Doctors Lounge - Fertility Answers
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Forum Name: Female Sexual Disorders
|kaitka - Sun Dec 17, 2006 2:56 am|
I'm a 23-year-old female who has a pretty normal health history. I was diagnosed with Mitral Valve Prolapse/Irregular heartbeat at the age of 18, but was experiencing symptoms of it from about 15 years old. I am married, a stay-at-home mom, pretty laid back, and lead a fairly mellow and low-stress life. I got pregnant when I was 21 for the first time, and had a miscarriage at 7 weeks gestation. 3 months after, I got pregnant with daughter, who is now 1 year old. I started having periods when I was 13, pretty normal. After my initial period, I didn't have one for nearly 6 months, but things eventually regulated and I had fairly regular periods until I got pregnant for my daughter. Once I had my daughter, I missed a month (which I know is perfectly normal) and resumed having periods the month following, which was February. Ever since, my periods have been totally irregular. For example, one will be a 26 day cycle. The next will be 38. The next will be 44. The shortest it's been is 26 day cycles. The longest, 44... until now. Ever since I gave birth to my daughter (a totally traumatic emergency c-section after 21 hours of labor, that I was put to sleep for), I've been tired. REALLY tired. Not like I just had a baby tired, but more like can't get out of bed tired. It reminds me of the way I felt when I had mononucleosis when I was 17. I weighted 140 pounds when I got pregnant with my daughter (pretty normal for 5'8"), and I gained 49 pounds when I was pregnant. I currently weigh 173 pounds. I've tried exercising, dieting, diet pills, everything! And the lowest my weight has gotten is down to 166, and that was only after about a month of being addicted to prescription painkillers. I don't gain weight regularly, but I don't lose it - even when I try. On top of that, I've been getting more and more tired. I used to wake up after 9 hours of sleep. Ever since my daughter was born, I sleep for 13 hours sometimes, and wake up feeling terrible, or don't wake up until somebody wakes me up. I've tried setting alarms and getting up after just 9 hours of sleep, thinking maybe I'm sleeping too much, but I just feel worse and then fall asleep later in the day. I don't use any drugs (including the prescriptions I was briefly hooked on), I eat a relatively balanced diet (maybe a little low on veggies). I've cut a lot of unnecessary sugars out of my diet (like soda, for example). And still, I don't lose weight. It fluctuates between 5 pounds regularly, sometimes within a day.
In late November, even though my periods are irregular now, my husband and I decided to try to get pregnant again. I joined a fertility website that keeps track of cycle information and makes it easier to know when to try to conceive. I entered all my past period information since the birth of my daughter (which I keep track of), and we attempted to get pregnant. That was at the end of last month. My period (which was figured to be due at about a 40-day cycle) never happened, so I figured maybe I had gotten pregnant. I took a pregnancy test at about 9 days past ovulation, which clearly wasn't long enough to tell. But there was a very, very faint line indicating some, albeit not much, hCG was detected. I labeled it inconclusive, since it hadn't been long enough and the line was very faint and the test was a generic brand. I took more tests over the next couple weeks, bringing us up to date. Today is my 20th day since I supposedly ovulated. And the pregnancy test is negative. Less than a week ago, I couldn't sleep because I had horrible pain in my left pelvic region, which hurt with each pulse. Thinking maybe it was an ectopic pregnancy, I figured if it still hurt in the morning, I would go the emergency room. The pain was completely gone in the morning. Now I don't know what to think. I'm ridiculously tired all the time, yet I can't sleep when I go to get in bed at night. I have always had poor circulation, but I am either freezing cold or burning hot all the time now. I feel pregnant... slight nausea on and off all day, frequent urination, lower back pain, some cramping, sore breasts. I was sure two weeks ago that I would either start my period very soon or get a positive pregnancy test. But neither has happened. I found out from a forum that people sometimes develop postpartum hypothyroidism, and I was interesting that a lot of the characteristics were similar to mine, but it seems too extreme. I don't gain weight. I don't have vision problems.
