Pregnancy Concerns: Endometriosis, Miscarriage & Irregular Periods - Seeking Guidance

Question
I am 34 years old. I have a 7 year old son. I have endotrometriosis. I am trying to get pregnant. I have written you before.My last period was May 3. On Aug 4 I had a miscarriage. I actually had an app. and they found no heart beat. I was perfectly fine no pain no nothing I didn't even know the baby's heat stop. On Aug 5 I had a D&C. I didn't not bleed at all. I went back to the doctors after 2 1/2 months still no period. they cave me provera to help it come down. Nothing just cramps, is what I got.They did some blood tests, my hormones were a ittle out of wack. I had an app yesterday they did a hestosonogram and another D&C. They told me my uterus was small. What does that mean? Will that stop me from having/carrying a baby full term? Did it shrink or could it have shurnk  i did carry my first child full term.The outcome of this visit was they put me on 1.25 mgs(is that alot?) of premarin(estrogen) for 30 days on the 20th day I have to take the provera again for 10 days if I don't get my period 2 weeks after that come back to see them. She also told me my hormones are a little off and I will need help to get pregnant. So please help me. What is wrong? why is this happening? What else could it be if I don't get my period? Should I get another opinion? I hope you can give me some help. Thanks so much...

Answer
You are being treated correctly. When you did not get your period after the miscarriage in August, the first step was to give you Provera (progesterone). If you needed progesterone only, this usually would have been enough to slough off your endometrium (a period). If Provera does not work, it means that the wall of the uterus (endometrium) was not thick enough to slough off. Then we have to "prime" the endometrium with estrogen (another hormone of your cycle). We give estrogen for 30 days and add progesterone from day 20-30. This should be enough to mimic a normal cycle and you should get your period after day 30. If it does not work, it will be repeated. Eventually the wall of the uterus will grow enough to be sloughed off again. Once you are getting regular cycles (and you will), you can start trying to conceive once more. Good luck.