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Menstrual Cycles
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shelby33 posted:

A couple of months ago I had a heavy period. I went to the doctor and got medicines to fix the problem. Everything went back to have normal cycles, but now these past two months I have been getting my period way to early. Last month it came a week early and this month 2 weeks early. I don't know what is wrong, do I have something to worry about.


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Jane Harrison Hohner, RN, RNP responded:
Dear shelby:It sounds like you had a prolonged heavy flow a number of months ago which was possibly treated with synthetic progesterone pills (eg Provera /medroxyprogesterone). You returned to your usual, regular cycles, but the past two months have had erratic bleeding instead. Hope I am tracking you correctly.

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. The good news is that you have enough estrogen to make a lining that does shed.

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/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 can be MANY causes for not ovulating: low thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with partners, boyfriends/girlfriends, finances), increased body weight, anorexia, rotating shifts at work, etc. You did not mention your age, but if you are in your 40's ovulation frequency can become more erratic as one moves into perimenopause.

If your usual cycles do not reset themselves this month it is time to see your GYN or clinic. They can do an evaluation to determine if there is an overt cause for the irregular bleeding pattern. Certainly if you have pelvic pain (eg an ovarian cyst) you should go in promptly.

Yours,
Jane


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