I've looked at my mother and sister's patterns since the birth of their children. My mom was very, very thin before getting pregnant. After she had all her children, she never really lost the weight. She wasn't fat until she was older (her eating habits are not good), but she never was back to 100 pounds. My sister remained chubby after her daughter was born, losing only about 10 pounds of the 60 she gained. She has a lot of fertility problems (a calcified placenta with her first and an ovarian cyst with her current pregnancy). My father's side of the family has a bad history of fertility problems, and my great-grandmother went through menopause at just 28 years old! All the females on that side of my family have had hysterectomies in their 40's. My mother's side has fertility problems too. My maternal grandmother had several miscarriages, and my maternal aunt had complications with her pregnancy due to diabetes and a previous abortion and was told she would never be able to carry a child to term (although she did once). I had a difficult but relatively healthy pregnancy with my daughter. I had extremely low iron throughout, and the doctors tried to get me to agree to a blood transfusion at the birth of my daughter because my iron level was so low, but I refused and it returned to normal within the week. I've never had anemia otherwise.
I've always had pain during intercourse. Not extreme pain. It's bearable, but pain nonetheless. At one point when I was 18, I was having very bad, sharp pains in my pelvic region immediately following intercourse. Between 18-20, I was having frequent instances of severely bloody feces when I deficated. I would get very bad stomach cramps, and then the fecal matter itself would be extremely bloody. I was very worried, but never had the insurance to get checked out. The instances let up, and I had several more last year. But, once again, lack of insurance kept me from investigating further. I haven't experienced the bloody feces in awhile.
My primary question is what is causing the absent period, the pregnancy symptoms without the pregnancy, the constant fatigue, and the chronic headaches I have almost all the time.
Please, if this sounds like something familiar, let me know. Thank you!
|Dr. Safaa Mahmoud - Sun Dec 17, 2006 4:15 pm|
Follow delivery, most women have an interval of anovulation and menstrual cycles irregularity.
How about breast feeding?
Breast feeding impairs the return of ovulation and most of women breast feed (no supplementation) might get their period every three weeks, every six months, or without periods for many months.
This is due to the fact that the pituitary gland makes more prolactin, a substance which suppresses ovarian function and causes your breast to enlarge, be tender and sore.
Feelings of exhaustion and fatigue are extremely common for women after childbirth for many different causes.
I would also consider the possibility of you being anemic, anemia would cause changes in your general condition and your ability to work and concentrate.
It is easily treated with iron supplements, or with an increase in iron-rich foods. It is also better to take a vitamin supplement.
Regarding the past history of bleeding per rectum, it may be due to constipation and internal hemorrhoids which may aggravate the anemia. Occult blood in stool will confirm the presence of blood.
I advise you to follow up with with your Doctor for proper management. There is no replacement for direct clinical examination.
|Dr. Chan Lowe - Sun Dec 17, 2006 4:16 pm|
I would recommend you discuss your symptoms with your obstetrician. You are absolutely correct in that occasionally after childbirth women can become hypothyroid.
You describe the birth of your daughter as traumatic. Did you loose a lot of blood? There is a condition known as Sheehan's Syndrome in which severe bleeding during pregnancy causes a transient low blood pressure. This low blood pressure causes enough problems to result in damage to the pituitary gland-the "control" gland of the hormonal system.
Your fatigue symptoms, cold intolerance and increased weight are all very much consistent with hypothyroidism and I would recommend you have your TSH and T4 levels checked to evaluate this. Also, you should consider having some of the other pituitary hormones checked. These can include FSH and LH which help in regulation of the menstrual cycle. Checking a prolactin level may be a good idea as well.
Hypothyroidism in itself can also cause irregularities or cessation of the menstrual cycle.
If I had to pick one, I'd go with the thyroid test first.
Your OB can help you in getting all this evaluated.
Keep us updated. Hope this helps.
|Dr. Safaa Mahmoud - Sun Dec 17, 2006 4:30 pm|
There is an increasing awareness that several disturbances of thyroid function may occur in women after delivery by different proposed mechanisms.
I agree with Dr. Chan Lowe, Hypothyroidism should be also excluded especially if there was a heavy postpartum bleeding .
|kaitka - Sun Dec 17, 2006 6:59 pm|
I did not have any severe bleeding during or immediately following the birth of my daughter. I did, however, have extremely low iron levels (I believe the level was 2 when it should have been 11 or something along those lines). At my 2-week doctor visit following the c-section, my midwife reported that my iron levels were completely up to par again.
The trauma I spoke of included being induced with Pitocin because I was developing preeclampsia (I was 40 weeks pregnant that day). I had many allergic reactions to what I believe was magnesium that they were using to control my blood pressure, which was given via the epidural, and caused me to have horrible itching in my legs. I was also given anxiety medication, which put me in kind of a haze, and they maxed out my doses of Benadryl until they said they could no longer safely give me any more. I had developed an infection after they broke my water in my amniotic fluid and developed a temperature of 104. They were extremely concerned about the baby at that point, and performed the c-section. For two days, my daughter and I were both hooked up to antibiotic treatments every hour or so, but my daughter never got the infection. My c-section went smoothly with no complications, and the incision healed perfectly. The only suspicious thing at that point was a strange and sudden illness about a month postpartum, in which I developed another extremely high fever and was horribly sick for an entire day, and then was virtually fine in 24 hours. I visited the emergency room, and was given pain medications. They had no explanation for the illness, but assured me it probably wasn't surgically-related.
