brown spotting

Hi,

I have a history of uterine polyps.  I have had 2 d+c's over the last 5 years, the last one was about 2 years ago.  I am 38 years old with a history of some infertility problems.  Got pregnant with my 1st after 8 months of trying.  then with my 2nd it took over 2 years, I have a short luteal phase and concieved with progesterone suppositories.  I had a full endocrine workup in March as a result of an elevated prolactin level....I was on an occassional dose of reglan for gerd and my level was 165 ( I had been very ill and noticed a cyclical pattern to it, that is why my md tested some hormosnes)  Anyway, my prolactin level went down to 3.6 and 5 a few weeks later.  I also had a brain MRi witch only showed a prominant pituitery, no lesions or tumors.....

I have been having brown spotting all day ( day 11 of my cycle).  I had a vaginal ultrasound in August which was normal ( having some low back pain at the time).  Is this anyting to be concerned about.  I have had boatloads of bloodwork within the last 7-8 months..  CBC, SMA 6 all normal.  The only abnormals were the prolactin and cortisol(mildly elevated)  The endocrinologist did a 24 hour urine (slighlty elevated and followed up with a dex suppression test which I suppressed.  she also did FSH, LH, thryroid stuff, IGF-I all normal.  My PCP followed up with one more 24 hour urine which was normal.

If I had another polyp wouldn't that have shown up on the ultrasound in August and if I do have another one why do I keep getting them?  My children are 8 and 12 so no recent babies.

[Elaine Brown, MD]

Hi!  It may be nothing at all, or it may be a sign of another polyp.  I would watch and wait.  If it is a polyp you will very likely have more symptoms such as more spotting, heavy periods, prolonged periods, etc.
  
I don't think anyone knows for SURE why all polyps form, but hormone imbalance can be one reason, and it sounds like you are subject to that from time to time. Particlularly too much estrogen and too little progesterone.

I assume you've stopped the Reglan?

Your August ultrasound SHOULD have showed something IF it was there at the time, and IF it was a good quality ultrasound.  If the polyp is new since August, then of course it wouldn't have shown.

You may want to consider supplemental progesterone in the luteal phase, or oral contraceptives to reduce your risk of new polyps.

Good Luck!

Dr B