Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Saturday, 23 October 2010

Seeking medical advice

I've gotta admit it: I'm completely baffled. And I hate it when my body confuses me (if you are hoping this will be about a sports injury and won't be "gross", you might as well stop reading now).

So, it's now been three months since I had a miscarriage (I know, I said I wouldn't write about it again. But I didn't think I would need to). Generally I feel healthy. I am eating better, getting probably more than enough sleep and have been in no way under the weather since July.

But now, I have just had a 2 ½ week menstrual cycle. This means that I actually ovulated while I was still having my last period. I have a decent imagination and would never underestimate what the human body can do, but THIS seems impossible. Anyone who has studied the estrogen and progesterone cycles knows the impossibility of this.

Since my miscarriage, I have had a 38 day cycle, a 34 day cycle and now, a 19 day cycle. I will also point out that the second period was very light. The other two have been such that I am afraid to go to bed at night because I am bleeding so much. (if the men haven't clicked away already, they are all gone now)

I did what I think was a very thorough literature search this morning and have only come up with two articles, which both indicate that return to normal ovulation, hormone levels and cycles should occur within two month after a miscarriage. But I can't get online access to the full articles through the U of Copenhagen, because they are too old.

1. Donnet ML, Howie PW, Marnie M, Cooper W, Lewis M. Return of ovarian function following spontaneous abortion. Clin Endocrinol (Oxf) 1990;33:13–20.

2. Elkas JC, Cunningham DS. Effect of 1st-trimester loss on restoration of the hypothalamic-pituitary-ovarian axis. Gynecol Obstet Invest 1995;40:257–260.

However, if you simply do a google search, there are women from all over the world, with no medical background, who simply say "of course menstrual cycles are abnormal after a miscarriage - sometimes for many months".

So what gives? What is "normal"? When should I start to worry (by the way, I started a long time ago)? And can someone please explain to me how you can ovulate while you are having a period?

Before there is a stampede of people writing "go to your doctor", I will explain this: I have an equal amount of general medical training as most of the general practitioners in Denmark and I think they will likely also be baffled and simply send me on to more tests, without knowing they are looking for. Second, my doctor is also our next door neighbor and the father of The Lorax's best friend. 3rd: you can't make an appointment with an OB-Gyn without a referral from your GP, who again, is our neighbor. 4th: I generally find going to the doctor to be a waste of time (with certain, though limited, exceptions).

Update from the last post: the sex shop from the last post just closed yesterday out of the blue.

Running songs of the day:

I Want the World to Stop by Belle & Sebastian
Licenses to Hide by the Posies


sea legs girl said...

Sea Legs, this is your more rational side. What if you are not actually ovulating at all and you are simply experiencing a fluctuation of hormones leading to irregular bleeding. So the real question may be "why am I/are you not ovulating"?

cherelli said...

Ha - got to the comments section and you said what I was thinking :) Your body probably didn't ovulate last time around. My body is still re-setting too. Normally I am pretty regular to the 28-29 days, but I've had two 33-35 day periods since the m/c. In all other regards I feel good - although find it odd to have such strong sugar cravings in the first half of my cycle so believe it may be a little hormonally schizo still...happy ovulating next time around :) !!

wildknits said...

Like that you said what I was going to tell you.

Periods can be whacky after a pregnancy. Plain and simple. My guess is no ovulation and things will get back to "normal" soon enough.

I went 5 years without a period after my first girl was born... during that time I got pregnant with my 2nd. Yup, no bleeding, but obviously I ovulated at least once during those years!

Once my period returned it was heavy! The kind of bleeding that would have me, as an RN, advise a woman to be seen. I figured it was just the rebound from not having a period for so many years. Eventually (can't remember how many months it took as this was 19-20 yrs ago) things returned to normal.

Give it time, at least you are young enough to not be mixing perimenopause into the equation ;->

Kathleen said...

You didn't ovulate (as the other commenters said!). I know it seems odd, but it's normal to have that kind of wackiness after what you experienced. If this is still an issue a year from now (I'd be surprised), then it might be worth going in, but you outlined all the reasons it's worth avoiding.

Ewa said...

