TMI: Period/birth control help

In My Humble Opinion
1

Seriously, not for dudes.

I have PCOS. I’ve never gotten my period on my own, so I’ve been on the pill since I was 13 or so. The BC Pill I take Lo/Ovral which is “a combination of ethinyl estradiol and norgestrel.” In 2011 my doctor gave me the OK to take the pill continuously and get my period every 3 months. That worked, I did that.

I’ve been lifting and doing cardio for about 3 years now, very regularly. In the first 2 years I wasn’t watching my diet so I didn’t lose weight, I just maintained (or gained!)

So in January 2012 I started with the diet and losing weight, and continues with the working out. I got my period in January, unplanned, but went on the placebos for a week and let myself uhm “bleed out.” Then for like 4 months, I had spotting every day. It sucked. My gyno said it was probably because the pharmacy switched generic brands of the Pill, so she got me back on the original generic, had me get my period a couple times, and all seemed well. But by then the year was up and I still hadn’t had a chance to see a pattern in my cycle.

Now this year I’ve finally figured it out…my period is coming every 3 weeks, despite me taking the pill (meaning I am taking the active pill, not the placebo, and I am getting it). If I continue to take the pill through what should be my period, I just spot bleed forever. This is what was going on all through 2012 - not affected by the generic switch.

If I go to the placebo for a week when I start bleeding at the beginning of my 3-week cycle, I end up having a normal period with full bleeding, then 2 weeks of not bleeding while taking the active pill, and then here comes my period again while taking the active pill.

This has happened 3 cycles in a row now.

Oh, also I had trans-vaginal ultrasound last year (yay me!) and they thought my lining was thick. So they gave me one of those procedures where they do an ultrasound while they fill your uterus with saline for a better picture, and decided my lining was fine. But holy canoli was that not fun…Anyway, my lining is right and AFAIK there’s nothing hinky going on that an ultrasound would see.

I also get my thyroid tested all the time since I’m so fat, and so far it’s never come back poor.

So now you know the story, here are my questions:

  1. Is it worth a trip to the gyno? Or is this just a “oh well that is your cycle!” thing.

  2. Since I’m losing weight, have PCOS and take metformin, would an endocrinologist be helpful to me? I keep thinking the same doctor should be monitoring my metformin and BCP instead of my regular doctor and gyno.

  3. The big question is…does bleeding regularly “despite” the pill have any bearing on fertility? How closely are your uterine lining and eggs related? If I am bleeding does that automatically mean I released an egg prior, or are they not as related as that? I don’t WANT to be more fertile, that’s for damn sure.

  4. Does this extra bleeding mean anything in regards to endometriosis? I don’t have it but my 2 female cousins have it big time.

  5. Seriously, how bad is a hysterectomy? I’m almost 35, I do not want children, I hate having to care for a uterus. What are the ramifications of a girl with PCOS being without one?

Sorry to ramble. I just need some help trying to decide what doctors to spend money on. Thanks, America.

2

As I understand it, “period” bleeding on the pill is not a true period in the reproductive sense. I think that means its not related to fertility.

3

This is waaaaay above my pay grade, but since I didn’t know what it stood for, I’ll just offer that PCOS is Polycystic ovary syndrome:

4

Yes but period bleeding related to the pill means when you are off the active pill, you bleed because of the dip in hormones.

What does it mean when you bleed - nay, get a full-blown period (I get PMS, then start bleeding) - while taking the active pill? Is this period related to the pill then, or is it a period despite the pill?

5

ZipperJJ, have you seen an endocrinologist? I have a girlfriend who is successfully treating her PCOS with glucose and has been able to conceive twice since starting glucose therapy after ten years of missed periods and infertility. I don’t know much about the connection between PCOS and insulin levels, but I’ll poke around online and see if I can find some helpful information. Can you ask the mods to add “PCOS” to your title so that women with experience in treating the condition chime in?

6

I address the thought of the endocrinologist in my OP. It’ll cost $150 to go see one. I do not wish to become pregnant, ever, so I do not need someone who will help me get pregnant despite PCOS. However I do need to know if they could help me get on a less irritating cycle, or get back to being a person who can only have 3 periods a month.

7

Have you talked to your gynocologist about getting an IUD?

I don’t know how awful a hysterectomy might be… but I would bet dollars to doughnuts, it would be hard as balls (bordering on impossible) to find a gyno willing to do one prophylactically because you don’t like your cycle.

8

I only recommend the IUD because one of the benefits is almost zero period. Plus you just set it and forget it for about five years. I love my Mirena. Yes. I said love. About an IUD.

9

I’ve contemplated Implanon but me and the gyno backed out at the last minute since I need the estrogen one gets from pills.

One of the benefits from the pills I am taking should be no period, yet here I am! So not sure how an IUD would help :slight_smile:

10

Huh. Doesn’t the Mirena have estrogen. Google…

Nope, no estrogen. Sorry. :smack:

11

How old are you? Is there any chance that you’re heading into perimenopause? (Note: I have no idea if the pill would mask that. I kind of assume it would, but having been off the pill for more than a decade, I don’t know).

I also have PCOS and my new doctor has suggested an endocrinologist as a possibility - I’d not been to a doc in ~6 years, so once I do the gyno visit (first visit was history, followed by a blood draw), that may happen.

