Still spotting after period - just finished 3 months of provera

I finished a 5-6 day 'normal' period, and have continued spotting - it will be 5 additional days today for a total of 12 days (including normal period). I was on provera for the past three months for cycles that were coming very close together - 18 - 21 days, but when it came at 13 days, my gyn put me on the provera.
I'm just turning 49 years old, and have had the close cycles for about 2 years - sometimes heavy with clots and other times lighter.I never spotted like this before.

I also had an endometrial biopsy 2 years ago, because of the heavy bleeding - the results were normal.
I called my GYN and since I have my yearly appointment later this month, she didn't renew the provera, and said we will re-evalute at that time.
I do have three fibriods, and had an ultrasound in February that showed a functinal cyst. (I've have small complex cysts over the past two years, that have always resloved.)
I have no other symptoms,except the spotting (which is heavier at times), so I'm thinking that this may be all hormonal, given my age and I just need to ride it out. My GYN has said that my progesterone is low (which is why she gave me provera). I wonder if I'm just not making eneough to stop the bleeding?

Mary

[Machelle Seibel, MD]

In the window near menopause, such as you are in, estrogen levels are usually still normal or near normal, but progesterone levels are low. That is why provera, which is a synthetic progesterone, is helpful. To be sure there isn't a problem, it might be helpful to repeat the endometrial biopsy with your annual exam. In two years things could change. You might also check your iron level and blood count to be sure you are not anemic from the spotting. Low iron levels can cause spotting.

The progesterone might be taken two weeks of every month to bring on a period but prevent the spotting. That is one way you can discuss with your gyn. The reason is that you are making the estrogen, but not ovulating, so you don't make the progesterone to cause the period to come.

In the end, it might be necessary to just ride it out as you said. But first be sure that there isn't anything the matter and make life as comfortable as you can.
Machelle M. Seibel, MD

[marymk]

Just additional information. I'm still spotting, it's almost gone at bedtime and seems to start up around late morning. It's usually just when wiping, but once in a while a spot in the toilet. It's quite red - just like my 'normal' periods.

Also, since I had an endometrial biopsy two years ago this month, would I need one again this soon - is two years soon eneough for something to develop? I've also had about 6 ultrsounds during this time period to follow cysts that usually dissolve.

Thank you for your time.