fertility problems from the pill #2

[Christy1980]

I posted this in the "I'm pregnant" forum also, but I wanted to see if anyone here was familiar with this also.....

I just found out that since i was on the pill for 5 years, my ovaries have completely shut down, and that is why I haven't had a period in 5 months. My gyno gave me a prescription to "kick start" my ovaries, but she said that there is a chance that this won't work and that I will have trouble trying to conceive, if I am able to conceive at all . Basically, if these hormones don't work, then I may not be able to have children . I've been crying all morning since I found out.

My question is this: Has anyone else had this problem or know where I can find information about this, and has anyone here had the same problem and still been able to conceive without major intervention?

thanks in advance for the help!

[EnviroBecca]

This sounds very suspicious to me.

a) How does dr. know your ovaries have shut down? What tests did you have? What evidence is there other than no periods for 5 months?

b) What did she prescribe?

c) Did she say that your ovaries shut down BECAUSE OF the Pill, or that you have a reproductive disorder (such as PCO) that was masked by the Pill?

I have not had experience with this specifically, but I spent half my life (age 14-28) believing whatever was the latest pronouncement by a whole parade of doctors, and they ALL were WRONG!!! Yes, there is something weird about my hormone cycling, but it isn't any of the things they've ever said it was, and their attempts to fit me into a mold and medicate accordingly made me violently ill and may have harmed my fertility. Last winter I decided to chuck 'em all, see a midwife for my gyne care, take vitex, and listen to my body for a while. So far, it's going very well. I'm not pregnant yet, but this is only my second cycle trying, and I've had 2 cycles in 3 months which is better than usual for me!

Hang in there!

[Jish]

I don't know about what your gyn said, but I have had several friends (that I know of) who were on the pill for years, had regular cycles before going on the pill, and had a miserable time after going off the pill. For most of them it took many, many months (or more) and medical intervention for them to get pg with their first. The good news is that they all were able to conceive. The other good news is that they were all able to get pg with the second child much easier and without drugs.

[stafl]

I was on bcp for about 8 years or so. I think it took a bit over a year before it was mostly out of my system, and even so my cycles have not been regular since. I did get pregnant without any sort of medication, and definitely not any sort of hormone therapy!

You should probably seek out a second opinion, preferably from a RE (reproductive endocrinologist). Sounds like your doc is decidedly lacking in bedside manner!

[Christy1980]

I've been thinking about it, and to give you some background on the whole thing....

I was kinda letting my body "do it's own thing" and someone gave me an article on PCOS, (poly-cystic ovarian syndrome) and all the symptoms sounded like me... Well, while I was researching PCOS, I hurt my back and couldn't stand the pain anymore...I went to the ER and of course they took blood to check my pg status and hormone levels since I hadn't had my period in 5 months. The ER doc wanted me to follow up with my OBGYN since my hormone levels were "in the low to normal range." I don't speak doctor-ese....anyway, I also had a mild UTI that wasn't causing me any trouble, but the ER dr. gave me antibiotics for that. I didn't even know I had one...

My OBGYN's office is right across the street from the hospital i went to. I assume she got my records pulled up from the ER since she didn't run any blood tests or anything on me. I had a regular pap and pelvic exam, and I asked her to check for PCOS, (which can be checked when they "give you the finger"), and she said my ovaries felt a little swollen, but not abnormally so. I am a big girl, I have been big my whole life, and of course she said I was at risk for PCOS in the future, but I don't have it now.

I hope that can clear things up a bit. Now that I have already started the hormones, I guess I will just stick with them, YKWIM? I will finish this week and then no more. I was pretty scared and sad earlier, but I think I am alot calmer now.

Thanks for the input!! You have all made me feel much better and alot less frightened. Thank you!

[stafl]

Christy,
I still think you should see a different doctor. They can't diagnose or rule out PCOS with just a pelvic! "At risk for PCOS in the future" makes no sense whatsoever! It's a hormone imbalance, and you either have it or you don't. What were your cycles like before taking the pill?

[Pookietooth]

I don't think this doctor knows what she's talking about. She didn't run any tests, she didn't rule out other causes, and she tells you that being on the pill made your ovaries shut down. That all sounds very suspicious to me. PCOS cannot be diagnosed with a pelvic exam, and even if the doctor did an ultrasound to detect whether you had cysts, it still would not be a definitive diagnosis. You can have cysts on your ovaries without having PCOS, and you can have PCOS and not have cysts. It's more about the levels of hormones than it is the cysts.

Run, don't walk to another doctor who is more willing to work with you to resolve this. The doctor should have run several blood tests, more than what would be run in an emergency room, not only to detect PCOS but also to rule out other causes, such as hypothyroidism, pituitary tumors, Cushing's syndrome, etc. (all are rare, but should be ruled out nonetheless).

Being on the pill probably did shut down your ovaries -- but that wouldn't explain the PCOS. The pill might suppress some of the PCOS symptoms, but I don't think it causes it. PCOS is a genetic abnormality, like diabetes, and has more to do with your metabolism than your ovaries (the cysts are just a symptom, not a cause). You're born with it --- or at least the potential for it.