I had a miscarriage years ago followed by months of very irregular cycles. BUT before that my cycles had not been regular to begin with though after the miscarriage they got even more wild. As far as scientific papers go, many studies unfortunately lack in scope and rigorous methodology. I know you are a scientist and I am not trying to put your profession down. I am a physicist by education and often when I see some studies I am baffled by the lack of care in their design. Having said so, in this case, I would listen to what women are saying. It seems that such irregularities could be more common than medical literature is suggesting.
Now the remaining question is why and if there is a cause for concern. That I have no idea about. My cycle returned to its 'normal' state which seems actually to have coincided with the time when I truly got over my loss.
OK, long answer that does not really give you any solutions. Hope you will get back to whatever your normal state is soon.

Olga said...

Not miscarriage related. I had 2.5-3 weeks period for about 5-6 years during my heaviest training years, which also coinsided with years 8-13 of my IUD since its insertion. Anyhow, I don't like to go to doctors either and think they are a waste of time (to me), but at some point I did go (for a different reason) and brought it up. Usually when you train heavily you loose periods. I was having them more often and very heavy and long too (not light). I never figured out why. I got new IUD, had a year of "spotting between normal 4 week periods" and finally, I hope, settled in to a 4 week thing, which I haven't had in a long, long time. Not helpful to you, but FYI.
Lorax looks adorable!

SteveQ said...

The sex shop, after your visit, said, "well, if THAT's the kind of riff-raff we're attracting, we might as well close."

I'm glad I'm not the only one who comments first on their own blogs, nor the only one who'd rather worry than go to a doctor who won't necessarily be helpful.

Three months of irregular periods doesn't sound like much to me (but then again, I've...ahem... never had one). Ovulation during a period, while seemingly impossible, I think has been reported, but I'm not going to look for a reference.

Lani said...

I think I agree what's already been said, this may be completely unrelated to your miscarriage, and more normal than you think. I've had 2 (5 pregnancies, 3 kids). My cycle returned to a 'normal' 28 days within a few months after every pregnancy (fullterm or not).
But, about a year and a half ago (1 year after my most recent pregnancy), my cycle went wacky. Now I've settled in to a 'sort of normal' a 3-4 week thing. The initial wackiness coincided with a time of high-stress. The only other thing that coincides with the overall change is a slight increase in training intensity, which I would expect to lengthen my cycle, not shorten it.
I haven't visited a doctor because I've been more irritated than concerned and don't think that I would get any helpful answers. Now, we are hoping for a 4th child (call us crazy). If this shortened cycle seems to delay getting pregnant, I guess I may have to finally go to a doctor.

I would give it a few more months and try not to worry about it. (Easier said than done.) Good luck!

Unknown said...

I did not read the other comments so I apologize if this is redundant.

After my MC as well as getting my cycles back after having children, I learned that all manner of weirdness falls within the normal range.

I found the book, "Taking Charge of Your Fertility" to be the most informative source of information I had come across, including doctors, midwives, nurses, ect.

Glaven Q. Heisenberg said...

Um ... okay, you don't like going to the doctor. But, really, sister ... Your Plan B is to consult anonymous idiots on the Intertubes? I'm always baffled by this. Because I see it on blogs all the time. "I have such-and-such symptoms. What do you foax out there in the Intertubal aether think it might be? You haven't seen me, much less examined me; you're most likely unqualified to give medical advice, but if you are qualified and give it on a blog, you should probably have your license revoked; you don't even know if the symptoms I've decided to mention are necessarily the relevant ones; but, yeah, what do you all think?"

Compared to that, a Plan B of killing a chicken and reading its entrails would seem more rational. Also, compared to that? Doesn't Plan A: See A Doctor sound slightly better?

I realize people blog about these things more to air them out, to deal with the anxiety they are feeling, not really because they expect to be correctly diagnosed; and I hope this post accomplished that for you.

But seriously, sister: Go see a doctor.

sea legs girl said...

Basically my comment is goint to be about why I disagree with Glaven :).

This is not really the type of problem one needs to get a physical exam for. I think I have already learned more from the above commenters than I would from a visit to my assigned-by-the-government GP, who I have mentioned is our neighbor. Don't get me wrong; I am sure he is a great doc.

I WOULD go to the doctor if I thought I was in danger. And if things keep going on this way, I guess I may have to see someone.