12

Do you take the pill at the same time every day? If not, we expect to see more breakthrough bleeding.

Do you take any other medications, supplements or herbs? Drugs/herbs/supplements that are metabolized in the liver using the CYP450 pathway cause more breakthrough bleeding. (Short and dirty: they use up the same protein in the liver that the birth control pill uses up. Without enough protein to go around, some things don’t get fully metabolised.) Antifungals, some antibiotics, anticonvulsants and St. John’s Wort are some of the better known troublemakers, but there are others. (Metformin is not one of them.)

Do you smoke? Smokers on the pill have more breakthrough bleeding.

If none of the above apply and the endometrium is not too thick (a very common cause of breakthrough bleeding in women with PCOS) then I’d suggest changing brand of BC pills.

Whatcha most likely have here is wonky estrogen levels. This can be extra wonky when losing weight, because fat cells can make and store estrogen. Excess estrogen causes breakthrough bleeding. So can insufficient estrogen. And estrogen that’s just right, but in the wrong proportion with progetin/progesterone can cause breakthrough bleeding. Seriously, estrogen is a bitch.

Generally, your body figures out how much estrogen you’re taking in the pill and adjusts it’s own production of estrogen so that you’re not dealing with excess or insufficient estrogen. Sometimes it gets stupid though, and can’t figure it out. For reasons we entirely haven’t figured out, but we think maybe it has something to do with the type of progestin in the pill (there’s more than one in common use), changing brands of pill can sometimes help.

Here’s a paper on the topic, if you feel like wading through science speak. It’s not particularly layperson friendly, but you’re pretty smart. :wink:

http://www.jfponline.com/pages.asp?aid=4454

13

Has your doctor tried adding metformin to the mix? I have PCOS and had absolutely awful periods that sometimes lasted six weeks with the “tap” turned on full blast, and then I’d get a variable break between two and sixteen weeks before the nightmare started again. I wanted to conceive, so I didn’t go on the pill and just toughed it out for years. I didn’t get diagnosed with PCOS until a few years AFTER I finally gave birth.

My gyno referred me to an endocrinologist who put me on metformin, and my periods immediately became regular. Metformin is referred to as a “magic bullet” drug that solves a number of PCOS- and diabetes-related problems, but I had no faith until I saw it in action first-hand!

Another (usually) permanent alternative to hysterectomy is endometrial ablation–it zaps the lining of the uterus so you’ll be done with periods but will still have the uterus there to “hold things together” and avoid prolapse. You should still remain on birth control with this method, though, just to be sure.

Good luck!

14

It is mentioned in the OP that she is already taking metformin.

15

Whups… I totally missed that. :smack: My reading comprehension must be at an all-time low.

16

There’s probably a pill for that, too. :wink:

17

When you say you’re getting your period “every three weeks” do you mean three weeks between the beginning of one period and the beginning of the next, or three weeks between the end of one period and the beginning of the next? The latter isn’t especially worrisome IMHO. My cycle changed to just about that (26 days instead of the 29 it always had been) right around the time I hit 30.

18

Let me echo anyone who’s said it’s time for a birth control checkup/change. Your body changes with age, anyway, and with long-term use of any kind of birth control as well. Losing weight, working out…all that will change your hormone balance.

So get in the stirrups, have a nice checkup, and talk about other strengths/brands/types of birth control.

19

**elfkin477 **I have 3 weeks between the beginning of my period. Two weeks after I stop bleeding before I start again.

I’ve seen my gyno - who is actually a gyno nurse practitioner (since the practice is all all male otherwise) - doesn’t really seem like she’s all that knowledgeable about hormones. I mean she’s not ignorant of them. But I’ve seen her 3 times in the past 12 months and she never suggested changing the pill. I also might not be giving her enough info or seeing her enough, but I’ve become very frustrated with their phone system and my inability to reach anyone there, so fuck 'em.

But, it seems like my one question is answered…most women who have PCOS see an endocrinologist and I need to see one too. I just need to tough it out until I can afford it in a couple months.

Does anyone have any opinions on whether or not I am ovulating?

My train of thought is as such: the BCP mimics my hormonal cycle and every 4 weeks when I drop to the inactive pill, it’s making my body think I’ve ovulated and nothing was implanted, so I shed my lining.

However, now that I am shedding my lining NOT according to the lack of hormones in the BCP in week 4, instead I am shedding in week 3 while my hormone levels are the same as week 1 and week 2. So what is causing me to shed? Is it because I actually DID ovulate?

That’s the scary and confusing part for me.

20

It’s very unlikely that you’re ovulating if you’re taking the pill correctly.

If it would make you feel better, pick up a basal temperature thermometer (it goes to two decimal places instead of one) and take your temperature every morning just after you wake up and before you move or get out of bed. And then do some reading about basal body temperature or symptothermal Fertility Awareness Methods to figure out how to interpret your results. Basically, if you are ovulating, you’ll see a dip and then a spike in your morning temperature when you ovulate. There will be little teeny ups and downs if you’re not, but no great changes. Some caveats there: you have to get at least 4 hours of sleep, you have to take your temperature at the same time every morning, and drinking alcohol the night before can mess with your temperature and give you an inaccurate result. With practice, you learn how to adjust for an outlier here and there, but if you work swing shifts or something, it won’t work very well for you.