Dr. Marjorie Greenfield
Specializing in pregnancy and birth.
|
|
 Ask Dr. Greenfield
Bleeding between Periods | | | QUESTION | | | Dear Dr. Greenfield:
I am 33 years old and have just stopped taking birth control pills to attempt to get pregnant with my first child. For the past eight or nine years I have gotten breakthrough bleeding every month causing a second mini-period. It is much lighter than my regular period and usually lasts for five or six days. It occurs one week or sometimes two weeks before my regular period. And it happens whether I am on or off the pill and no matter which brand of pill I use. After having a vaginal sonogram done a few years ago, my doctor concluded that it may be caused by my not producing enough progesterone. Although he says not to worry about it too much, it can interfere with conception and sustaining a pregnancy. Now that I am ready to get pregnant, is there anything I can do to aid in conception and ensure that this doesn't cause a miscarriage?— Just Want to Know | | | ANSWER |
February 20, 2002 | | | Dear Just Want to Know,
This raises an interesting question: what can cause bleeding that will occur regardless of whether a woman is on or off of birth control pills? It can't be low progesterone, because birth control pills have lots of progestin, and women on the pill don't need to make their own. It can't be other forms of hormonal problems, or stress, because the hormones of the pill mask those causes of abnormal cycles.
If the bleeding, which occurs both on and off of oral contraceptives, is to be explained by a single problem, it is likely that there is something anatomical that is bleeding, like a polyp or small fibroid in your uterus. A polyp, which is a benign out-pouching of tissue from the inner uterine wall, might be missed on a vaginal sonogram, as it can lie against the uterine wall and escape detection. Polyps are usually identified with a saline sonogram or hysteroscope, where the cavity of the uterus can be visualized. Usually the polyp can be removed with a minor surgical procedure. Dilation and curettage, sometimes called a D&C, or hysteroscopy, operating through a trans-cervical telescope called a hysteroscope, can remove the polyp. The doctor will send the tissue to the lab to be certain that it is benign.
Alternatively, I suppose you could have two common reasons for bleeding, since many women get some breakthrough bleeding after long-term pill use. Breakthrough bleeding would be expected to resolve off of the pills, unless there was a second problem that occurred when you were cycling on your own.
So the most likely explanation is that there is some thing that is bleeding, and a diagnosis should be made. It isn't a good idea to ignore abnormal uterine bleeding, particularly as you get into your thirties and older. As one experienced gynecologist once told me: the uterus only has one way to show it's having a problem and that is to bleed. Even though most causes of abnormal bleeding are benign, if you ignore bleeding, eventually you will ignore a serious condition. You should get a better explanation, and treatment, for the abnormal bleeding before getting pregnant. And from what you have told me, your prognosis for successful pregnancy should be excellent.
Take care, and good luck with your family-to-be! Don't forget to take your folate.— by Marjorie Greenfield, M.D. |
|