PLUS, I think way too many women go through these things and never ask and suffer in silence. And maybe some of them will find this blog and be comforted. I know. I'm a saint.

Anonymous said...

Why not try charting? You would have more information on what is going on with your cycle and whether you're ovulating. Given the detail with which you track your training stats in running, I would think you might like something similar to analyze with respect to fertility.

Anonymous said...

I just wanted to re-iterate your comment to Gavin, which I thought was a bit insentive. It is your blog afterall, you can write whatever you want.

Yes, as a doctor, you really know when to go to a doctor and when not to. And I agree, this isn't something I would go to a gynecologist for yet.


Anonymous said...

Read "Taking Charge of your Fertility"... amen...
best book ever... very medically sound... and something we should all have been given in 7th grade health ... and again in high school... and college... and before we try to have kids... and after... and... well, you get my point.
and i'm not an idiot. nor am i an OB/GYN.
--Kristin Z, PT, mom of 1, ultrarunner, and reader of TCoYF mentioned above, also big believer in my midwife and my OB/GYN.

Anonymous said...

Would love to know what you come up with. I was totally regular until my M/C 8 mos ago, and then had several mos of 30-31 day cycles, followed most recently by 3 cycles of 26-26-24/23 days. My training intensity and stress have been higher but not immensely so.

Anonymous said...

I was about to say what you yourself said in the first comment! For what it's worth, since I started running ultras, I've had (a) an entire year with zero bleeding, and (b) an entire year where I bled every single day. I noticed that The Lore of Running (Tim Noakes, if you don't have it) says that bleeding for more than 90 days at a time is the same as no periods...

Also for what it's worth, there's no point going to the doctor (at least in my experience)--they'll happily throw birth control pills at you, but I still haven't found a doctor that wants to figure out *why* the problem exists in the first place.

In other words, good luck:)

Anonymous said...

Long, heavy periods close together can be a sign of a serious problem, though. if they keep coming back, just get an appointment. i'm not going to use an anecdote that will scare you (has nothing to do with infertility or anything like that, just a sign of something more serious). I am very glad my cousin got checked out when her menstrual cycle was overactive. of course, her period was coming close together (2 weeks apart) quite frequently.

just keep an eye on it.

Lisa said...

This has nothing to do with periods, Sea Legs, but I got a good chuckle out of your post regarding the Danish attitude that people who exercise are lazy!

pernille said...

On topic, I think you’re right in your first comment too, no need to be overly worried just yet.
Slightly of topic:
I do see why you’d rather not be talking about sensitive matters with the guy next door which also happens to be a family friend. But why do you have him as your doctor then? He might very well be a brilliant GP. If you refrain from seeing him because you don’t want to think about what he (and his possibly his wife?) knows about your very personal affairs while having them over for dinner or meeting them on your doorstep. Then he can’t be a good GP for you. I’d think he’d understand as well… he might even be able to recommend some other great GP?

Kel said...

HighWire Press sometimes has free full text journal articles available online, especially if they are more than a few years old.

I was able to bring up abstracts for both of the articles you cited, but the full text for neither are free :(

I didn't do any further searches, so there may be other articles out there that you can get free access to.

sea legs girl said...

Thanks, Kel. I'll have to check that out if there are aticles I can't get access to. I actually did have access to the abstracts, too (otherwise I couldn't have said what they found :)).

sea legs girl said...


Yeah. I guess I could switch, but he has been assigned to me by the Danish government (just by chance) and you have to go through a lot of trouble and paperwork to request someone new.

sea legs girl said...

Thanks anon for the rec of The Lore of Running.

And I just wanted to add that I have ordered a used copy of "Taking charge of your Fertility" - thanks Angie and Kirstin Z.

Anon, re charting my running stats. I am really very unmeticulous about my running and training stats, to be honest. BUT, just ask SR, I enjoy reading my own body's signals to determine when I am ovulating as much an any other woman and like to believe I am quite meticulous about it and good at it (why this last "cycle" really caught me by surprise). Not really something I blog about much, though :).

SteveQ said...

And now for something completely different: running song of the day is "Too Dramatic" by Ra Ra Riot.

SteveQ said...

and Pink Mink: "Earthquake On the Loose" is a near-miss in my book.