I breast fed my daughter for about 2 weeks, but she developed Thrush and wasn't getting enough food, so I decided that for my emotional situation, it would be better for me to stop breastfeeding. I'm glad I did. I had a brief bout with baby blues, and it helped to know my daughter was getting the nourishment she needed. My daughter was born on December 27, and my period resumed by mid-February. The most irregular thing about it has been the most recent one, which was November 3. I was having spotting all during the mid-to-end of October. It was very dark and sticky and thick. It continued until November 3, when it turned red, and I assumed it was an actual period at that point. I haven't had any bleeding at all since.
The problem with seeing a doctor is that I have no medical insurance at this point. I am trying to get covered under Medicaid, but I don't know that I'll get approved and even if I do, Medicaid has refused to cover certain things that they don't consider necessary. It's a vicious cycle, and it would cost much more money than I have to get checked out at an OB/GYN or GP. :(
|Dr. Chan Lowe - Mon Dec 18, 2006 12:02 am|
Without a significant bleed, it makes Sheehan's Syndrome less likely, but hypothyroidism following pregnancy can still occur.
You may be able to find a clinic in town that can see you with a reduced or no fee plan. If you do qualify for insurance, I'm confident that with your symptoms your insurance company would consider the testing necessary.
I hope you are able to get an evaluation soon. I'm quite suspicious of hypothyroidism.
Just as an off chance, do you eat a lot of food that may contain iodine? High levels of iodine inhibit the thyroid from properly making thyroid hormone. It's a long shot, but worth thinking about.
|kaitka - Tue Dec 19, 2006 2:05 am|
after reading about cysts on a fertility website, i went to a doctor last night and had myself checked out. they assured me that i'm not pregnant, and they found a cyst on my right ovary that is apparently big enough to affect menstruation. they referred me to an ob/gyn, so further testing will be done. they mentioned a potential biopsy as well. they suspect i developed the cyst following the birth of my daughter, which was a year ago. i wonder if the cyst can keep my thyroid from functioning properly, or if it is somehow keeping me from losing the pregnancy weight.
|Dr. Chan Lowe - Tue Dec 19, 2006 7:55 pm|
It would be very unusual for a cyst to affect your thyroid, though it could certainly affect your menstrual cycle (although cysts generally do not affect cycles and often resolve after several months without intervention). Also, it's unlikely that the cyst is related to weight gain.
I'd still recommend having your thyroid checked.
Hope this helps.
|kaitka - Thu Dec 21, 2006 1:37 am|
I really appreciate all your imput. So I solved a little bit of the problem - the ovarian cyst. But from the looks of things, that's not what's causing the majority of my problems. I really feel like there's a bigger issue going on here. It's hard to explain. It seems like almost every aspect of my health has been affected by whatever is going on. I'm very convinced that there is something hormonally wrong, because I've had several symptoms that indicate so: skin breakouts, lack of menstruation, stinky feet (for lack of a better word - i don't really know if this is directly affected by hormones, but i have never EVER in my life had stinky feet until about 2 -3 weeks ago). But there are additional things that I feel may not be hormonally-related. Such as bowel problems (fecal bleeding on a large scale), very bad stomach cramps and having to use the restroom immediately. Also, I've started feeling very light-headed, as if my blood sugar drops suddenly just out of nowhere, much more than usual. It's so extreme that I've actually gotten to the point where I'm considering horrible things like bowel cancer or ovarian cancer. I'm ALWAYS tired.... no exceptions. Very low energy, I wake up very tired, my blood sugar seems to drop and I'm dizzy to the point of passing out very quickly for what seems like no reason, excitement causes me to have heart palpitations (which I have been actually diagnosed with by a cardiologist when I was 18) to the point where I can see my heart beating irregularly through my chest. Something feels very wrong. But I don't even know where to begin with a doctor, because they seem to want to send me to specific doctors for specific things, but there are many symptoms, so nothing gets done. I do have an OB/GYN appointment coming up. But something tells me that's not going to solve my problems. I hope whatever it turns out to be isn't as extreme as it feels. It's scary. I will indeed request that my thyroid function gets checked out at the OB/GYN, although I'm not even sure if OB/GYNs handle that kind of thing.
