Dear An: tlkittcat has spoken correctly. Your age does have an impact on how long one should continue to try to conceive. HOWEVER, if a GYN suspects that the woman has a known impediment to conception (eg chronic non-ovulation from PCOS) it may be appropriate to have her worked up after 6 months of trying to conceive.
In terms of your ultrasound, retroverted uterus is not a problem.The thickness of your uterine lining is 11 mm. This could be normal if you are right at ovulation or in the 10-14 day interval right before the next flow. Multiple peripheral follicles, if they are follicular cysts, can suggest PCOS ("string of pearls" appearance).
If you can document that you are ovulating it may be reasonable to wait 12 months as your GYN suggested. If you are not ovulating then six months may be a time to check back.
On final thought. Here's a link to more information about PCOS and TTC. The first link if "How do I know if PCOS is the problem?". From there you can click on the follow up "What treatments might help?":
Dear sweety: If you are having unprotected sex then pregnancy should always be ruled out. However, if your pregnancy test is negative (which I would hope and expect) then the reason for your current missing flow may be as follows.
You used the ten days of Provera to stop a month long, heavy flow. As you have read above (in the other posts), Provera can be used to stop a prolonged flow as most long, heavy flows are caused by missed ovulations. No ovulations means no progesterone produced by the ovaries.
Your flow stopped after the Provera pills; then you have not had one since. You are not currently using any birth control pills---hope i am tracking you correctly. If all this is correct, your current lack of flows probably reflects more missed ovulations.
In a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month. The good news is that you have enough estrogen to make a lining that does shed sometimes.
In a normal cycle, progesterone production increases following ovulation and release of an egg.. Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining—your period.
So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus—your missed period. Alternatively, the built up lining can begin to shed on its own creating erratic bleeding patterns which are usually "too-light" or super heavy and prolonged.
Causes for not ovulating are MANY:low thyroid, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with partner, kids, finances), increased body weight, anorexia, rotating shifts at work, etc.
In your specific case sweety, since this seems to be a continued concern, you should return to the GYN or clinic. You can ask specifically about missed ovulations and see if they believe that is the culprit. If so perhaps the root cause can be identified and treated instead of just treating the symptoms.
Dear All: Anon_6061 has given a superb summary of the basic science behind thyroid testing. The best explanation as to why most MDs/endocrinologists prefer T4 as medication (eg levothyroxine) was posited by a PharmD candidate. I'll quote directly, then provide the link to the source:
Armour Thyroid (desiccated porcine thyroid gland) and Synthroid (levothyroxine) are used as replacement therapy for thyroid hormone when the thyroid is under-active, nonfunctioning, or has been all or partly surgically removed. The thyroid hormones naturally produced in your body are liothyronine (T3) and levothyroxine (T4). These hormones are necessary for metabolic regulation, normal growth, development, and mental function, among other things. T4 is found in the body at approximately four times the level of T3, but T3 is four times more potent. T3 is the active thyroid hormone used in the tissues, whereas T4 is a storage form that is stored in the liver, converted to T3 as needed. This storage mechanism acts as a buffer to help the thyroid keep up with the body's demand for thyroid hormones. The controversy over whether to use synthetic versions of thyroid hormone (Synthroid, Levoxyl, et al.) versus natural forms (Armour Thyroid) is better stated: "whether to use T4 alone or a T3 and T4 combination." Armour Thyroid was the only treatment for hypothyroidism for about 50 years, but it was found that the amounts of T3 and T4 varied greatly from batch to batch. Eventually, synthetic T4 (Synthroid) was being produced and widely used because it did not have similar problems of standardization in common with the naturally derived Armour Thyroid. A disadvantage of Synthroid is that some patients do not feel quite as well on T4 alone as they do on T3/T4 combinations. This is thought to be because not all tissues have the ability to convert T4 to T3 equally, such as brain tissue. In order to compensate for this, physicians may over medicate patients with T4 in order to compensate for this conversion problem. This may lead to greatly increased T4 levels, resulting in a temporary hypothyroid condition. Synthetic T4 products have not been shown to produce permanent hypothyroidism, though most patients return to a normal thyroid state soon after stopping the medication. In some patients, combination products may be better than single T4 products, because of a lack of ability to convert T4 to T3. In recent years, a synthetic T3/T4 combination (Liotrix) has been developed to deal with the problem of standardization of the Armour Thyroid. However, Liotrix is more expensive than either Synthroid or Levoxyl, and remains the reason why most therapy for hypothyroidism is initiated with these agents. Prepared by Jed Oyer, PharmD candidate.
In my clinical practice I would start a patient on T4 (eg levothyroxine) because this is not my area of expertise. Community standards of medical practice (as Anon_6061 points out) are to use standardized T4 rather than "natural" dessicated animal thyroid. To be sure there are individual differences in metabolisms of all drugs, but we tend to start with standardized regimens---even with antibiotics and birth control.
Dear An: What you did (not take last two active pills to bring on flow earlier) was OK. The most important thing would be that you started your next, new pack two days earlier, too. The crucial thing is to not be off the active hormones for more than seven days. Thus, if you were off active pills for nine days the breakthrough bleeding may be the result.
