No period after Provera?!?!?!!?!?

[trin2bpatient]

I am 25 years old -have PCOS and have been ttc#1 for only 6 months. I have taken provera the last 3 and started my period right away but this time I took my last pill on the 23rd and still haven't started so I called my OB today and he wants to start me on estodial along with the provera and see if that works? Has anyone ever heard of this? Has it worked?

thanks for any info!!

tyin

[miyaya]

Hi Trin~

I have never doen estradiol. My re said that it could take 14 days afetr taking the last pill. BUT I am learning that each doc is different. I usually start 7 days post pill. Hope this helps.

[revlon005]

trin2bpatient- I had the same thing no period after provera. I do not think that you have PCOS. I've had exactly the same problem, only to learn two years later that I have hypothalamic amenorhea and not PCOS and need to take etradiol for 10 weeks to build uterus lining and then take provera to get AF.
here is some info for you:


What's the difference between HA and PCOS?
The difference isn't always clear. HA'ers tend to have low FSH and LH, whereas with PCOS LH is usually about 2-3 times FSH. Ultrasound isn't necessarily diagnostic, as HA can have polycystic ovaries. Estrogen tends to be higher in women with PCOS, who usually respond to a Provera challenge. HA'ers usually don't respond. The problem is that there is simply no way of conclusively differentiating between them, as they are both diagnoses made on the basis of judgment and exclusion of other diagnoses. I had an ob tell me it was PCOS, and my RE tell me he was 99% sure it was HA. I have done a lot of research and thinking on the subject, so I'll lay it all out here:

-LH:FSH ratio tends to be 2:1 or 3:1 among women with PCOS
-LH:FSH ratio tends to be < 1 among women with HA

-estrogen tends to be normal to high among women with PCOS
-estrogen tends to be low to normal among women with HA

--the majority of women with PCOS will have polycystic ovaries - however, not all of them will.
-up to a quarter of "normal" women have polycystic ovaries, indicating it may simply be a normal variant of ovarian morphology
-up to 50-75% of women with HA (depending on source) have polycystic ovaries, as they are the result of chronic anovulation

-androgens tends to be elevated among women with PCOS
-one research review says polycystic ovaries - *regardless of what caused them in the first place* - produce testosterone because follicles can't produce estrogen until they are bigger, so this may not be an effective differentiating factor

-many women with PCOS are also insulin resistant (i.e., high fasting levels of insulin); women with PCOS are more likely to have problems surface in their lipid panel (e.g., high bad cholesterol)
-women with HA are more likely to show the opposite - very low levels of fasting insulin as fasting insulin is correlated with levels of the hormone leptin (see sidebar)

-many women with PCOS are overweight (though may be of normal weight)
-most women with HA are underweight (though may be of normal weight)

-many women with PCOS will demonstrate high bone mineral density (this is a function of high levels of estrogen)
-many women with HA will demonstrate low bone mineral density (this is a function of low levels of estrogen)

-most women with PCOS will have a withdrawal bleed to progesterone (again, high levels of estrogen)
-most women with HA will not have a withdrawal bleed to progesterone (again, low levels of estrogen)

-other indications of PCOS not present in HA: hirsutism, family history of PCOS or diabetes
-other indications of HA not present in PCOS: history of strenuous exercise, restricted diet, tend to display higher (but subclinical) scores on measures of depression and anxiety

[bags]

Did you check a pregnancy test? Not to get your hopes up, but my "infertile" friend with PCOS got pregnant during the provera round prior to starting her clomid. She found out after she freaked out because she didn't get a period after provera.

[trin2bpatient]

revlon --

Thanks so much for the information! I will be sure to ask my DR about HA. I am going to print off what you said and see what he has to say. The only thing is that I am overweight and have been all my life. But I don't know of anyone in my family that has had this issue. UGH!!! This is soo frustrating b/c you put all your faith in your DR then find out it could be something esle! If in fact I end up having HA do the same drugs for fertiltiy work - ie Femara, Follistem, metformin?

thanks so much for the info it was extremely helpful!

[trin2bpatient]

bags--

Yes my OB had me take a pregnancy test before i started the estrogen and it was negative - thanks though for the input!

I am glad it worked for your friend though - that means there is hope!

trin

[revlon005]

trin2bpatient- i was misdiagnosed 3 times. Doctors do not know everything. Did you start estrogen already? Are you taking it as a pill, injection or vaginal suppository? I've been taking 2mg of estradiol for almost 3 months and then did provera challenge, and then repronex injectibles, IUI and got pregnant on my first cycle, unfortunately i miscarried very early in the pregnancy due to clotting disorder that i developed when got pregnant. You can check out HA board, it's under infertility/general infertility/hyphothalamic amenorhea.

[trin2bpatient]

revlon --

i took the estrogen on teh 2nd and the 3rd and started my cycle on the 3rd so i quit taking it (per dr) then i took my femara the 3 - 7 day of my cycle and yesterday i started follistem shots at 150 for 6 days and MOnday the 14th i will go and get a sonagram to see if i have any follies! If i have a good one we are going to do the IUI. Keep me in your thoughts and prayers as you are in mine!

thanks for the input!
trin

[revlon005]

trin2bpatient- I wish you all the luck!!! YOu are in my thoughts and Keep me posted

[s.lahm]

I have PCOS and have always started after taking provera. Infact thia last cycle I started two days after stopping the pill. Which I thought was odd.
Good luck