The root of all these problems began when I was 15 years old, with the heart problems, that I honestly think were caused by extreme stress. Then again, I'm not a doctor. So it's just a guess.
|Dr. Chan Lowe - Thu Dec 21, 2006 4:37 pm|
Problems such as yours can be difficult to diagnosis. Persistence is important. Sometimes, we as doctors don't "get the whole picture", so I encourage you to continue to follow up with your primary doctor. They can coordinate all the specialists and help make sure that all the specialists are talking to each other.
Your primary doctor can do much of the screening steps for you, such as checking your thyroid hormone, cortisol levels, etc. Also, you may want to consider inflammatory bowel disease (IBD) in the work up. There are some blood tests for this, but the best way to make the diagnosis is to see a GI doctor for an endoscopy where they can look at the colon and take some biopsies. With IBD, there are many chemicals released in the body. One of these, known as tumor necrosis factor-alpha, is a potent inhibitor of "normal body function" including things like growth, energy, etc.
I would still start with the thyroid, although blood bowel movements are harder to connect to this. You should also get a CBC to look for anemia with the bloody stools and lightheadedness.
Keep pursuing the answer. Eventually you'll get it figured out.
Keep us updated.
|kaitka - Fri Dec 29, 2006 9:14 pm|
I had my first doctor visit since the discovery of the ovarian cyst yesterday morning. It was determined that, as I suspected, I have a Urinary Tract Infection (caused by the catheter in the emergency room). I have been prescribed Keflex for that. Also, I was given two more appointments - an ultrasound on January 11 to determine how big exactly and what type of cyst it is. And a follow-up to the ultrasound on January 18. I wasn't really impressed by the doctor. He wasn't very thorough, and didn't really communicate with me. He seemed more interested in what the chart said than anything I had to say. I was told that small cysts rarely affect menstruation, so I'm really not sure where to go from here, since it's been 2 months now, with no period. I am definitely not pregnant at this point. I now have a bad cold and a fever. I haven't filled my prescription for the UTI medication yet, because of financial issues. I wonder how long you can have a UTI before it becomes a kidney infection and is more serious. I have been especially tired lately, even more than I was, if that's possible. The heart palpitations have slightly decreased over the last week.
If there is a doctor who is going to be able to piece together everything and be thorough, this isn't him that I'm seeing right now. He hasn't shown much interest in what's really wrong. It seems as if he's just trying to get through his day as quickly as possible. My expectations are little. But it's to be expected with no health insurance, although I've applied for some benefits through some state agencies that might be of some help. I don't think I will be approved for Medicaid, but it's in the application process. It's so frustrating, not having the money for insurance and having something wrong.
I'd like to get pregnant as soon as possible (at which point, Medicaid kicks in), so that the next baby can be born as close to my daughter as possible. But I didn't find out about these problems until I started trying to conceive. Ironically enough, I had very few menstrual problems before we started trying to get pregnant, although I really don't think it's "stress", as everybody and their mother tells me it is. I'm really not that stressed. I'm pretty laid-back in general.
So now I'll just wait until the ultrasound and see what's going on with this cyst. I wonder if I should even worry about the possibility of getting pregnant, since I don't know that you can if you're not having periods.
|Dr. Chan Lowe - Fri Dec 29, 2006 11:45 pm|
Urinary tract infections can travel backwards up to the kidneys. At that point, they generally cause fevers, back pain and a worsening ill feeling. Cephalexin (Keflex) is one of the cheaper generic drugs, so if at all possible, I would encourage you to try to fill your antibiotics. Hopefully your insurance will come through soon.
Regarding your desire to conceive, generally the lack of a period indicates that ovulation is not occurring; however, I would never use this as a sign that pregnancy is not possible. Given all your symptoms I am still highly suspicious that you may have hypothyroidism.
Also, it is important that you feel comfortable with your doctor in order to insure that you are able to communicate well and relay all your concerns to each other. If you are not comfortable with your doctor you may be able to find one that you are better matched with. Sometimes, expressing your concerns to your doctor can help get you both on the same page and improve your doctor-patient relationship.
