Unusal Cycles

Hello Dr. Brown,

I am 41, healthy by all accounts and have had very regular cycles my entire life.  Over the past 2 years I have experienced 5 miscarriages and after the 4th, my cycle changed from 28 days to 25.  Not big cause for alarm, I chalked it up to hormones.  I am now 8 months post partum (I finally had a healthy baby boy in January!!), and my cycle returned when he was about 4 months old.  It has been fairly regular, returning to 28 days.  Heavier periods then used to be, but again, nothing that caused me concern.  This cycle I got a positive ovulation test (we are ttc again) at cycle day 12, but then I got my period on cycle day 23.  It is very different.  Usually I start out spotting then it gets heavier until day 3 or so, tapering off (for a typical 5 day period).  This month is started out spotting as usual, but by that evening it was exceedingly heavy...almost to the point that I began to become concerned.  Today is day 2 and it is lightening up, although started heavy this morning.  Is this a possible sign of perimenopause, or is it more then likely just one of those odd cycles?  My plan was to see if the next cycle was more normal, but if it wasn't to make an appointment with a gynecologist.  Curious as to what your thoughts may be?  Is it normal to have unusual cycles this far post partum?  Thanks so much!!

Oh, I also wanted to thank you.  I wrote you several times in the last two years about my recurrent miscarriages and you gave me some excellent advice and information.  I took that to my OB for discussion and combining some of your thoughts and her own, I finally was able to have a baby.  Thank you for all your help!!

[Elaine Brown, MD]

Hi!
Congratulations!  I am so glad that I may have helped in a small way.  Boys are fabulous--I have three of them!
If you were my patient, I would probably advise you to do exactly what you propose--wait and see what the next cycle is like.  It is quite common to have "different" periods in the postpartum months.  It probably doesn't represent menopause.  If your next period was also extremely heavy, I would do an ultrasound to see what was going on in the uterus--any retained tissue (unlikely) any polyps or fibroids?  I might be tempted to do an endometrial biopsy and/or treat empirically for endometritis with a course of antibiotic therapy to see if that helped.
Hopefully, your next period is normal!  You have enough on your hands with a newborn!
Good luck and Congratulations again!
Dr B

[adgal]

Thanks so much for the congrats.  Actually, you helped a great deal. You had recommended fish oil and baby asprin and my OB agreed it was worth a shot.  

I do have 2 fibroids that were discovered during the investigation into my losses.  At the time she opted to leave them alone as they were relatively small and she didn't feel they were causing any problems.  I also recently had a biopsy as some of the tissue in the vulva area is changing color.  The biopsy came back negative for cancer (thank God!) but positive for something else...I cannot remember the name but basically a pre cancerous condition.  I am being treated with laser therapy for it.   It's not considered serious at this time.

The fibroids have not been checked again since I became pregnant with my son, but now I am wondering if that is not the issue?  They grow during pregnancy don't they?  And although this period was unusual, all have been heavier then they used to be with more menstrual cramping...nothing unbearable, but more then there used to be.  Perhaps I should ask they be removed?  I know they can cause more bleeding, but can they also cause irregular cycles?  I think retained tissue is unlikely as I did have a c-section.  I will also bring the other info you provided to the appointment...she is very open to suggestions, I like that about her.

Thanks again, I appreciate you taking the time!