recurrent miscarriages, constant spotting, possibly POF?? Not sure...

[childrenrtreasures]

I am 29 and have Hashimoto's(dx in 2005 been on Levoxyl w/ normal labs for just over a year). I have 5 healthy kids (had a m/c prior to baby #4 and baby#5). I had a 2nd trimester m/c in Nov '04 and had 4 more losses follow including another 2nd trimester loss.

Since my m/c in Nov '04 I have had constant bleeding/cramping, 3 ruptured ovarian cysts and 2 uterine hemorrhages. In Dec '05 after my last m/c my OB put me on birth control (ortho-evra) to stop the bleeding. I stayed on it for 6 months and had regular cycles (w/bleeding that lasted 9).

I would like to ttc asap so went off it at the beginning of June. I had my typical 9 day flow but started spotting on day 16. I am now on day 24 and still have not ovulated but still spotting.

I am also experiencing vaginal dryness, arrhythmias (had these before...holter monitoring revealed PACs; went away while on BC)irritability/moodiness/irrational (I was very emotionally stable on the BC), no libido, slightly depressed/disinterested in life (this is NOT like me AT ALL!) and my breasts have shrunk an entire cup size. I had been having hot flashes on my week off the BC but don't have them now.

I have an appt with my endo Sep 1 and will bring these things up. I'm wondering however if I may be experiencing premature ovarian failure (POF). My OB mentioned at my last appt (dec '05) that I may have low estrogen levels (didn't test them due to the recent m/c). I'm concerned that they're going to say take an antidepressant and go home; I don't believe that's the solution (especially since the BC helps).

Thank you! Kelly

[Machelle Seibel, MD]

A. It is difficult to know the origin of your problem without an exam and some laboratory testing, but it certainly seems something has changed given you have 5 children.  

Premature ovarian failure is a possibility.  That can be tested by getting a blood test for FSH.  If it is elevated, it certainly suggests that is the problem.  Women with thyroid disease like you have are at more risk of POF as the antibodies that attack the thyroid also attack their ovaries – both are endocrine (hormone secreting) glands.  If the FSH is elevated, there are antiovarian antibody blood tests that further make the diagnosis.  It is also possible that your thyroid hormone levels are off and the dose of your Levoxyl needs to be adjusted.  Your endocrinologist might also check other hormone producing glands such as your adrenal glands or get a blood test for prolactin.

It is also possible that your are feeling a little depressed, not necessarily causing the problem, but because of the problem.  All this is understandably very upsetting.  So treating how you feel can be helpful, though it may not make the problem go away.

Consider staying on the birth control pill for another month so your mood is better and you don’t have vaginal dryness or bleeding.  You can come off the pill at least two weeks before your visit to the endocrinologist.  By then any tests he or she checks should not be affected by the pills.  You will likely get to the bottom of this problem at that time.
Machelle M. Seibel, MD

[childrenrtreasures]

Thank you so much Dr. Seibel for your reply.

I called my OB this afternoon to get his opinion and he said he wants me to have a serum HCG done and then start Provera. If it's neg (which we're expecting that it is since we're still preventing preg). He wants me to take the Provera for 10 days.

The nurse explained that it would help me to build up a thick uterine lining and then shed it all at once when the Provera is discontinued rather than my current condition of constantly shedding the lining.

I'm not clear on the purpose of this; it seems like a very short-term solution to a potentially long-term problem.

I think that since I felt so much better on the birth control I'll start that again. I hadn't realized I could have testing after only two weeks off. The nurse today told me that it can take up to 6 months for my body to adjust from being on birth control. I was a little alarmed since I was only on it for 6 months.

If you or anyone else here is able to give me a little insight as to how Provera might help my situation I'd appreciate it!

Thank you.

Kelly

[girl522]

Read a little bit about the side effects of birth control.  I had many of the same symptoms you had after about 6 months on ortho evra...no libido, irritability, depressed, boobs shrinking.  My gyno didn't believe me and I finally starting reading up on it and realized that these are true side effects.  Luckily 2 months after I stopped...the symptoms went away.

[childrenrtreasures]

Thank you for replying! I had those symptoms before I went on the patch. They were alleviated while I was on it and now they're back.

My dr said it's due to falling estrogen levels. The problem is to discover if that's what is happening with me and the real "biggie" is WHY it's happening to me.

Kelly