Pregnancy

What`s wrong with me?

11/20/2009

Question:

About Myself: I am a 22 year old female. At age 16 I became pregnant for the first time. This pregnancy resulted in a miscarriage, due to unknown causes. I passed it off a my body not being ready due to my age and size. I was only about 98 pounds when I became pregnant.Over the next 3 years, I would again become pregnant 2 more times, both also resulting in miscarriages. At age 19, I was put onto birth control, to prevent myself from getting pregnant and miscarrying again. Within the first day of applying the patch (Evra), I began to bleed. I talked to my doctor, and he said it was "normal" to bleed when starting birth control. This was very heavy bleeding and after one week, I took the patch off, due to lack of energy because of the blood loss. Even after I took the patch off, I remained bleeding in the same heavy manner for 29 days. After that peiod of heavy bleeding, I didn`t experience another menstrual cycle for a year and a half. When I did get my menses back, it became very irregular. Sometimes not coming for 4 or 5 months. My doctor says its an irregular period, but has never tested m for ANYTHING else. My fiance and I have been together for 7 years now, and we would really love to start our family. At this time, it has been 4 months since my last menses. I am also always tired and weak. I have been doing a lot of my own research, and have come across two things that worry me. My symptoms seem to be very similar to the symptoms experienced with hyperthyroidism and/or Graves.
So my questions are: 1) What could the cause of me bleeding for 29 days be? 2) With my peiod being so irregular, do I still ovualte and if so, how could I determine when? 3) In your opinion, what would be yor first guess as to the cause of my problems? 4) Do you think I am able to conceive? 5) Is it possible that the Evra Patch had some effect on me which inabled my ability to conceive/carry to term?

Answer:

When a woman has menstrual periods infrequently, it is called oligomenorrhea. Usually this is associated with infrequent ovulation. Sometimes the ovaries are producing normal amounts of estrogen, but for some reason ovulation does not take place to trigger the period. This can result in a heavy buildup of uterine tissue, so that when bleeding does finally occur it can be long and heavy. This is more often the scenario in women who are overweight or who have PCOS (see http://www.netwellness.org/question.cfm/75031.htm).
Other times, the problem is that the ovaries are not producing enough estrogen to cause any growth of the uterine lining. This is more likely in women who are underweight (for example competitive athletes, eating disorders, etc.). When oligomenorrhea is a consistent problem, hormone levels should be checked for thyroid hormone, prolactin (another hormone made by the pituitary gland that can interfere with ovulation), and some test to check estrogen (which can be done by taking a hormone pill to see if it triggers a period). Various treatments are available to help women conceive if they ovulate infrequently, but the treatment will depend on the cause.

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Response by:

Jonathan A. Schaffir, MD
Assistant Professor
Division of General Obstetrics and Gynecology
Department of Obstetrics and Gynecology
College of Medicine
The Ohio State University