Menstrual Irregularities: Questions About Inducing Periods

Menstrual irregularities and issues related to menstrual induction medications?

1.
I have always had irregular menstrual cycles and often miss my periods.
This year, I started taking birth control pills to regulate my cycle for two months, but after stopping the medication for one month, my period did not come.
I went to the hospital for an ultrasound and blood endocrine tests, and the doctors said there were no issues, yet my period still does not come.
Could this be related to anovulation (I once did not have a period for an entire year)? Or is there a possibility of related organ pathology? I have consulted both Western and traditional Chinese medicine multiple times, but my menstrual cycle does not regulate itself and relies on medication.
The doctors have also advised me to undergo ultrasound and blood tests, then prescribed me medications to induce menstruation or birth control pills.
What other tests and treatments can I pursue? (I am unmarried).
2.
Later, the doctor prescribed me Provera 10mg to induce menstruation, to be taken after each meal for five days.
(In the past, other doctors advised taking 5mg twice a day instead).
I would like to know if this daily dosage is too high, as I experience discomfort in my breasts after taking the medication.

Xiao Ru, 30~39 year old female. Ask Date: 2013/08/02

Dr. Dong Yuhong reply Obstetrics and Gynecology

Hello; the condition you described is characterized by light menstruation, requiring medication to induce a period.
You have undergone several tests, but the results indicated no issues according to the physician.
Since you have already been tested and the treatment has not been effective, it is recommended that you bring your test results to a larger hospital for further evaluation.
A medical center or a hospital specializing in infertility treatment would be more appropriate.
Thank you!

Reply Date: 2013/08/02

More Info

Understanding menstrual irregularities can be quite complex, especially when it involves issues such as anovulation (lack of ovulation) and the use of hormonal medications. Based on your situation, it seems you have been experiencing irregular periods for a significant amount of time, and despite various treatments, including hormonal contraceptives and progestins like Provera, you are still facing challenges in regulating your menstrual cycle.

1. Anovulation and Hormonal Imbalance: It is indeed possible that your irregular periods are related to anovulation. Anovulation can be caused by various factors, including hormonal imbalances, stress, significant weight changes, or underlying medical conditions such as polycystic ovary syndrome (PCOS). If you have a history of not menstruating for an entire year, it may suggest a more chronic issue with ovulation. The fact that your ultrasound and blood tests have returned normal results is encouraging, but it does not completely rule out the possibility of subtle hormonal imbalances or conditions that may not be easily detected through standard testing.

2. Further Investigations: Since you have already undergone ultrasound and blood tests, you might consider discussing with your healthcare provider the possibility of further evaluations. This could include:
- Hormonal Profiling: A more detailed hormonal panel that checks for levels of estrogen, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and possibly androgens to assess for conditions like PCOS.

- Thyroid Function Tests: Thyroid disorders can significantly impact menstrual cycles, so checking your thyroid hormone levels could be beneficial.

- Prolactin Levels: Elevated prolactin can also lead to menstrual irregularities, so testing for this hormone might be warranted.

- Pelvic MRI or CT Scan: If there is a suspicion of structural abnormalities (like fibroids or polyps), imaging studies beyond ultrasound may be helpful.

3. Provera Dosage and Administration: Regarding the Provera dosage, the standard dosing can vary based on the specific clinical scenario. The typical regimen for inducing a period is often 5-10 mg taken for 5-10 days. Your doctor’s recommendation of 10 mg three times a day is on the higher end of the dosing spectrum, but it is not uncommon in certain cases. If you are experiencing discomfort, such as breast tenderness, it is essential to communicate this to your healthcare provider. They may consider adjusting your dosage or switching to a different medication.

4. Lifestyle Modifications: In addition to medication, lifestyle factors can play a significant role in menstrual health. Maintaining a balanced diet, regular exercise, and managing stress levels can contribute positively to hormonal balance. If you are overweight or underweight, addressing these issues can also help restore regular menstrual cycles.

5. Follow-Up Care: It is crucial to maintain regular follow-ups with your healthcare provider. If you feel that your current treatment plan is not effective, do not hesitate to seek a second opinion or ask for a referral to a specialist, such as an endocrinologist or a reproductive endocrinologist, who may have more experience with complex cases of menstrual irregularities.

In conclusion, while hormonal treatments like Provera can be effective in inducing menstruation, understanding the underlying cause of your irregular cycles is essential for long-term management. Continuous communication with your healthcare provider about your symptoms and treatment responses will be key in finding a suitable approach for your situation.

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