Women's Health Community

Dear ladybug: The only way to know for sure if a miscarriage is occurring is to have a positive sensitive pregnancy test which then turns negative. Alternatively a blood pregnancy test, which measures exact amounts of HCG, would show decreasing amounts over 48 hours instead of doubling HCG levels.

You mentioned having four negative home pregnancy test results. This MIGHT mean that you did not conceive, but instead returned to your prior pattern of erratic and prolonged bleeding patterns. As you have likely read the most common cause of erratic and prolonged periods is missed ovulations. There can be many causes of missed ovulations including: low thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with boyfriends/girlfriends, exams), increased body weight, anorexia, rotating shifts at work, etc.

Given the severity of your bleeding PLEASE, please contact your GYN or clinic as soon as possible for follow up. They may want to order a blood pregnancy test and/or do a work up to evaluate for miscarriage. If it is not a miscarriage you may be offered a short course of hormones to get the bleeding to stop.

Should you want to conceive at this time they can counsel you in ways to document ovulation, and fertile times. If you are not ovulating regularly you should get tested for low thyroid or pituitary problems. You might even be a candidate for medication to induce ovulations so you can get pregnant when you want.

Yours,
Jane

Thank you. It turned out to be my period and I started back on provera yesterday as scheduled. I am scheduled to have the LEEP procedure done in November so hopefully I will get some questions answered. I just moved to Wichita Falls Tx from Tyler Tx and havent yet found a GYN/Clinic here. I would like to get pregnant within the year or earlier but understand that I probably should wait til after my procedure,results and recover time. My son will be 10 soon and also have a step sone who is 7. I am very ready for a baby and worried that I may not be able to have another one due to my medical issues. Wondering if Ill be able to get pregnant with an irregular cycle and needing to be on Provera to regulate it.

Dear ladybug: The easiest question first. An irregular cycle such as yours usually reflects irregular ovulations, which can increase the time to conception. Go right ahead and try to conceive (TTC). Even women with PCOS and/or irregular ovulations do have surprise pregnancies if sex happens to coincide with an unplanned ovulation. If you were to have an undetected early pregnancy, and took Provera, the medication would NOT induce a bleed and cause the pregnancy to be lost.

It's unclear to me if you are taking Provera 10 mg daily or for 14 days or less a month. If you are taking it daily the dose is still less than the equivalent of what you would be receiving in the older version of DepoProvera It is always best to avoid unnecessary medications when pregnant, but sometimes unplanned/undetected pregnancy happens. Be sure to talk with your new GYN about your TTC concerns. If need be they can discuss induction of ovulations for TTC.

It's good that you are getting the recommended LEEP procedure. A LEEP can be shallow or it can be deep and remove much more of the cervix. Again your new GYN can counsel you about TCC soon after a LEEP.

In trying to find a GYN in your new town, you might want to ask neighbors, co-workers, or other school moms for a recommendation. Your local county family planning clinic or Planned Parenthood is another reputable source of basic GYN care.

Yours,
Jane

TTC? I am taking the Provera 10mg,10days out of the month 15th-24th. It was suggested because birth control wasnt working and I DID NOT want to take the DEPO shot. Really would like to get pregnant right away but feel that I should have the procedure first because we have been putting it off since the first of last year due to money issues and not being able to get my bleeding to stop long enough to have it done. So I would like to start trying the first of next year but am also worried that after the procedure I wont be able to!? Thank you pso much for all of your help and suggestions.

Dear ladybug: The Provera 10 mg for 10 days a month should hopefully help create a more predictable cycle but it is not a form of birth control. You could still conceive if you are having unprotected sex.

Yes, get the LEEP done as soon as you can as you usually do not do LEEP during pregnancy. Once the cervix is healed (depends upon the depth of the LEEP) you can intensify your attempts to get pregnant. There were no studies of time to conception as impacted by LEEP at the National Library of Medicine site, but I did find this summary about LEEP nad pregnancy:

Clin Exp Obstet Gynecol. 2009;36(1):17-9.
Pregnancy outcome after treatment of cervical intraepithelial neoplasia by the loop electrosurgical excision procedure and cold knife conization.
Michelin MA, Merino LM, Franco CA, Murta EF.
Source

Research Institute of Oncology (IPON), Discipline of Gynecology and Obstetrics, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil.
Abstract
PURPOSE OF INVESTIGATION:

The aim of this study was to evaluate the effect of LEEP and cold-knife conization on the outcome of subsequent pregnancy in a tertiary public hospital.
METHODS:

One hundred and ninety-nine patients met the inclusion criteria (age between 18 and 45 years old). Cold-knife conization, LEEP, and both (conization and LEEP) were performed in 102 (51.3%), 95 (47.7%) and two (1%) women, respectively. Average ages were respectively, 33 /- 7.3; 25 /- 6.73 and 30 /- 2.8.
RESULTS:

Pregnancies occurred 2.6 and 4.8 years after LEEP and conization, respectively. Miscarriages and preterm pregnancies were more frequent in conization cases versus LEEP, 26% and 5.2%, 23% and 5.5%, respectively.
CONCLUSION:

If patients express a desire for pregnancy, LEEP should be the procedure of choice.

Yours,
Jane

Thank you so much for all your help! I should hear back from the doctor in the next couple weeks on when my LEEP will be scheduled. Hope to get back to trying to have baby soon after. Althought my fiance and I have discussed I want to have at least one more of my own if possible. Again thank you

You didn't go into detail about needing the LEEP. But one thing that struck me is if you haven't stopped bleeding long enough to have the LEEP done, has it been possible to get a couple of pap smears done this year while not bleeding to see if the abnormal cells reversed. The immune system can oftentimes get rid of abnormal cells on its own. But the pap needs to be done under certain conditions (one being while you're not bleeding). Plus, some relatively harmless conditions can cause abnormal paps. These links may be helpful -
http://www.cancer.gov/cancertopics/factsheet/detection/Pap-HPV-testing
http://www.cancer.gov/cancertopics/understandingcervicalchanges/page1

I apologize if this is all redundant to you. But with your financial challenges and TTC, I'd hate for you to go through this if you don't need to.

Ive two paps and one while bleeding... The cells are more in number so the doctor told me to get it done! It will only be $400 cost to me.