Women's Health Community

Dear Anon: There is a very uncommon condition called "hematometria" where a woman's periods do not come out--this usually occurs because scar tissue closes the cervix. But my best GUESS is that your cousin's situation was more about hormones, not scar tissue.

The most common reason for a menstrual pattern like you have described is not having an ovulation every month. 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.

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—as a missed period.

As you can imagine, the lining can get way too thick over five months time. Thus when the flow did resume (either because she finally ovulated or the lining started to shed under its own weight) the amount of bleeding/cramping can be very intense.

Causes for not ovulating are multifold: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with boyfriends/girlfriends, kids, finances), increased body weight, anorexia, rotating shifts at work, etc.

Without an evaluation it is hard to know which was the cause of the missed ovulations and periods. She can consider going to the local county family planning clinic or sliding fee Planned Parenthood type clinic. Hopefully the ER did enough of an exam to rule out an ovarian cyst.

Yours,
Jane

Dr. Hohner, I have a period about every 3 months and other times i have a very light flow. I was diagnosed as Polycystic when I was 20. I am now 30. I am on my monthly now but isn't to heavy of a flow. Which means I'll be ovulating this month....lol. How bad are birth control pills to regulate my period? And if i take bcontrol then what do i do to get pregnant? Thats the only way I have a normal period. Is Clomid an option for me? Is it possible i may need to be cleaned out? or should I go back on the bcontrol? Please help...I'm trying to stay fertile for my husband. We will be mariied next year and he is 6 years younger than me. I already have 2 kids, but he has none. So Im gonna have to drop a normal egg sometime or another. Can u suggest anything?

Dear isi_jo: It's helpful to know exactly what is your GYN situation (ie polycystic ovarian syndrome or "PCOS"). Let's address each of your questions in order, OK?

1. Birth control pills (BCPs) do a fine job of both regulating your period and also preventing the build up of a too thick lining inside your uterus. When one does not ovulate, no progesterone is produced. Progesterone "protects" the lining of the uterus. BCPs supply synthetic progesterone in the active (as opposed to the sugar/placebo pills) BCPs.

2. One can have a "normal" period when one ovulates. Yet with PCOS ovulation can be infrequent, as you have correctly mentioned. One could also take progesterone pills for 12-14 days a month. While cycle control is not as predictable as BCPs, this option would not suppress any ovulation that might occur (as compared to BCPs which suppress ovulation).

3. Clomid is used in PCOS women to induce ovulations. It may be less effective among PCOS women. Sometimes women with PCOS are first given metformin to see if ovulations will occur. If not Clomid can be added.

4. One can have any overly thickened lining "cleaned out" with a D&C. However most GYNs will try to get that lining shed by giving the woman 5 days of Provera 10 mg in pill form.

In terms of trying to maintain your fertility there is nothing one can do about aging. After age 35 or so our fertility begins to slowly decline. If you are heavy set, weight loss (10% of body weight) can help restore natural ovulations. If one is heavy set and has insulin resistance the use of generic metformin can sometimes restore ovulations.

Bottom line, you are asking all the right questions. I would urge you to bring your important questions to see your GYN or clinic for a preconception visit. They will have access to all your health history so are in the best place to give you solid advice.

Best wishes on your up coming marriage.

Yours,
Jane

I have been going through this same situation for about 5 months now. I went to the ER because after not having a period(but was spotting off and on but very light) I was cramping more then I usually would with a normal period and started bleeding very heavily. I had thought I might be pregnant before that and was scared to death something was wrong so my mom took me to a clinic the next day and the doctor there thought I possibly had a tubular pregnancy or a miscarriage and suggested i go to the ER. The ER did a pap test and said that everything was fine i wasnt pregnant and that my periods must just be backed up. Now its been nearly 5 months and again I was bleeding a little heavier then I had been for close to 2 weeks then for the past 2 days I have been bleeding heavily and cramping like a normal period for me.

My biggest concern is if its possibly for me to get pregnant if it is a backed up period and also would it be safe to get pregnant? My Fiance and I have not been using protection for the past 6 months or so and so far I am not pregnant..

Dear NerdMuffin: As you have read, a "backed up" or missed period is usually the result of having missed ovulations. If one is not releasing an egg it can take longer to get pregnant. It is also possible to release an egg and conceive before one's next "real period" arrives.

If you and your partner are seriously trying to conceive, and you have not gotten pregnant after six months (12 months if you are under age 30) it is time to see your GYN. You might be a candidate for an ovulation induction drug (eg Clomid) and/or an evaluation as to why you might be missing regular ovulations.

Yours,
Jane

dr. jane i am a 19 year old girl i was diagnosed with chronic pcos.. i had not had my period in 9 months then one day i had a period for about two days.. now another 4 months has.gone by and i am feeling cramps and everything but my period is so backed up the blood only seeps out when i push it out relieving myself in the bathroom .. ive had irregular periods all my life but now its startinf to cause me constant pain

Dear girl1in1pain: As you have read above, any condition where regular ovulations do not occur (eg PCOS) can result in a too thick lining inside the uterus. If you have been several months without a period, a gynecologist may give you some progesterone in a pill form (eg Provera 10 mg for 5 days). Within 48-72 hours after stopping the progesterone your "progesterone blood level" will fall, triggering the release of the lining that has been building up. Many women report that these periods are very heavy-- as though several months of lining are shed.

PLEASE, please see your GYN, local family planning clinic, or whomever diagnosed your PCOS. They can prescribe a generic form of Provera (very cheap) so you can "kick start" a period. You might want to ask them about an open-ended prescription of Provera that you could take, on your own, if it has been more than three months without a significant flow.

In Support,
Jane