Estrace/Progestrone Challenge - No Period

I stopped taking oral contraceptives in Sept 09 and had my normal withdrawal bleed after my last pack of pills.  Since then, however, I have not had a period.  I did the progestrone challenge with no withdrawal bleed in November, followed by the estrace/progesterone challenge in December with no withdrawal bleed.  However, about 3 days after finishing the pills on the estrace/progesterone challenge I had cramps, breast pain/swelling, and low back pain.  I have not had any prior surgeries/D&Cs/etc to cause uterine scarring.  What could be the cause of the lack of withdrawal bleed and why would I have had "premenstrual symptoms" but no withdrawal bleed? Thanks

[Elaine Brown, MD]

Hi!
I understand why you are confused!  Since you DID withdraw to OCs, the estrace/progesterone challenge should have worked similarly!
Unless there is some type of obstruction to the flow.  If you have ever had cervical biopsies for dysplasia, this can be enough to cause cervical stenosis.  It should be simple enough to check for that with a dilator in the office.  If you were my patient, I would suggest and ultrasound to look at the uterine lining and possible dilation of the cervix if it appears there is any build up inside the uterus.  I have seen this happen even years after the fact.
If the uterine lining and cervix are normal, the other possibility is that you need more estrogen to build up the lining, or more progesterone to cause it to slough.
The PMS symptoms were probably caused by the medications that you took.

If you are trying to get pregnant, I might consider giving Femara a try to see if ovulation could be induced and a period (or pregnancy) following that.  

I hope this helps!
Good luck!
Dr B