Women's Health Community

Dear sanaraza: It sounds like you have a overly thickened uterine lining--also known as endometrial hyerplasia. Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes 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 endometrial hyperplasia and the development of abnormal cells inside the lining tissue.

Endometrial hyperplasia is a common cause of heavy and prolonged bleeding. The diagnosis can be made by ultrasound or endometrial biopsy. The ultrasound image measures the thickness of the lining ("endometrial stripe"); with hyperplasia it is usually more than 12-15 mm. I had a patient once with a stripe of 30mm! The endometrial biopsy takes a sample of lining tissue and the pathologist can then make a very accurate diagnosis base upon the cells seen under the microscope. The treatment for simple hyperplasia/hypertrophy which does not contain abnormal cells is synthetic progesterone pills or shots. This shrinks down the too thick lining.

As you read above, the most common cause of hyperplasia is not ovulating. Not having regular ovulations also creates patterns of more erratic bleeding--like the patterns you have mentioned. 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—your missed/late 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.

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

In terms of a possible pregnancy, most GYNs will rule that out with a pregnancy test. You were prescribed a type of synthetic progesterone. If you have been several months without a period,or have a too thick lining, a gynecologist may give you some progesterone in a pill form (eg Duphaston 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. This "progesterone withdrawal bleed" will shed all the built up lining back down to a healthy level.,

Bottom line, you are asking all the right questions. After you have taken the medication be sure to let your GYN know about the results. You can also ask them about missed ovulations--if they believe that was the cause of your menstrual issues.

Yours,
Jane