Doctors Recommend The Pill
Question
Dear CANFP,
My son is 3.5 years old and about two years ago I started having spotting after my period that goes right up until ovulation. I have charted my cycle (cervical mucous + position, waking temp) for years and ovulation still clearly occurs with clear and seemingly normal temperature changes. Spotting is usually brown, occasionally red and changes with cervical mucous progress. My ob-gyn has done two blood tests to check various values and all have been normal. In Feb of this year, we performed a hysteroscopy and D&C and everything was fine with exception of slight tendency toward membrane thickening (but not a true hyperplasia). Recently I’ve noticed dull, constant headaches cropping up at menstruation as well and lasting 3-10 days (always gone after ovulation).
I am a healthy, active, married 38 year old, not overweight or under undue stress and eat a balanced, mostly organic, low-meat diet. I’ve seen other Drs as well, and they all seem unconcerned and recommend various treatments from birth control pills to control spotting to alternative treatments to correct whatever imbalance. Responses on this site were very interesting and I’d be grateful for additional insight.
Thank you,
Megan
Answer
Last Updated: March 12, 2024
It seems as if your physician is taking the correct approach, checking medical as well as surgical causes for your abnormal bleeding. The causes for your bleeding could be either hormonal, autoimmune, anatomical or infectious. Presumably your hysteroscopy ruled out polyps, fibroids, and chronic endometritis as well as hyperplasia. Even if your doctor did some blood tests, there may be some hormonal conditions that were not covered in his/her workup.
Occasionally, thyroid abnormalities can cause abnormal bleeding. In reproductive age women it is desirable to have the TSH be under 2.5, even though many labs suggest that a TSH up to 5.5 can be normal. Another possible cause for premenstrual spotting could be low estrogen, which would go along with headaches from estrogen deficiency, especially if the headaches are midcycle or immediately before the menses. If a midluteal (about seven days after peak day/ovulation) estradiol is less than 70 pg/dl or so, it is possible you are having symptoms from hypoestrogenism. Low estrogen/pre-menopause is fairly common over age 35 and frequently underdiagnosed in women in their late thirties. Low dose bioidentical estradiol patches (.025) for the cycle might eliminate the problem and get rid of the headaches if this is the case. It is unlikely that low progesterone could cause early cycle spotting, but if a midluteal progesterone is less than ten, it is possible.
Finally, especially if you have any autoimmune condition (such as autoimmune thyroiditis, chronic fatigue, rheumatoid arthritis, etc.) you may be deficient in the neurohormone beta-endorphin, and a trial of low-dose naltrexone might be helpful. It is hard to get a good test to diagnose beta-endorphin deficiency.Â
Mary L. Davenport, M.D.
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