I think you should go to http://www.pcosupport.org and research PCOS. You deserve to be informed so that you can make an informed choice about your treatments. There are many options, both to help you to conceive and to help improve your overall health.

I have PCOS, and am currently 6 months pregnant, thanks to a reproductive endocrinologist's help. We ended up going with Repronex, an injectible fertility drug, but many women with PCOS are able to conceive with just metformin, an anti-diabetes medication that equalizes the hormones systemically.

There is hope. You just need to find a smarter doctor.

[EnviroBecca]

So Christy1980 doesn't get too upset again--I think when Pookietooth said, "Being on the pill probably did shut down your ovaries," she meant TEMPORARILY. The Pill is supposed to stop the ovaries from making their usual hormones, in order to prevent pregnancy, but that's not supposed to be a permanent effect.

Christy wrote:

I went to the ER and of course they took blood to check my pg status and hormone levels since I hadn't had my period in 5 months. The ER doc wanted me to follow up with my OBGYN since my hormone levels were "in the low to normal range." I don't speak doctor-ese....

That may not mean anything's wrong. With no periods for 5 months, they don't know what cycle phase you are; they can get an objective measure of your hormone levels, but they don't know what standard to compare them to. Hormone levels normally are very low just after menstruation. The gobs of tests I've had have indicated that when my system "hangs" I am basically staying in that post-menstrual phase for weeks or months, until something nudges me back into action. If that's where you are, then your levels could be called "low to normal," meaning they're low for a woman in general but normal for the lowest phase of the cycle. It was appropriate to send you to the OBGYN because of the long stretch of no cycles and because the levels didn't indicate that you were premenstrual, but the low levels could very well mean nothing more than that your body hasn't gotten its bearings yet after coming off the Pill.

Other posters are correct that PCOS can't be diagnosed in a finger exam! If you really think you have it, seek out a dr. who has more of a clue.

You didn't tell us what hormones she prescribed. Is it Provera or another form of progesterone? I'm thinking so, because you said you'll be taking it for a week and then stopping. If it is progesterone, the explanation she gave you is not particularly accurate, and I think you should find a dr. who respects you enough to tell you the full story. If it's something else, disregard the next paragraph!

Progesterone is normally produced by the ovary after ovulation and causes the uterine lining to thicken; progesterone then maintains the lining either thru pregnancy or until the egg dissolves; when the progesterone level drops, the lining breaks down and menstrual bleeding begins. Taking Provera (I'm just going to use that name to mean any kind of prescription progesterone) causes the lining to thicken, and stopping Provera causes it to break down, which is called "withdrawal bleeding" by doctors because it's the result of your withdrawal from the drug. Provera acts on the uterus, not the ovaries, and will NOT make you ovulate. However, inducing one period w/Provera sometimes acts like a "reset" on the system, allowing for ovulatory cycles afterward when they otherwise might not have happened. (That's what your dr. meant about a "kick start.") If your response to Provera is a full-fledged period that starts within 10 days after the last dose, that's a good sign because it means your uterus is working properly, but it gives no info about your ovaries. Beware of any dr. who wants you to take Provera regularly, month after month; that won't help your fertility and may harm it. Speaking very cynically but with the force of experience, Provera is often prescribed to get women to bleed so they'll think everything is okay and stop bothering doctors w/questions that are inconveniently difficult to answer.

I agree that you should do more research on PCO, but try not to get too fixated on it; there are other things that can disrupt your cycle, or IT COULD BE NOTHING! You could be totally normal and just taking a while to recover from the Pill! Most important IMO is to get a very thorough understanding of how the reproductive system works and what the various hormones do, so that you'll know what questions to ask and can see thru any BS doctors tell you.

[Christy1980]

I am on Prometrium 200mg once daily for 5 days. I only have 2 days left, and I plan on persuing herbal treatments once this one is over with.

I had no idea that this drug was not supposed to make you ovulate!!!! The way I understood my doc was that this would make you (in her words) "pop out an egg. So be extra careful when you have sex unless you want to have a baby in 9 months." Then she proceeded to tell me that if I didn't respond to these pills, I would probably have a hard time conceiving, if I could conceive at all. Looking back on it, I think she talked herself into a circle, and somehow I missed it. Usually, I can read through some of the BS, but I guess I just heard what she said as opposed to reading between the lines and *listening* to what she *really* said...."If I don't THINK you have successfully responded to this drug, I want you to make another appointment with me so we can put you on ANOTHER DRUG to get you pregnant in the future."

Ugh!!

Thank you for all the help. I am definately going to be pursuing other treatment as opposed to going back to my dr.

Thanks!!

[EnviroBecca]

Prometrium is a natural progesterone (taken from animals) whereas Provera is a synthetic. That's about all I know about it. But it IS progesterone only, so to the best of my knowledge there's no way it could make you ovulate.

If you don't respond to these pills, i.e. bleed during withdrawal, then that IS a sign of likely fertility problems; she's right about that. Not responding to progesterone by building up a lining might mean that you wouldn't be able to maintain the lining for a pregnancy. But that's unlikely, so don't worry about it unless it happens!

