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    JANE!! PLEASE ADVISE ME!!! 45yrs old, MISSED PERIOD 2mos, peri or prego???
    mama2one92806 posted:
    45 yrs old, missed period the last 2mos. going on 10wks now. Its now making me a bit nervous,.
    i have multi small fibroids, a bicornuate uterus that is not septated. I had one great pregnancy and 1 child as a result.
    Last blood work i had was 4mos ago and i was just below the low on the lab scale for thyroid levels. My doc wasnt concerned and said you are a bit sluggish(Hypo) but no need for thyroid meds. my hormone levels were normal for my age and not showing any sign of menopause but great levels. I did have intercourse(TMI) once about 1mo ago. I am now cramping and have had very very little spots sproatically for about 1 day since saturday, nothing since.. not at all what i am used to having. usually it comes on big time. The only other symptoms I have had are nauseous all day yesturday and off/on today no matter what I tried to make it go away. what gives!? I am starting to wonder....the hpt test I took last night was negative!!! Should I just wait it out another week??
    Jane Harrison Hohner, RN, RNP responded:
    Dear mama2one: If the last intercourse was a month age then the urine pregnancy test should be pretty reliable. Still, with possible pregnancy symptoms a retest in a week is a good idea.

    In terms of the missed period, if the pregnancy test is negative then the most likely reason for a missed period is a missed ovulation. 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. 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.

    There are MANY causes for not ovulating: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors, increased body weight, anorexia, rotating shifts at work, etc.

    In your specific case, you have two more likely causes for missed ovulations. You have a known borderline hypothyroidism. Second, you are approaching perimenopause. The general age range for perimenopause is 46 or so. During this time ovulations can begin to be missed causing missed or irregular periods. You mentioned normal hormone levels four months ago. It is classic for perimenopause that FHS levels can swing wildly. This is why many GYNs are reticent to draw hormone levels at this time of life.

    Bottom line, if you have been three months without a flow you should return to your GYN. You can be given 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. You GYN might reconsider the thyroid issue to see if treatment restores more regular cycles.

    mama2one92806 replied to Jane Harrison Hohner, RN, RNP's response:
    thx Jane,
    I finally got my flow back,I spotted for 1.5wks and then it got heavier and now passing some clots starting suddenly last sunday. Im assuming its due to the fact it accumulated for so long. He has me coming back in after the new yr to get a cone biopsy just in case. I had one last yr and it was neg. So Im assuming its more the hormones and my age at this point. But, I have an additional concern that I really didnt get addressed.
    The hormone/Thyroid tests this past year showed the following and I was just a little perplexed re the "Low" areas. I know hormones fluctuate during the month but my gut feeling is the LH shouldnt be so low and no mention of this being a concern was brought up. Can you please explain this for me so I have a better understanding....if its explainable that is.

    TSH 3rd Gen 2.42
    Free T4 .78 ng/ml
    Estradiol 109.6 pg/ml
    FSH 2.4 ml
    LH 1.2 -----"LOW"
    No progesterone tested, not sure why

    Basic blood panel taken incl:
    TSH 3rd Gen 2.82
    Free T4 .70 ---"LOW"
    no other hormones tested this time

    Estridiol 166.0 pg/ml
    FSH 4.2 ml
    Progesterone 0.2
    LH 4.3----"LOW
    No Thyroid tested this time
    mama2one92806 replied to mama2one92806's response:
    Need additional advice Jane, please!
    Jane Harrison Hohner, RN, RNP replied to mama2one92806's response:
    Dear mama2one: Glad your flow returned, even if it was with a vengeance. I concur, it was likely missed ovulations and the resulting hormone pattern. An endometrial biopsy is a reasonable option to rule out abnormal cells in a too thick lining of the uterus.

    In terms of your GYN labs, your estradiol levels are normal (menopausal range is less than 30-40 pg/ml). Your FSH is nice and low (menopausal range is usually greater than 20-30 through 130). The LH should be low, and it is, given that you are not menopausal yet. The LH level will rise to the heights of the FSH when menopause if firmly established.

    So what does a "LOW" LH mean? Depending upon your laboratory's normal values it could be as little as 0.1 under the normal LH level. So it is called "LOW" but it is not clinically worrisome. More remotely, very low FSH and LH levels can signal "hypothalamic amenorrhea". This is the mechanism whereby stress impacts the hypothalamus and interferes normal ovarian hormone production.

    It is true that hormone levels can vary throughout the menstrual month. For example your progesterone level was very low on 11/23/2010. The interpretations of this could be either:

    1. These labs were drawn within the first two weeks after the first day of your period. Progesterone is normally low until after ovulation.

    2. You had not been ovulating. This would fit with your clinical picture of two months of missed periods.

    Your own GYN can give you the most "for sure" explanation as to why you might be skipping ovulations. Age 45 can sure be a factor.

    bstidwell replied to Jane Harrison Hohner, RN, RNP's response:
    sorry to interupt this is my first time using this i was wanting to ask you a question about my wife.

    mama2one92806 replied to Jane Harrison Hohner, RN, RNP's response:
    Thx again Jane, I am relieved to hear but not really surprised.. Now...I am just having a heavy bleeding prob for almost 1 week and its not getting better.. I guess if it doesnt wane off then i will be looking at surgury or? I had heavy bleeding last fall for a straight 8-9wks and a d/c with endoscope by my request did the trick and they found nothing but a lot of build up. But now it may be the same situation.
    sooo, probably the no ovulation thing is going on. So Im hoping it is as easy as that.
    -I failed to say, I have a mild bicornuate uterus with very small multiple fibroids. The Dr saw none submucosal when the endoscope was used.
    But, how do I stop this erratic build up without having a hysterectomy. I really dont want to torture myself but surgury is my last resort. Taking hormones will control this? Birth control? not sure if that is the best thing.
    I have others telling me I should take a more herbal supplement approach. not sure what to do.
    if it gets worse, the dr will be called.
    if you have any last tips, Id really appreciate it. thx.
    someonewhocares3 replied to mama2one92806's response:
    Sorry you're having these problems. Not sure I understand why he would do a cone biopsy "just in case." It's my understanding that procedure would only be done if you've had abnormal pap smears. If you've had one abnormal pap smear, it's generally recommended that you have a repeat smear as there could have been a mistake at the lab. Also, lab technicians' experience levels can affect error rates. Here's a story - .

