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PCOS and spotting
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nic14120 posted:
Hello!

I am 33 yrs old and had my second baby 9 months ago. I was partially BF for 4 months, but received a full period after 2 months post baby, then again aout 45 days later. Aug was the last time I had an actual period. I saw my OB beg of Dec for my annual, my pap was normal, and so was my exam. She wanted me to take provera to bring on my period, then start BC since I have PCOS, and have not had a period. I had taken provera right before I got pregnant, actually 2x before, and I don't feel comfortable taking it a 3rd time, since it is synthetic.

Sortly after my appt, prob a week later, I felt like I was starting my period. My bleeding was light as if it was starting, but red. then it tappered off, but I continued spotting every day going on three weeks now. Sometimes it can stain a pad lightly, other times with a bowel movement it can be a heavier wipe of blood. I am due to get my bloodwork done for my thyroid levels, and cbc/diabetes (since I was gestational)> does this sound common for PCOS since I have not had a period 4 months, that this spotting can last so long? Could it be due to my hormones being off from my thyroid levels?

Thank yoU!
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Jane Harrison Hohner, RN, RNP responded:
Dear nic: It is OK to start with the Provera concern? If a woman does not wish to use Provera/medroxyprogesterone acetate to "kick start" her period, the FDA has approved natural micronized progesterone in peanut oil ("Prometrium") to be used for this purpose. Both drugs are readily available at regular pharmacies. Here's a comparison:

1. Provera (or generic) is 10 mg per day for 5 days; Prometrium is dosed as two 200 mg capsules for 10 days.

2. Provera is MUCH less expensive--especially as a generic.

3. If one has a peanut allergy Prometrium should be avoided.

If you need to elicit a flow, you could safely choose either regimen. Some women will use Provera every few months if they have a history of frequent missed flows.

In terms of your light bleed followed by three weeks of spotting. This is a classic pattern for missed ovulations. If you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. The hormone levels don't decline, and the lining stays up inside the uterus—your missed period. Alternatively, just the top layer of the built up lining will begin to shed erratically. This produces prolonged, too light bleeding.

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 partners, money worries), increased body weight, anorexia, rotating shifts at work, etc. If you are currently hypothyroid that can certainly interfere with regular ovulations. Having a history of multiple ovarian cysts (PCOS) can definitely interfere with ovulations as well.

It is great that you were able to conceive, and deliver, your second child. That suggests that your hormones were relatively normal at the time of conception--good news. Hopefully the blood test results will be in the normal range.

Yours,
Jane
 
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nic14120 replied to Jane Harrison Hohner, RN, RNP's response:
Thank you so much, Jane. I am so sorry to sound like a pest, it has really started to concern me since this is a new thing for me. I appreciate your advice and will consider the "natural" route. Is there any certain diet that can assist in PCOS, or weight loss? All the "stressors" you mentioned are pretty much my issues. Outside of the history of cysts, hypothyroidism, I am also experiencing stress in my work, marriage, and money... so I have all of the above! It is ok for me to allow my body to continue to spot like this, or should I get to the OB or the natural remedy sooner rather than later?

My son took me 10 months to conceive naturally, and I did not know I had PCOS at the time. I did however, have a history of cysts prior and my thyroid issue was known. With my daughter, I actually had gone about 45 days between cycles, or about 2 months at most, so I took provera at that time. I actually saw a different OB in my field that specialized in fertily, and he put me on metformin, I resopnded well to that, and within one month of ebing on it, my period returned and I got pregnant! I am so blessed and thankful! Is metformin successful in resuming a period? maybe I can go on that route again? I tolerated it well, and I would imagine I am IR PCOS since I was gestational with both my babies...


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