerely,

Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com