    It's also important that you get the facts about the risks of cone biopsy. Long-term risks include scarring of the cervix which can cause painful menstrual periods, make abnormal pap smears more difficult to read, increase risk of infertility, cause an incompetent cervix (increasing risk of premature birth).

    If your doctor recommends hysterectomy to resolve your heavy bleeding, please know that there are much less invasive and less damaging treatments. There are several recent hysterectomy discussions here on this Exchange. Just do a search for hysterectomy. Or, click on my user name to see my posts.

    I wish you the best in deciding what treatment, if any is truly needed, is the best one for you.
    Jane Harrison Hohner, RN, RNP replied to mama2one92806's response:
    Dear mama: Someone who cares has given some excellent advice. Hysterectomy is often the last step since it is something which cannot be reversed.

    OK, you are correct, a too thick built up lining in the uterus is almost diagnostic for not ovulating ("anovulation"). Another way inadequate progesterone production from missed ovulations can create too heavy a flow (besides not triggering a flow) is as follows.

    Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes proliferation and a thickening of the lining ), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. It is also why women who miss ovulations (no progesterone produced) are at a greater risk for too thick lining.

    Therefore you can treat a too thick lining by having adequate amounts of progesterone to protect your lining. This can be acquired through low dose birth control pills, the progesterone IUD ("Mirena"), DepoProvera injection, or 12-14 days/month of progesterone pills. As far as I am aware there are no herbal supplements which can be assured of preventing a build up of lining tissue. Moreover, most progesterone creams available over the counter do not have enough of the active hormone.

    Use Someonewhocares' information to help you formulate questions for your GYN. You are definitely asking the right things.

    An_196191 replied to bstidwell's response:
    Did you ask or did I over look your question?
    Jane Harrison Hohner, RN, RNP replied to An_196191's response:
    Dear Anon: Bryan (bstidwell) asked his question in the usual way with his own subject heading as well. If you would like to give him some input on his wife's problems after the vaginal sling operation you can find it farther back in the queue over the past two days or so.
    mama2one92806 replied to Jane Harrison Hohner, RN, RNP's response:
    thx for the great answers and explanations.
    I think i will try the approach of taking progesterone pills and take into an account my drs input. I do agree with the comment on the cone biopsy. Id rather he did the annual pap smear first as i seriously dont think that I need the biopsy.
    Now, one question, the last 3wks I had....2wks of spotting and since then and looking at my last post, for going on 2wks Ive had heavy bleeding and passing of clots(in strips too) sorry tmi almost every day. it waned off yesturday but now today, i am cramping a little and my lower back hurts and starting to bleed again. I am worried I am passing more clots soon as i found the more my lower back hurts the larger the clot. ugh. Im assuming since i had no period for 9wks that this is typical due to build up. but really? flow for this long?? I also am feeling a bit queasy today too.
    Will the progesterone pills help this and the flow issue? Im assuming so.
    To make sure im clear, if i take the progesterone pills, i take them for 7-14dys then once stopped within 5-7dys i have a period? Im all for trying before the biopsy etc.
    plus will progesterone affect my small fibroids_1-2cm in sz). Im assuming not and that the estrogen is the driven factor there. At least thats what some studies have shown. I also had last yr talked to a dr who is studying and deals with firbroid complications, who has a wonderful website called, . whom gave me insite on the fibroids.
    can you pls comment further re above questions though. And I thought i didnt need more
    much appreciated!!
    mama2one92806 replied to mama2one92806's response:
    JANE, can you pls answer a few more questions? thx!
    mama2one92806 replied to mama2one92806's response:
    Hi Jane, Can you please respond again for me. Please!
    I need some questions to ask my Dr. Please advise.

    My heavy clotty period lasted a good 8 days with some spotting. I have be period free for about 3 dys now. but...I am very bloated, haveing some cramps here and there still. so, i called my Dr. He didnt like my suggestion to try progesterone and wants me to come in next week for an ultra sound. he said he would rather we ck if my fibroids are degenerating or giving me probs and to ck for any other adverse conditions. Im sure this is his protocal but...this same thing happened last yr and a d/c worked and i was regular again until recently. all tests last year for biopsy were neg. the u/s showed a poss submucosal fibroid on the slight septum i have from the bicornuate. but with d/c and scope, nothing was seen supporting the submucosal. I had great on time periods w/in range since d/c Dec 2009 with NO spotting, NO ongoing period. I didnt start having the darn prob until November when I had symptoms of painful nipples which seemed to have a mind of their own and then no period came for 9wks. its basically the identical symptoms as last year. this is so frustrating for me. My gut feeling is that my problem is partly or fully hormonal. I do have some underlying issues due to structure, fibroids, csec scar, age.
    what questions can i ask or bring up to my ob/gyn when i go in next week?
    mama2one92806 replied to Jane Harrison Hohner, RN, RNP's response:
    Hi Jane, Can you please answer some additonal questions.

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