Expert: Norman Solberg - 7/30/2009

Question
I am a 35 yr old woman with a history of menstrual and fertility issues.

Ob/Gyn recently prescribed Provera 10mg daily for abnormally heavy periods. Initially, he felt my hormones levels might be “off” but blood work revealed everything was “WNL.” Follow up phone consults with nurse and Ob/Gyn wrote prescription for Provera for 30 days to take one pill every day. Plan was to take script until next appointment (yearly exam) on Sept 3rd.  I’m on day 3 and already cannot handle side effects.[Heavy night sweats, insomnia, headaches, weird body pains / tingling, intense anger / rage for no reason]. Don’t think I can possibly take another day as I’m finding it hard to function. (work and home)

After doing research about Provera, it appears to me that the usual protocol is to prescribe for a specified number of days (usu no more than 10) then stop taking it to induce a period. My question is why would I be taking this EVERY day? And how is this supposed to stop my periods from being heavy / lots of clots? It seems to me it would more likely just stop my periods all together.

We decided to use Provera because I did not want to take BCPs on the off chance a miracle occurred and I got pregnant (hx of infertility).  Ob/Gyn stated Provera wouldn’t effect fertility. However, wouldn’t taking it every day keep me from getting a period and ergo, effect my fertility?

Now that I’m feeling as if Provera is not possible due to side effects, won’t BCPs have the same side effects and risks?

If it helps, my history is as follows:

Began periods in 1985 at age 10 – very heavy with heavy clotting, intense pain, generally lasted 7-8 days; very irregular frequency. (could go 3-4 mos with no period)

Within the past 5-6 years, periods have become more regular on a cycle of 30-40 days, lasting 5-6 days with very heavy flow, passing major clots and moderate pain.

1992-2000: Married and had unprotected sex throughout with no pregnancy. Attempted clomid for 2 unsuccessful trials during that time but no further attempts.

2000 – new sexual partner / relationship – unprotected sex, no pregnancy; multiple bloodwork ups, ultrasounds, HSG. Dx of PCOS at that time.

2001 – possible miscarriage; heavy period just prior to yearly exam and at exam (CD 8-9?) Dr found cervix dilated at ~ 1 and felt it may have been end of miscarriage; blood work didn’t show anything

2002 – miscarriage at 6 wks; emergency D&C required as fetus wouldn't completely expel

2003 – clomid use; ectopic pregnancy not discovered until week 7 which resulted in loss of left fallopian tube

2003 – present: unprotected sex but no further medical intervention; no pregnancies

2008: Severe anemia diagnosed. Hematologist had me taking 500mg Vitamin C QD and 325mg ferrous sulfate TID for 6 mos … then dropped iron to BID during last 3 mos and levels are finally within normal range although ferritin level still on the low side (around 14).

Sorry to be long winded and thanks in advance for any insight you can shed on my strange journey.

ky


Answer
I agree with you that taking the provera for 30 days is unusual, and I have no idea why it was prescribed that way.  Since you're having such bad side effects, I would stop the provera, realizing that you may get a period in a couple days.  Most women have no or minimal side effects from provera, but some hate the way they feel, as you do.  Because you reacted that way to provera doesn't mean that you would have the same reaction to birth control pills or to a different progesterone, such as Prometrium.  You could talk to your doctor about switching to either.  I'm not sure how likely you are to ovulate on the provera, but since you've had problems ovulating in the past, I suspect it may keep you from ovulating and getting pregnant.  That's only a guess.  Usually the best way to prevent the heavy periods you've been having would be to take the provera for 7-10 days every 4-6 weeks.  You could do the same thing with Prometrium or birth control pills.  Doing it that way probably wouldn't keep you from getting pregnant if it were going to happen (You'd be taking them after possible ovulation occurred).  You might want to consider getting a second opinion.  Good luck.