Don't let anybody put you on a drug "to get you pregnant in the future" unless they can make a good case that they're treating a disease that cumulatively would harm your fertility (like PCO). Otherwise, even if your fertility IS lower than average, it's healthier for you and for baby to avoid drugs unless you've tried for a good long time (like, a year of serious TTC, if you're under 35) and you really are having trouble getting pregnant. Doctors like to prescribe stuff because it's easier than being patient, IMO.

Edited to add: As for herbal treatments, I'm impressed w/vitex. I've had more regular cycles and been ovulating and felt more "womanly" (hard to explain, but there's this feeling I lose and forget all about when my system's hung, and it's always a surprise when it comes back) since about 3 months after I started taking it. Clinical studies in Germany indicate that it improves fertility!

[Christy1980]

If you don't respond to these pills, i.e. bleed during withdrawal, then that IS a sign of likely fertility problems; she's right about that. Not responding to progesterone by building up a lining might mean that you wouldn't be able to maintain the lining for a pregnancy. But that's unlikely, so don't worry about it unless it happens!

can you elaborate on that a bit? My dr told me to expect to have my period within 10 days of stopping the prometrium and to be prepared for "the period from hell." I assumed that if this doesn't make me ovulate, that it WOULD make me build a lining...?

Thanks!

[Christy1980]

Originally posted by EnviroBecca
Beware of any dr. who wants you to take Provera regularly, month after month; that won't help your fertility and may harm it.

actually, she did prescribe 2 refills to be used later if my period didn't start again in 3 months. She wants me to have a period at least every 3 months b/c she said that was the minimum that was biologically sound...? It was along those lines. Anyway, would taking prometrium 3 months from now and then 3 months from then effect my fertility? I'm not going to do it, but I was wondering if it would be a bad thing or make things worse.

[gina]

Sounds like clomid- doesn't this encourage ovulation...

[stafl]

Christy, since you have more questions than answers from your doc, you really do need to go get a second opinion!

[EnviroBecca]

can you elaborate on that a bit? My dr told me to expect to have my period within 10 days of stopping the prometrium and to be prepared for "the period from hell." I assumed that if this doesn't make me ovulate, that it WOULD make me build a lining...?

Yes, it will make you build a lining unless there is something wrong w/your body's ability to respond to progesterone, like prog. receptors in the uterus have shut down or something--but total lack of response to prog. is very rare, so as I said, don't worry about it unless it happens! Since you were so recently bleeding on withdrawal from the Pill (i.e. during the placebo weeks and, I assume, when you stopped taking it) it seems particularly unlikely that you won't respond.

Oh, and if you don't bleed within 10 days, even that doesn't immediately mean something's wrong--the more likely explanation is that you happened to ovulate while taking Prometrium (this would not be caused by it but just a coincidence) so your body made some of its own prog. and it's taking a while to clear out. If you feel extremely PMSy, esp. very swollen painful breasts and cervix feeling hard and tight, that's probably what's going on. You could just wait or have a blood test (see if prog. level is sky-high) or have an ultrasound (see if lining is thick) or take a pregnancy test (you never know! and the symptoms would be similar). If this happens you'll still bleed within 2-3 weeks, and you'll bleed a LOT. This has happened to me twice.

It may or may not be "the period from hell." It is possible, when cycles are wacky, to build a lining and not shed it; some of it gets reabsorbed, and the rest hangs around and adds to the next round, so your first period after 5 months could be shedding >1 month's worth. But if you haven't been ovulating, then you'll only have the lining created by Prometrium, so it may even be lighter than normal. May as well be prepared for a deluge just in case!

actually, she did prescribe 2 refills to be used later if my period didn't start again in 3 months. She wants me to have a period at least every 3 months b/c she said that was the minimum that was biologically sound...?

Doctors are very keen on that idea, but the evidence is weak...it does seem that regular menstruation (in the absence of pregnancy) helps prevent reproductive cancers, but they don't really understand how that works...and w/regard to fertility, all they've proven is that women who NATURALLY bleed regularly are more fertile; the long-term effects of INDUCING periods w/drugs haven't been studied much aside from contraceptive drugs. Frustrating!

Anyway, FWIW, here's my advice after years of trying different hormone cocktails vs. nothing and after reading everything I can find on the subject: If you are not TTC yet, take Prometrium every 3rd month, but keep a close eye out for EWCM or one-sided cramps or any other sign of ovulation or PMS; if you think your period might be about to arrive on its own, skip Prometrium! Also, when you finish the induced period, start taking vitex (chaste tree berry) every day; it acts on the pituitary gland and is supposed to help the hormones cycle normally. If you are TTC, avoid the Prometrium, because it will only confuse you and your body! After a really long stretch of no periods and no O (more like 6 months) you might want to try the "jump start" again.

There's no evidence that Prometrium itself will harm your fertility, but putting prog. into your body might discourage it from ovulating: "Oh look at all this progesterone! I guess it's not time to ripen another egg after all!"

Gina, Christy is taking Prometrium, not Clomid. Very different stuff.