No period yet even after Provera

[farrout]

I am 44 and my last normal period was June 20.  Since then, I had one day of spotting on Sept 6 and one day of light bleeding on Sept. 7 but have had nothing since.  I recently went through a 10 day treatment on Provera at a 10mg dosage and have still not begun a period even though my doctor told me that the Provera would jump start my periods.  Up until my last normal period, I was not experiencing any problems.  He had tested my TSH, Prolactin and Testosterone and told me that they were all normal.  Any suggestions on what I should do next?  Are there other tests that I can ask my doctor to run to help figure out my problem or does this maybe mean that I am in menopause or perimenopause?  I am not have any symptoms of menopause that I have read about, though, except for not having a period.

[Machelle Seibel, MD]

A. The commonest cause of a missed period is pregnancy.  While it isn’t likely, if there is any chance that you are pregnant, it’s worth getting a pregnancy test.  Also ask for a test for FSH that tells if you are approaching menopause if the level is high. Your pattern of bleeding isn’t unusual for perimenopause.  An estradiol test is also good to check.  People who don’t have a bleed after Provera usually have low estrogen levels and the addition of the progesterone doesn’t cause a period because the lack of estrogen didn’t build up their uterine lining enough to shed after the progesterone.

It is also possible that provera doesn’t work because a person isn’t ovulating. Common reasons are excessive exercise, stress and weight loss, or poor diet.  Once again, it causes low estrogen levels to occur so provera can’t cause a bleed. Not having a period isn’t necessarily a sign of a bad problem; it is more a sign of hormonal imbalance.  If provera alone doesn’t work, then you will likely need to take estrogen plus progesterone in the form of a birth control pill or perhaps another combination of estrogen and progesterone at a lower dosage.  You can always stop it after 3 – 4 months and see if you start again.  If weight related or stress related issues are likely, they need other kinds of attention. If it's perimenopause, you might just want to wait and do nothing.
Machelle M. Seibel, MD