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Bleeding Half the Month
Question
Dear Doctor,
For the past few years, I’ve had spotting (dark brown blood) that starts a few days after ovulation and continues until I start my actual period (which lasts about five days). My cycle is fairly regular and lasts about 28 days, but it is very annoying that I end up bleeding in some capacity for half of the month.
I have had ultrasounds and blood tests (to test estrogen prog., FSH, thyroid, etc.) at various times of the month and everything has come back in the normal range. My doctors have said that it’s just stress and nothing to worry about, however, I am tired of bleeding and would like a resolution to this.
I have two kids and have had a few miscarriages in the past, and I’d like to try to get pregnant soon and wonder if this spotting will hinder my successfully getting pregnant. (I’m 35, btw) I just started taking 200 mg of Prometrium per day after ovulation and so far, it hasn’t really helped. Is it ok to take Prometrium while trying to get pregnant? (I believe it says not to take it while pregnant on the bottle.)
I just wish I could get some answers to my problem, as nobody seems to be able to help me and they dismiss it as an “inconvenience” and say I have no medical problem, which makes me feel very belittled.
Thank you. Lorissa
Answer
Last Updated: December 13, 2014
Dear Lorissa:
Yes this is quite a lot of spotting and understandably frustrating not to get any answers. It sounds as if you have had some “work up”. However I wonder when those blood levels were drawn. What typically happens is that progesterone is drawn once based on day of the cycle not physiolocial signs of the cycle. The same goes for the estrogen. This spot checking does not accurately reflect the woman’s physiology.
It is much more accurate and medically meaningful to get multiple blood levels at particular parts of the cycle. These levels reflect the natural up and down curves of the hormones related to the cycle. In other words, more labs give more information.
Yet, labs are just one piece of the answer. It sounds as if you are keeping track of your cycles. It would be most helpful to for you to get taught by a Natural Family Planning teacher. There are a great many details that can be gleaned from well done charts.
I would recommend taking the Prometrium on the third day after ovulation…or the last day of Peak type mucus. Ovulation can occur for up to three days after the last fertile mucus is present. By taking the Prometrium (progesterone) right after the last of the fertile mucus, you may be missing actual ovulation. It is a missed opportunity to conceive, or conceive but the child could not implant in the womb.
With a history of miscarriages, I wonder if your symptoms are a sign of previously undiagnosed polycystic ovarian disease. As with any disease, there is a range of severity from very mild to overt symptoms. About 8% of women in the US have it and it is associated with irregular cycles, irregular bleeding, miscarriages, acne, diabetes, Again, some women’s symptoms are so mild they are not diagnosed or it is not a problem.
A treatment for this can include progesterone at the proper time of the cycle which happens to be what you are doing with the Prometrium. Depending on the situation and severity, many doctors treat with a diabetes medicine, even if they have normal blood sugars. There seems to be a common factor with the blood sugar system and the menstrual cycle hormones but these are not known yet.
Progesterone is used routinely in pregnancy at the Pope Paul VI Institute and many physicians. The research done there shows that there is no concern with this. The research against using progesterone in pregnancy is very poor and thin. At PPVI, they have been treating infertility for 30 years. Many women have had previous miscarriages and need progesterone to maintain the pregnancy. This has been done safely.
As to what I would recommend now for you is to have CANFP help you find a certified NFP teacher and a physician who is trained in using the charts. This will help you take the Prometrium at the most helpful time of the cycle. Also, you will be able to identify when you are most fertile so you can focus intercourse at that time. I would also take a multivitamin with folic acid which is recommended for any woman who may conceive.
I hope that this will help you.
Sincerely, Gretchen V. Marsh, D.O.
Yes this is quite a lot of spotting and understandably frustrating not to get any answers. It sounds as if you have had some “work up”. However I wonder when those blood levels were drawn. What typically happens is that progesterone is drawn once based on day of the cycle not physiolocial signs of the cycle. The same goes for the estrogen. This spot checking does not accurately reflect the woman’s physiology.
It is much more accurate and medically meaningful to get multiple blood levels at particular parts of the cycle. These levels reflect the natural up and down curves of the hormones related to the cycle. In other words, more labs give more information.
Yet, labs are just one piece of the answer. It sounds as if you are keeping track of your cycles. It would be most helpful to for you to get taught by a Natural Family Planning teacher. There are a great many details that can be gleaned from well done charts.
I would recommend taking the Prometrium on the third day after ovulation…or the last day of Peak type mucus. Ovulation can occur for up to three days after the last fertile mucus is present. By taking the Prometrium (progesterone) right after the last of the fertile mucus, you may be missing actual ovulation. It is a missed opportunity to conceive, or conceive but the child could not implant in the womb.
With a history of miscarriages, I wonder if your symptoms are a sign of previously undiagnosed polycystic ovarian disease. As with any disease, there is a range of severity from very mild to overt symptoms. About 8% of women in the US have it and it is associated with irregular cycles, irregular bleeding, miscarriages, acne, diabetes, Again, some women’s symptoms are so mild they are not diagnosed or it is not a problem.
A treatment for this can include progesterone at the proper time of the cycle which happens to be what you are doing with the Prometrium. Depending on the situation and severity, many doctors treat with a diabetes medicine, even if they have normal blood sugars. There seems to be a common factor with the blood sugar system and the menstrual cycle hormones but these are not known yet.
Progesterone is used routinely in pregnancy at the Pope Paul VI Institute and many physicians. The research done there shows that there is no concern with this. The research against using progesterone in pregnancy is very poor and thin. At PPVI, they have been treating infertility for 30 years. Many women have had previous miscarriages and need progesterone to maintain the pregnancy. This has been done safely.
As to what I would recommend now for you is to have CANFP help you find a certified NFP teacher and a physician who is trained in using the charts. This will help you take the Prometrium at the most helpful time of the cycle. Also, you will be able to identify when you are most fertile so you can focus intercourse at that time. I would also take a multivitamin with folic acid which is recommended for any woman who may conceive.
I hope that this will help you.
Sincerely, Gretchen V. Marsh, D.O.
Answered By:
Gretchen Marsh, D.O.
Dr. Marsh graduated from Western University of Health Sciences in 1987 in Pomona, CA and is board certified in Family Medicine by the American Osteopathic Board of Family Physicians. She has been certified as a NaProTechnology® Medical Consultant (NaPro) and Creighton model Fertility Care System (CrMS) teacher since 2001. She and her husband, Jon, have 5 sons and live in the Reno region, where she sees patients in person, in addition to her telehealth services offered via MyCatholicDoctor.com
