Common Period Problems

My periods start early and then get heavier at the right time, and I've had two miscarriages. Are these two things related?

It's possible you may have an "inadequate corpus luteal phase," which can be explained this way: There are two phases of the menstrual cycle. The first, called the "proliferative" phase, is when the lining of the uterus proliferates (gets thicker). After you ovulate at midcycle, the area of the ovary from which you ovulated, called the corpus luteum, makes progesterone, a hormone that enables the second half of the cycle—the "secretory" part. In the first half of the cycle, the lining grows and is heaped up, and in the second, the lining is matured by the progesterone to prepare for the implantation of a fertilized egg. If implantation doesn't happen, the progesterone production from the corpus luteum falls, the lining has no more hormonal support to keep it organized, and it falls apart—what you see as a period.

Now, if the corpus luteum is not a good one, and the production of progesterone is therefore less than adequate, then the lining will become fragile before the time you'd expect a well-timed period. This is your early spotting. But like the uterine lining, the plot thickens: Since progesterone is necessary to keep the lining of the uterus intact for the pregnancy, and if it's too low, a miscarriage can occur. So an inadequate corpus luteum can be responsible for both spotting and recurrent pregnancy loss. But it's very important to understand that, more than likely, the progesterone is low because the pregnancy is faulty, rather than the pregnancy being faulty because the progesterone is low. But it's impossible to tell once trouble starts brewing, so most doctors will give a pregnant patient with low progesterone pills or suppositories that will increase the level of progesterone. If the baby's in trouble because the progesterone is low, this may be pregnancy-saving. But you must be willing to accept that if the progesterone is low because the baby's in trouble (the opposite), then giving a patient progesterone will only delay the inevitable miscarriage.

I tend to have brown spotting three to four days prior to my period. It does not happen every month. According to my temp charts and ovulation prediction kit tests, I am ovulating regularly at approximately cycle day 13 to 14 and my cycles are 27 to 28 days. What might be the reasons for this spotting? I was told I don't have the signs for endometriosis.

It's probably some lining of your uterus that requires a certain threshold to maintain, but sloughs before the rest of your period when the hormone levels begin to fall. Then the rest of the menstrual tissue follows like normal. It is possible this could represent a luteal phase defect, but the fact that you're so cyclic speaks against that. A progesterone test on day 21 to 22 can tell you whether you ovulated well. An endometrial biopsy a week later can tell whether the rest of your endometrium (lining) is in sync with the ups and downs of your cyclic hormones. Endometriosis has nothing to do with this.