Undiagnosed bleeding, pain and recurrent miscarriage

I'm a 36-year-old woman with one child (4). I started TTC in 2008 with no success for 12 months. In 2009, I became pregnant only to miscarry at 7 weeks. That miscarriage was followed by three subsequent miscarriages at 6, 8 and 9 weeks. I had a D & C after the last miscarriage. After the D & C, I continued to bleed off and on for approximately 10 weeks. Because I had not established a normal cycle, my doctor prescribed birth control pills. I established a cycle briefly, but my period was extremely heavy, included clots and very intense cramping. After a couple of months on the pill, I started again experiencing bleeding between periods, accompanied by extremely painful cramps, headaches, backaches and fatigue.

I've had every conceivable test - a full hematology workup that showed no problems/no indication of malignancy, a pelvic CT scan, ultrasound (my uterine lining was very thin), hormone and thyroid tests. Everything is "normal." Four months ago, my doctor performed another D & C and a laparoscopy. She said my endometrial lining was still very thin and that the laparoscopy showed no obvious signs of endometriosis (what she'd told us to expect). She prescribed a higher dose oral contraceptive and instructed me to skip the placebo pills so I would not have a period at all. The pill seemed to have worked for a while although I continued to experience intensely painful cramps on a regular basis. Two weeks ago, however, I began bleeding again - bright red blood with clots that occurs every time I urinate or have a bowel movement. I'm also fatigued and in pain. I do not bleed between trips to the bathroom. I have spoken with my doctor and she is at a loss. Because there is no indication of cancer or other serious illness, she seems to think that managing my pain is adequate. But my husband and I are extremely frustrated. We want to have another child and have no idea if that is ever going to be possible. Without a diagnosis, how can we move forward?

Can you help?

[Elaine Brown, MD]

Hi!
I'm sorry to hear that you have had so many miscarriages.  I definitely think its time for you to start working with a specialist in reproductive endocrinology.

If you were my patient, I would work up BOTH recurrent miscarriage  (there are LOTS of tests for this including anticardiolipin antibodies, etc)  AND
irregular bleeding.

One of the first tests I would probably do is an endometrial biopsy.  I would time it with an ovulatory cycle to see if your lining is in sync and also to rule out endometritis (different from endometriosis).  I might also consider hysteroscopy to rule out Asherman's syndrome (scarring of the lining).  This would also eliminate a septum as a cause for recurrent SAB.

Pardon me for saying so, but "at your age" don't was any more time, go to a specialist!

Good luck!
Dr B