Infertility/Fertility/hormonal imbalance?


Hello and thank you so much for this service!
I am 47 and started having spotting after periods about 15 months ago. Then missed a few. Had uterine biopsy which showed normal but 'proliferative' and doc said I could take progesterone but I declined due to fear of side effects.
Biopsy started me bleeding heavily, lasted two weeks and then started to get periods again every three weeks for about 6-7 cycles.  Last significant one was in June. Started spotting in August and it's been on and off, very light, for three weeks.  Although I feel as if a period is coming, I went in for ultrasound to check on fibroids, unchanged from the past. But lining was 1.25cm and doctor now insisting on six months of norethindrone. She says that if I don't take, I may end up in ER with uncontrollable bleeding or precancerous condition. All else appeared normal on the scan.
Is this a logical treatment? The symptoms are certainly not unpleasant at this point, but I don't want to set myself up for disaster. I feel as if I have no choice, so perhaps looking for reasurance re: side effects (I suffer from migraines w/aura already) I am in the NYC area, by the way!

Thanks again -

Hello Victoria from the U.S. (NYC),

I get the sense that you are trying to self treat, since you've now discounted your doctor's advice twice, but I think that questioning the recommendations is reasonable.  Your doctor's latest advice may be a little too aggressive.  The lining is not that thick so I don't think the 6 months of progesterone is necessary, however, I think that your bleeding needs to get treated.  Your doctor is correct in that you could end up in the emergency room with hemorrhagic bleeding or the lining could change into endometrial cancer with time.

I think that the bleeding you are having is due to an ovarian dysfunction and the most likely culprit is perimenopause or pre-menopause.  This is based on the fact that your biopsy was normal previously and there is no other anatomic reason for the bleeding.  You are at the age that these changes would be occurring since you are approaching menopausal age.  In the perimenopausal period, the ovary starts to dysfunction, like an engine starts to sputter as it begins to break, and so you have irregular hormonal output leading to the endometrial break down.  Over time the ovary will eventually stop, which is menopause.  As such, my recommendation is to go on medication to restore normal cycles.  Yes, using progesterone only for 10-12 days each month may work for now but eventually you will need estrogen too.  There are no significant side effects or risks with this treatment.  The other option is to go on a low dose birth control pill.  This will suppress the ovarian dysfunction and restore normal cycles, which will restore normal endometrial lining health.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at if you are interested in continuous access to me.


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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