Brown Spotting, Moodiness, and Dark Facial Hair

Question

I am 29 years old and have 2 healthy daughters, a 4 yr old and a 20 month old. In the last 6 mos my periods have been regular, however I have dark brown discharge for 5 – 7 days before my period. I have also noticed that I am extremely moody 2 weeks before my period (EXTREMELY). Also, after the birth of our last child I have a lot more hair (upper lip, chin, etc). I have my yearly physical scheduled for next month. Should I have them check my hormone levels? My husband and I are planning to start trying for another baby in a couple of months, but I would like to know what is going on with my body before we start ttc.
Natalie

Answer

Dear Natalie,

Thank you for your question. The changes you describe with the premenstrual spotting and moodiness are certainly suggestive of low progesterone levels in the luteal phase of your cycle. With your observation of the increased facial hair, you may also have increased androgens, such as testosterone. The most common condition causing these changes would be polycystic ovarian syndrome, but there can be other causes as well.

Sometimes the polycystic ovarian syndrome can be brought on by weight gain. If you are not at the weight you were before pregnancy, getting back to your ideal body weight will help normalize your cycle. Your doctor may want to evaluate you further by checking an LH and FSH, TSH, glucose and testosterone levels. If you are currently charting your cycles with a natural family planning method, I would also suggest checking a progesterone level on the seventh day after your peak day. If low, progesterone supplementation has benefitted several women with premenstrual tension and the premenstrual spotting. The recommended supplementation would be with bio identical progesterone, either through formulations made by a compounding pharmacy, or with the commercially available progesterone.

If you are not currently using a natural family planning method, I would highly recommend it. The charting of your biological markers is a wonderful tool that can give incredible information on a woman’s health.

I wish you the best as you seek to improve your health, both for yourself and your children.

Sincerely,

Lynn Keenan, MD, CFCMC

Answered By:

Lynn Keenan, MD
Lynn Keenan, MD, Immediate Past President of the CANFP Executive Board, is a Clinical Professor at the UCSF/Fresno Internal Medicine Residency Program (now retired), Board Certified in Sleep and Internal Medicine, and Vice President of the International Institute for Restorative Reproductive Medicine. She earned her BSN at UCLA, her MD at Temple University School of Medicine, and completed her Residency in Internal Medicine at UCSF/Fresno. Dr. Keenan served on the Executive Board of CANFP since 2004, as President of CANFP since 2010, and graciously agreed to continue her service to CANFP on the Advisory Board at the beginning of 2019, upon her retirement from the Executive Board of CANFP

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