Question:
Good evening, Dr. Ramirez. Thank you for taking the time to read this email.
I am concerned about my periods. Nearly two years ago, I made the difficult choice to have an abortion. Not wishing to go through that again, I chose to have the Depo shot for six months after. However, due to weight gain, I stopped taking it. That was over a year ago.
For the last year, my periods have been coming every two months, but the last one I had scared me. Instead of being red, as was the normal, the blood was brown in most areas and black in others. It lasted seven days, but did not increase in flow, if anything it slowed and thinned towards the end.
I went to see my local doctor, and she told me that I would not get help because I am under 30. My partner and I have been having unprotected sex in the hope for a baby, but to no avail. I cant even work out when I am ovulating.The women in my family have been known to suffer from Polycystic ovaries, especially my sister who is close to me in the gene pool. Is it possible to develop this? I'm so worried and depressed all the time. Please can you help and advise me? I am writing to you from chilly England.
Regards, K. from the United Kingdom.
Answer:
Hello K. from the U.K.,
I can't give you specific advice because I don't have enough information. Certainly if your cycles are irregular, something is going on with the ovaries. There are several levels that have to be checked to find where the problem is. Polycystic ovarian syndrome, or PCO, is an ovarian disorder where the ovaries dysfunction and don't ovulate. That certainly is a possible cause, and probably the most common cause of irregular cycles. Again, without testing it is difficult to know. PCO can be latent for a period of time and then for unknown circumstances, like weight gain, can manifest itself!
In terms of your bleeding, the brown and black blood are nothing to be concerned about. That is old blood that has made its way out of the uterine cavity. It started out red but sat in the cavity for some period of time before making its way out. One concern that I might have, since you are interested in fertility, and because of the bleeding change, is if any damage was done within the uterine cavity from the abortion. Sometimes if the D&C is done too vigorously, scar tissue can form within and prevent the blood from flowing out easily. A procedure called a hysteroscopy would need to be done to evaluate for this.
Regardless of your age, if you have not been able to achieve a pregnancy after one year of trying, you fall into the category of infertility and should see an infertility specialist. They would not only evaluate your for your menstrual irregularity and try to remedy this, but will also evaluate the uterine cavity. So go tell your unhelpful gynecologist that you want to be referred to an infertility specialist!
Good Luck and a very Merry Christmas over there in chilly England!
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
Comment: Helpful, polite and understanding. Everything you want when you need help!
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