Suddenly spotting

[alj315]

I've had two easy pregnancies and we thought everything was working fine with me. My baby is only 18 months old, and my periods returned when he was 8 months old; I stopped breastfeeding when he was 13 months. My periods have always been regular. However, in December they suddenly began getting strange. My periods began getting "long" which I didn't realize until later, was because I started spotting for a few days before actual full flow. Then I started spotting randomly through the luteal phase, sometimes after intercourse, sometimes after a bowel movement. Then we did an IUI with a hcg shot, but it was after natural LH surge, and I had no spotting that month, but an unusually short cycle. Now the next month, I have had spotting after ovulation continually and am still waiting for full flow.

My docs are giving me the roundabout and telling me to ask another doc; we are waiting to start an IVF cycle when my period begins; my tsh has been around 2.2 but I have elevated peroxidase antibodies. My OB has done tests for std, infection, pap, and all are normal. They say they will do a uterine biopsy next <if I want> but don't seem concerned. Do you think baby aspirin or hcg affected my cycle? Do these signs point to hormonal issues or due to thyroid (hypo/hashi's runs in the family) or should I be worried about things like cancer and make sure to do the biopsy before IVF? I just feel concerned because this all just started back in December out of the blue but has not gone away. This just can't be normal.


june 13 *first period after pregnancy
july 15 (32)
aug 11 (27)
sept 8 (28)
sept 6 (28)
nov 1 (26)
nov 27 (26)
dec 25 (28) *probably counted spotting as start of period, lasted 8-10 days total spotting+full flow
spotting @ cd17, cd24, cd26
jan 24 (30)
spotting @ cd21, cd25
feb 20 (27)
take baby aspirin this cycle. cd11 LH surge followed by hcg injection ** no spotting
mar 14 (23) ** unusually short cycle
cd17 start spotting brown cm. continue until cd22 red spotting. Continue, currently cd25, waiting.

[Dr. Wisot]

Hi:

I can't diagnose or offer advice here but from what you describe it sounds like a luteal phase defect and with a normal TSH it's unlikely related to the thyroid.

But to really tell we would need to see all your hormone tests and an ultrasound.

Good luck.

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

[alj315]

Thanks for your input! I was told u/s is normal, and my 6dpIUI progesterone test was satisfactory that they did not feel the need to supplement. However that month I didn't have any spotting. Would a HCG injection work to help overcome a luteal phase defect? And do you have any idea why that cycle would have been so uncharacteristically short?

Do LPD's come on suddenly like that -- normal cycles, until they aren't anymore?

I know there's really no way for you to know for sure, I've just been trying to understand and figure this stuff out for myself. Thank you!!!

[Dr. Wisot]

There are two definitions of luteal phase defect: low progesterone levels and short luteal phases. Either can be treated with Clomid or progesterone supplementation.

If your progesterone level was normal and in that cycle you did not have spotting, you probably did not have the LPD that cycle. It can be intermittent.

To me, this does not seem to a great mystery.

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