Abnormal Menstrual bleeding

[kylee]

I'm 41 years old with a history of long periods and irregular bleeding. My FSH is between 5 and 7 and i have been told I have good hormones. Docs have done sono, uterine biopsy, and hormone blood tests. All came back fine. I did not require progesterone in my IUI cycle. My fertility specialist is at a loss as to how to control the bleeding. We tried estrogen but had to stop because of severe headaches. She wants to try FSH injections, but I am hesitant because my FSH is normal and I am worried about overstimulation. Is there any other way to control the bleeding or is pregnancy now out of the question because of this problem?

[Dr. Wisot]

Hi:

It does not sound like FSH injections are the correct approach to control bleeding. Heavy periods may often be caused by fibroids, especially those protruding into the cavity, or a poor luteal phase maked by low progesterone. To check for significant fibroids, a hysteroscopy is the most accurate approach. They can monitor your progesterone levels in the luteal phase to see if there is some issue with the quality of your ovulation. Both of these issues can affect fertility.

If there is no physical reason found, there is a new medication, Lysteda (tranexamic acid) that can help control a heavy flow.

Good luck.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Redondo Beach, California

[kylee]

Can you be on Lysteda while trying to get pregnant, though? I just had a hysteroscopy. It was normal. My doctor has monitored my progestrone after ovulation and has found it to be rising quite normally, without the need of a progesterone supplement.

The bleeding is not abnormally heavy, just that I bleed when I shouldn't. I characterize it between spotting and a small period. This last IUI attempt, for example, I had a trigger shot to induce ovulation because I was going away the next day. I had my IUI, and the day after I started to spot. The spotting became heavier with each day.

Thank you for your response. I am trying to find a solution to this problem before I continue with any more IUIs. Your input is greatly appreciated!

[Dr. Wisot]

Hi:

The Lysteda is only for heavy bleeding with your period, not for bleeding when you shouldn't so pregnancy is not an issue.

Unfortunately from this vantage point without actually following your cycle there is really nothing else I can offer except perhaps recommend a second opinion and let someone else have a look at it.

Arthur L. Wisot, M. D.

[kylee]

Thanks. In your experience, can women get pregnant with this type of bleeding, though? My sense is that this will hinder implantation or affect the ability to sustain a pregnancy.

[Dr. Wisot]

Bleeding during the luteal phase can make it more difficult to conceive successfully. But we do not know what is causing it. Get that second opinion.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Redondo Beach, California