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An_249190 posted:
have had irregular periods since I was 16 when i was in college i had my cycle for 3 month heavy the doctor said i was fine but i would need help getting pregnant. i stop having cycles for 6 months the next doctors says i need to stay on birth controll in order to have a cycle 3 years later i get pregnant(accident) and miscarried after 8 weeks i didnt find out untill 14 weeks. then im diagnosed with untrine cancer. after that was taken care of i have a normal cycle for 4 months before i went back on birth control for a year now im off and want to have a baby with my husband but i dont have great insurance to pay for all the test they need to run what can i do.
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David K Walmer, MD, PhD responded:
What you are describing is not that rare. There are two potential approaches:


#1 You can undergo an extensive evaluation and plan treatment that addresses all of the potential issues that are identified.



#2 You can make some assumptions about the most likely cause of your problem and initiate therapy without a complete evaluation. This would require you to have a trusting relationship with a healthcare provider who understand your situation.

What you are describing is most consistent with what the World Health Organization calls a type II ovulation disorder. Many doctors and patients refer to it as Polycystic Ovarian Syndrome. A more informative way of describing it may be functional female hyperandrogenism resulting in estrogenic ovulatory dysfunction. This is a fancy way of saying that you have a hormone imbalance involving testosterone and estrogen. Approximately 5% of the adult female population has some symptoms of this disorder making it the most common endocrine problem that women have. Normally women's ovaries secrete estrogen for approximately 2 weeks followed by estrogen progesterone for approximately 2 weeks. Women with this problem often get stuck in the first half of their menstrual cycles and secrete estrogen continuously. Estrogen is a hormone that causes the uterine lining to grow. Over a period of approximately 10 years this unopposed growth can lead to the development of uterine cancer , which you describe. This is often a fairly treatable cancer using high-dose progesterone under the care of a gynecologic oncologist if a woman wants to conceive.



In the absence of cancer, this progesterone-deficiency disorder can be treated with birth control pills, other progestins or ovulation induction to help your body naturally produce progesterone. This latter therapy would increase the chances that you would be able to conceive. There are a number of relatively inexpensive oral medications that can be used to try to induce ovulation if this diagnosis is correct.



Three medications that are commonly used for this purpose are clomiphene citrate, tamoxifen and letrozole. I would recommend that you develop a relationship with a healthcare provider that understand your personal circumstances and is willing to work with you within your resources.



Good luck!


Dr. Walmer
 
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njacs replied to David K Walmer, MD, PhD's response:
Thank you very much I will find a physican that works best for me.


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