I hope you feel better soon. Keep us updated.
|kaitka - Sat Dec 30, 2006 8:54 pm|
Well, today I got online and found some insurance I can afford. It has a high deductible, but I can work that out over time. So as of January 15, I will be covered! :) I am insanely pleased with that. I woke up this morning with a very high temperature and a swollen-shut throat. I don't know if it's just a cold (my daughter had one a few days ago) that turned into something worse. My immune system is clearly not the strongest. My abdominal pain is worse, so you're probably right about the kidney infection. Besides, it was roughly two weeks between the time I had the catheter and when I got the prescription for Keflex. I did get some generic Keflex (cost $26.00) and I'm taking it 4 times a day. I wish this was all happening after tax return season. :P
As soon as my insurance kicks in, I will find another doctor. The one I'm seeing now is simply the only one available through the ambulatory care clinic I was referred to for people without insurance. I think the insurance policy will be a good investment, and it's not ridiculously overpriced at $80/month.
Now hopefully things won't get worse before January 15. :)
|Dr. Chan Lowe - Sat Dec 30, 2006 10:10 pm|
That's great news. Let us know how things turn out. I'm sure that you and your doctor will be able to discover a cause for your symptoms.
Happy New Year.
|kaitka - Mon Jan 08, 2007 2:42 am|
Well, on January 3, I started my period. The doctors said it would probably be very painful, but it hasn't been at all. The antibiotics to cure my UTI from the catheter caused a yeast infection, of course. So now I'm dealing with that and a super heavy period! I guess a month late just adds more blood or something! My hormones seem to be evening out a little, without any medication. An interesting point to note is that as soon as I started having period issues (as in, missed periods) I noticed my feet stinking, which they never have before in my life. For about the last two weeks, they completely stopped stinking. And then today, the smell has returned. I assume this has to be hormonally-related. Also, hot flashes, constantly. I'm either dying of heat or freezing to death!
I'm considering cancelling my ultrasound appointment at the hospital, solely because my insurance isn't completely effective yet. I do not want to have to pay for that when I just received a bill for more than $2,000 just for the ER visit to get the cyst checked out. I really wish medical help wasn't so expensive! I understand why it has to be, but it is crippling! Besides, I dislike my doctor at the ambulatory care clinic, and I refuse to have another catheter put in right now, since I just got over the UTI caused by the first one. It was soo painful! Then, once my insurance kicks in, I'll schedule a gynecological appointment and tell them I'm trying to conceive, since we would like to get pregnant in February (thus creating a Scorpio boy).
I'm not sure if the cyst is gone or not, but I'm feeling more normal. As long as I have a period next month, I don't know that I'll have the motivation to go in for an appointment.
So that's what's happening right now. I'll see about how the hormone thing works out.
|Dr. Chan Lowe - Mon Jan 08, 2007 12:30 pm|
If the ultrasound was solely to follow up on the cyst, waiting a month is OK. That way your insurance can kick in.
Increased androgens are responsible for sweating and body odor. It is likely that you are having some increased androgens along with the estrogen surges for your period. These may even out some. I would encourage you to mention this to your doctor, just for thoroughness.
I hope you feel better soon. Keep us updated-especially when you get your thyroid hormone test results. :)
|kaitka - Sun Feb 11, 2007 7:44 pm|
I never had the ultrasound on the cyst, but I have a different kind of ultrasound scheduled for early March - a fetal ultrasound! :) I got pregnant at the end of January, and am due on October 14.
I went to the doctor just before that, and they suspected I had a kidney stone, but it wasn't. They suspected then that the cyst had burst. I'm not sure yet, but I'll find out soon enough.
As for the hormone problems, I guess they'll have to wait until after the baby is born.
|Dr. Chan Lowe - Mon Feb 12, 2007 7:58 pm|
Congratulations on your new family member! Thanks for the update.
Not to harp on this, but if you are pregnant it is quite important to ensure that your thyroid hormone levels are normal. Your obstetrician can check these levels for you.
|kaitka - Sun Feb 18, 2007 1:17 pm|
Oh, okay. I wasn't sure there was anything they could do about abnormal hormone levels during pregnancy, but I will definitely let my OB know that I've had issues leading up to this pregnancy. Is an OB able to test for that, or will he send me to an endocrinologist?
|brunnette - Fri Jan 16, 2009 5:56 am|
Hello, I usually have my period for five days. I've finished my last period and then I had unprotected sex and had taken the morning after pill. Four days later I got my period again and I read that it's okay because you can get it early, normally or later from the MAP. But I now have had my period for 2 weeks straight and still have it! should i be concerned? is this normal?
|philomina - Fri Jan 23, 2009 2:14 am|
well it is a very normal thing, see if you are missing your period or having two periods in one month then it is may because of tensions or unsystematic life style.
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