Common Period Problems
Your top questions about irregular menstrual cycles answered
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.
Late or Missing Periods
I am over two months late for a period, but the pregnancy tests are negative. Are the tests wrong?
Probably not. What you’re describing is a medical condition called secondary amenorrhea, meaning that you’ve developed a condition of having no periods after having had them regularly before. (Primary amenorrhea would mean never having ever had a period at all). Everyone’s entitled to an erratic cycle or two from time to time. Stress can cause this, but don’t be too quick to assume stress is always the cause. It is generally not worth pursuing an investigation with expensive testing until you’ve gone more than three months without a period.
If this happens, there are several things that should be investigated:
- The first thing to do is undergo a physical exam to see if there are any ovarian cysts (possible) or tumors (very unlikely). This exam can (and should) be backed up with an ultrasound, preferably a vaginal ultrasound.
- Blood work should be done, including the following: 1) thyroid stimulating hormone (TSH), to rule out thyroid problems; 2) follicle stimulating hormone (FSH), to rule out premature menopause (unlikely); 3) Prolactin, to rule out a pituitary tumor which can mimic a breast-feeding state that inhibits ovulation, and with it, menstruation. 4) Estrogen and progesterone levels, to see if you’re making the “right stuff” to cycle with periods.
- You could be given a “progesterone challenge”: If you’re making estrogen, then a round of progesterone (given, then withdrawn) should yield a period. If not, you may not be making estrogen. This will indicate possibly premature menopause. However, this can also be ascertained by doing estrogen, progesterone, and FSH levels. Mechanical problems should be ruled out after all of the above.
- Aschermann’s Syndrome, a condition involving scarring within the intrauterine cavity, can effectively seal the uterus or be so scarred that there’s no tissue remaining which builds up with each cycle, causing amenorrhea (no periods). Previous dilation and curettage (D&Cs) and abortions can cause this. This can be ruled out with a hysteroscopy (looking into the cervix with a lighted scope) or with a hysterosonogram (a vaginal ultrasound in which saline is swished up the cervix to expand the intrauterine cavity to show any scarring or obliteration).
Common Period Problems
I am 18 years old, have stopped having periods and have gained weight. The pregnancy test is negative. What could be going on?
This also sounds like secondary amenorrhea. Pregnancy is the most common cause of secondary amenorrhea, but all of the other causes are not normal. A person can have a “post-pill” amenorrhea when discontinuing birth control pills until the pituitary gland resumes normal function after being blunted during the time on the pill, and this is fairly harmless. The same applies after depo-provera shots and other hormonal manipulations.
But there are other more suspicious reasons to experience secondary amenorrhea. An ovarian cyst (benign, pre-malignant, or malignant) can interrupt the cycle. A benign condition called polycystic ovarian syndrome (PCOS) puts your cycle on hold because you can’t ovulate. This interruption causes a build-up of testosterone and weight gain. Many doctors would recommend a serum testosterone level to see if it’s elevated, an ultrasound to check for cysts of the ovaries, and of course a thorough physical exam. If all of this turns up nothing, then it’s possible that becoming overweight has caused production of extra estrogen from your fat cells, which will muck up the works. And then there is the consideration of premature menopause, which at your age is extremely unlikely. A simple blood test of your FSH could be done at the same time as the serum testosterone. You should be evaluated by an OB-GYN.
I had a baby two months ago. It just dawned on me I’ll get my period again eventually! When should I expect it?
Most physicians say as early as two months, so it could be any day for you. If you are breastfeeding, it is likely to be longer. Some women don’t resume their menstrual cycle until they wean their baby. But (unhelpful as this is) not all of them. So the best advice is just to be prepared! Keep some pads or tampons on hand, and realize that postnatal lack of a period does not guarantee contraception! Your first ovulation may happen while you think you are still not cycling. (If you’re concerned about getting pregnant, check out Birth Control Options for New Moms.)
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