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Infertility

Prometrium, Hyperplasia, and Getting Pregnant

01/23/2009

Question:

Hi there, I would like to know if it is possible to ovulate on Prometrium 100 mg, (i take it 14 days a month to induce periods) I have had two incidencies of Endometrial Hyperplasia, and we tried the old fashion way, after finishing up on my 14th day of prometrium, and I took my cd21 progesterone test and it was 1.1 My dr gave me clomid but i am rather afraid to take it. I have read about the estrogen receptors, and think maybe this might complicate things given my history of hyperplasia. I also worry about the cancer risks associated with clomid. I wonder if i could ever ovulate while taking the prometrium to induce my periods. I also get my period on day 10 , which i take 14 pills so there are four pills that i take "after" i get my period, is the prometrium not working right? I thought it was suppose to do the withdrawal bleeding to induce period but i actually have a period while taking prometrium. I also wonder if i am getting enough biopsies for the hyperplasia. A huge worry i have is, what if while trying to concieve, what if i actually "have" hyperplasia, would this be dangerous? would it be able to grow into cancer while being pregnant?

My History:

1992 Age 14- Started first period From age 14 until age 24 Had cycles of every 3-6 months. When I was 14 I had just lost about 30 lbs, I was a little chubby kid in school, and lost weight and kept the weight off for 4-6 years then gained it back. Age 24-28 Didnt have any cycles at all I do not believe or recall Age 28 until recently (will put below in dates) (I am now 31) and will just abbreviate EMB for endometrial biopsy-as I know you know what it means:) and will put my weight Nov 2005-EMB Simple Hyperplasia w/out Atypia (wt. 220lbs) Dec 2005- D&C Hysterscopy Simple Hyperplasia w/out Atypia (wt. 198 lbs) Feb-April 2006 Took Megace 20mg for about four months one a day. (wt. 198 lbs) I know you gain weight on Megace so i stuck to my diet and just maintained the weight) April 2006 EMB- Clear (wt. 198) Lining was around 11-17mm End of April 2006-Stopped Megace since EMB was clear, and 5 days later had pretty well Hemorraging with large clots the size of a fist. Nov 2006 Had Ultrasounds ever 3-6 months usually at 5.5mm Feb,Mar,Apr,May,June 2007 Had NO period at all, despite taking Prometrium 14 days a month, (we were selling our house and i was under tremendous stress) June 2007 Had Ultrasound lining 5.5mm nurse said the dr. may not want to mess with my lining since it was a good measurement, but Dr. wanted to do ENB- came back Complex Hyperplasia w/out Atypia. Sept 2007 Continued taking Prometrium 14 days but had a heavy period, and had D&C right after the heavier than usual period to follow up with the ENB results, D&C came back clear. (I thought that maybe my heavier flow may have cleaned things out? as i just had been pretty well spotting for periods which my dr said counted) March 2008 Had Sonogram Lining 7mm Sept 2008 Had Sonogram, Lining was 10.5 (this was 8-9 days before my period was expected) I thought that when i saw the 10.5mm lining that it was bad, but the dr said it was ok? (weight was 191 lbs) October 2008- Had very very heavy period. Heaviest I had ever had on prometrium, (the other time was after taking megace) Also.. 12-14 days of my cycle BEFORE this heavy period i had extreme breast tendernous and for one day straight had a slight pain in my lower abdomen and felt like I ovulated, I also tested with the OPK and it showed a pretty dark line, not as dark as the test control and technically should be but darker than i had ever had it, i really felt like i ovulated) Nov 2008 Started trying to conceive after finishing up on 14th day of Prometrium, wanted to try on my own first. (Weight 178 lbs) Nov 2008 Had my 21 day progesterone test- It was 1.1 results (I didnt feel like i ovulated this month anyways, unlike the month before) As I normally have i usually just spot, but before this month i actually had a heavy flow just like the days before my d&C which came out clear, so i always thought maybe this is my body ovulating? So basically i`m wondering, *Can i take the prometrium and be safe with trying to conceive, or would the prometrium keep me from ovulating. *What if i have hyperplasia while trying to concieve and actually become pregnant, would this be a bad situation? *Does clomid cause cancer, and would it cause any complications with my hyperplasis situation? *Is there any safer ways to achieve fertility via a medical point of view? *Is the prometrium working for me or not working correctly in that I have my period WHILE taking it? (Day 10 of 14 day pill) Thank you so very much :)

Answer:

If your periods are irregular, it is likely that you are not regularly ovulating (making an egg).  You should have blood testing performed, including a TSH level (to test for thyroid function) and another hormone called prolactin.  If you have hair growth on your face, chest, back, or abdomen, you may have polycystic ovarian syndrome (PCOS). 

Usually, treatment is simple and consists of taking a fertility pill (such as clomiphene citrate) to get you to ovulate.  Prior to treatment, your husband should have a semen analysis, and you should consider having a dye test to see if your tubes are open. 

There are no definitive cancer risks by taking clomiphene citrate during a limited time frame (most patients do not take more than 8-10 cycles total of clomiphene citrate).  Taking progesterone will not typically cause you to ovulate.  You are simply taking the hormone that you would normally make when you ovulate (i.e. progesterone).  If you do not ovulate regularly, you either need to take progesterone or birth control pills which contain a form of progesterone) if you are not trying to get pregnant;  OR use a medication to cause you to ovulate such as clomiphene citrate if you are trying to conceive.

For more information:

Go to the Infertility health topic, where you can:

Response by:

Daniel B Williams, MD Daniel B Williams, MD
Formerly:
College of Medicine
University of Cincinnati