In one study of 99 women (Elomaa, 1998) the women were asked to deliberately start their new pill pack three days late. This would create a ten day vacation off the hormones. Ultrasounds of the ovaries and blood hormone levels were taken. While many women showed enlarged follicles in the ovaries, no one actually ovulated. Thus suppression of ovulation may actually extend beyond the recommended seven days of sugar pills. However, as lower doses of synthetic estrogen are used (e.g. 20 micrograms), it becomes more likely that a dominant follicle might actually ovulate (van Huesden, 1999). In summary, to provide the widest protection to the greatest number of women, we still say protection is best when seven days (or less) of placebo pills are used.
An_250599, if you did not extend your time off active pills, then my best GUESS would be "normal" breakthrough bleeding (BTB). Sometimes this occurs even when one does everything perfectly.
Hopefully your prolonged BTB will resolve on its own, surely by the end of this pack. If it does not let your GYN or clinic know so it can be checked out. So sorry this had to happen to you, stopping pills early to get a early flow does not usually cause BTB throughout the next pack of pills.
Dear MrsLiyahPooh & An: tlkittycat has spoken correctly. Here are some additional medications which are known to decrease effectiveness of birth control pills (BCPs):
· Alertness drugs (eg Nuvigil) can enhance rapid metabolism of estradiol by increasing liver enzyme activity thus decreasing hormone levels. · Barbiturates (eg, phenobarbital), hydantoins (eg, phenytoin), carbamazepine, rifampin, or St. John's wort because they may decrease estradiol effectiveness.
In terms of other, common antibiotics interactions with BCPs: · Azole antifungals (eg, ketoconazole) or macrolide antibiotics (eg, erythromycin, azythromycin, Biaxin) may increase the risk of estradiol 's side effects by increased blood levels of estradiol. Thus these would actually increase effectiveness of BCPs.
Dear missjennifer: Gosh, with a diastolic of 90-95 while on medication (Clonidine) I can GUESS that your second MD did not feel BP was well controlled on medication. That leaves you with options such as non-estrogen types of contraception (eg Mirena IUD with synthetic progesterone, DepoProvera injection, progestin only mini-pill, and Implanon) or getting BP diastolic down with other measures/meds. Hope you can identify, with your MDs, what will be best for you.
Dear An: I hear you, and I would like to give my OPINION, but I'm out of time today. Check back. Hopefully other readers will give their input as well as your question makes an excellent departure point for discussion.
Dear missjennifer: If one looks at the guidelines about combined oral contraceptives (would apply to the NuvaRing, too) older women can use these hormones if they are non-smokers, have no history of deep vein thromboses, are not diabetic, are not obeses, and have well controlled blood pressure (including those taking medications). Here is a citation from the American Academy of Family Physicians, targeted to health care providers, which summarizes the medical contraindications to NuvaRing use (and other forms of birth control): [a title="Link: undefined">http://www.aafp.org/afp/2010/0915/p621.html
If we do give hormonal birth control to a woman with an elevated blood pressure (on meds or not) we usually have her back in to recheck blood pressure when on, say birth control pills (BCPs). If BCPs seem to make blood pressure worse she is taken off. My best GUESS is that you may not have had severe hypertension, and that the Ring did not worsen your BP.
While there are guidelines, what an individual MD decides they are comfortable with is what they will do. Your experience with the two MDs' response to the same patient is a case in point. I do not know your full history (especially your BP numbers and body weight) but I would suspect that your original MD was still within "standards of good practice". If you went back to your original MD they might renew your NuvaRing prescription.
Again, my best GUESS is that the newer MD wants to try you of DepoProvera rather than the NuvaRing. DepoProvera does not contain any estrogen; it is a higher dose of synthetic progesterone. DepoProvera is designed to eliminate menstrual bleeding but some women can experience erratic breakthrough bleeding.
Every method of birth control has its pluses and minuses. Which ever MD you decide to utilize, be sure to ask lots of questions about the method they suggest. You are asking all the right questions--keep it up.
Dear risa: Thanks for awaiting an answer.Given that you have ruled out pregnancy, bilateral breast tenderness could be caused by a number of conditions:
1. Hormonal shifts---Women will report breast tenderness when first using birth control pills or postmenopausal hormones. It is usually thought to be linked to estrogen levels. Other times when this MIGHT be a factor include months with missed ovulations (often presenting with missed or erratic periods or being perimenopausal). The hormones stimulate glandular tissue within the breasts.
2. Fibrocystic breasts--Again hormonal stimulation is the underlying cause. There can also be tender masses or lumps. Usually this will appear before menses and resolve after flow. Given that your pain has been constant for the past two months, I rather doubt this is your culprit.
3. Elevated prolactin levels--Increased levels of the pituitary hormone prolactin is one of the more uncommon reasons for bilateral breast pain. Often there is an accompanying change in menstruation patterns, and even nipple discharge.
4. Chest will pain--Pain from the chest wall can be perceived as breast pain. Chest wall pain can arise from trauma, muscle strain, or even the lining of the chest.
risa, there have been many treatments advocated over the years for breast pain. Rather than taking a shotgun approach I would urge you to see a GYN or even your local county family planning clinic. They can do a focused breast exam. If indicated a blood prolactin level can be done. Once a cause has been established then a targeted treatment can be given.
For additional information about treatments check out this link: