HPT when irregular??

MariaBend25

I have always had irregular periods, went on BC when I was a teen to try to get regularity and to help my horrible acne. Well fast forward a decade I felt it was time to get off BC since I had no acne and I did't want any long-term effects on my health. Plus my husband and I are comfortable having kids now and I wanted to get regular to better conceive down the road.

My first period was on time...30 days, then the following was over 40, then over 50, then 28. My face and back have completely blown up with very bad acne again. Now to the question, how do I time a HPT? I may very well be pregnant now as it is 36 days since my last period....yet considering my irrgularity I don't know when I would get accurate results. My fertility friend tracker doesn't show a predicted period until late next week, and I doubt the past 6 months of irregular data are reliable. I would probably not care too much and just wait it out but I am about to start a vitamin A treatment for my acne that is not to be taken when pregnant. Considering we just got back from a late "honeymoon" pregnancy is definitely possible. But I have also heard that women with irregular periods don't even ovulate, so I have no idea if I can even conceive. I have tried discussing these hormonal concerns with a doctor but he just gave me a prescription for my acne. Any advice or plan to go forward in my circumstance (including specific concerns I could bring up in my next appointment, if end up not being pregnant)?

Thanks ladies!

MariaBend25

I only have 8 months of data in my fertility friend tracker. And every cycle has been completely different. Each predicted menses is wrong each "month" or rather whenever my body has a period. Right now it is predicting my period to start next week when I will be over 45 days from date of last period. So basically, I know how to track but since it hasn't ever been right and I'm not normal I don't know what to trust. Again my concern is starting an acne treatment that I can't be pregnant for, so at 37 days into my cycle and coming off a honeymoon I could be pregnant. I am asking for help with what condition could be causing these irregularities and hormonal imbalances as my doctor just gave be acne meds without investigating my irregularity complaints. Any further advice would help, right now I only have a doctor who hasn't investigated my concerns further than my acne and a fertility tracker that has been unreliable in predicting anything.

MariaBend25

As for the not ovulating/ not fertile thing, two doctors suggested this. One said even though I may not get a period one month I may still be ovulating, or than I could be having false periods without any egg dropping lol. Another said that many women with irregular periods may have further fertility issues and to come back after a year off the pill to see if anything has straightened out. Then again, I go to military doctors sooo not always the best or most experienced, and certainly not specialists.

hopanka

Hm, if starting the acne treatment is the priority here, then I would do my best to minimize the chance of pregnancy. I would test for at least a month, maybe once weekly, while minimizing the chance of getting pregnant in the meantime. I would probably use at least 2 forms of birth control (condoms and spermicide...etc). If still negative after a month or so, I would do the treatment. If getting pregnant is your priority, then I would probably contact your GYN for advice. You may have to get blood drawn to determine your hormone levels because your testosterone could be high. I'm not diagnosing you, but since your acne is still this bad in adulthood, you could have your hormones out of whack.

DebateThis

Unless you are charting your basal body temperature along with that tracker, the tracker is 100% useless. Take a pregnancy test. Take one per week until AF shows or you get a positive test. Don't start Retin-A until you get AF. And if you're about to start Retin-A, go back on birth control.

Duggan11

I see military doctors also and I and have interesting cycles. Few things I have noticed they like to give several scenarios as to what is wrong. Doesn't mean much until blood work and proper charting is done. Also there are specialists available but military drs tend to always be in a rush so unless you specifically ask for a referral your PCM is going to assume you don't want it. I asked, was told I had to have officially tried a year and lost 15lbs plus all the blood work and H getting tested. I now get to see a specialist on post. It's possible just have to jump through their hoops.

miriandradjr

I would start on a BC method right away, maybe condoms if you don't want to take the pill. Then, you should take the HPT in about two weeks, which is the latest you could be pregnant, asuming you ovulate the same day you start using condoms. If that test comes back negative, you can start the Vitamin A treatment. Please be a 100% sure that you are not pregnant when you start that treatment because it does cause severe birth defects. If the Vit A treatment is not a priority and you want to get pregnant first, I would ask a dermatologist for another option. Also, you might want to go to your ObGyn. 

miriandradjr

Irregular menses can be caused by a lot of different things, from hormonal imbalances, PCOS, prolactinoma, etc. The problem is that even though menses are irregular, you could be ovulating as little as 1 or 2 times a year and as much as 9 or 10 times a year. For an ObGyn to consider you infertile, you have to try to conceive for a whole year without results, and then they evaluate your husband and you for this and other causes of infertility. If they understand anovulation is the problem, they will start you on Clomid (a medication to induce ovulation). Some might start it earlier, but these are the standard guidelines. So, if you are one of the unlucky women, who just ovulates once or twice a year, this is a very long frustrating period. 

Extra info- Menstruation doesn't equal ovulation. Actually if a cycle is longer than 35 days, your doctor will just assume that you are not ovulating, and will give you Provera, so you get your period. If you don't take Provera, you can have cycles as long as 100 days like others have said. That period can mean 2 things... either you ovulated at some point and got your period, or something doctors call "breakthrough bleeding" happened. It just mean that your endometrium was so thick that it just basically had to get out. That is why, women with irregular periods have very heavy bleeding, even to the point of causing anemia. 

I hope this info is useful for you Good luck! 

miriandradjr

Also it will take longer that 2 weeks for the pill to work. You should use a barrier method, male or female condoms, or a diaphragm. 

Unknown

This content has been removed.

miriandradjr

Joy2611 said:

miriandradjr said:

Actually if a cycle is longer than 35 days, your doctor will just assume that you are not ovulating, and will give you Provera,

If your doctor throws Provera at you once you've gone 35 days without a period, I'd find a new doctor.  60 days is the more realistic number for needing Provera.  I'd also - AGAIN - highly recommend basal body temping to anyone wanting to know if they are ovulating each cycle, even with long, irregular cycles.  It's so much easier than guessing or having unnecessary interventions.

I didn't say "at once" for goodness sake! But if you go with a complaint of having recurrent long cycles, he will do a Provera challenge test to determine if you're ovulating and if your aren't he will tell you to take Provera every time you reach CD 35 and have still not gotten your period. This is actually FOR YOUR OWN GOOD!! It prevents the endometrium from growing excessively which increases the risk of endometrial cancer in the long run! I'm not an ObGyn, but I'm a medical doctor and have plenty of menstrual problems myself. I didn't feel it was necessary to recite all the ObGyn guidelines and procedures here. I was just simplifying. 

miriandradjr

In addition to prevent endometrial cancer in the long run, it also prevents anemia in women who have heavy bleeding due to breakthrough bleeding!  

BTW, anovulation puts you at higher risk for most female cancers. That's why they do it. They're not just "ignorant"! >_>

DebateThis

miriandradjr said:

In addition to prevent endometrial cancer in the long run, it also prevents anemia in women who have heavy bleeding due to breakthrough bleeding!  

BTW, anovulation puts you at higher risk for most female cancers. That's why they do it. They're not just "ignorant"! >_>

Maybe, maybe not, but I can't tell you how many OB's I've seen Rx Clomid over the years w/o proper preliminary testing and subsequent monitoring because so many women are blind to the facts of ovulation and want to get pregnant "faster". In fact, I would wager a quick guess that the vast, vast majority of OBs hand it out that way. Frankly, I'd be A-OK if OBs finally owned that they aren't fertility specialists and stopped prescribing it altogether.

Oh, and by the way, cycle lengths of 30, 40, 50 and then 28 days are NORMAL after someone stops taking hormonal birth control. There's nothing in the OP to indicate annovulation at all.

miriandradjr

Joy2611 said:

miriandradjr said:

I didn't say "at once" for goodness sake! But if you go with a complaint of having recurrent long cycles, he will do a Provera challenge test to determine if you're ovulating and if your aren't he will tell you to take Provera every time you reach CD 35 and have still not gotten your period. This is actually FOR YOUR OWN GOOD!! It prevents the endometrium from growing excessively which increases the risk of endometrial cancer in the long run! I'm not an ObGyn, but I'm a medical doctor and have plenty of menstrual problems myself. I didn't feel it was necessary to recite all the ObGyn guidelines and procedures here. I was just simplifying. 

Why in the world would you take Provera to determine if you're ovulating when there are far easier and less invasive ways to do that?  C'mon now.

I'm fully aware that having your lining build up endlessly is bad and can lead to cancer, but there is a disconnect between what the OP is saying and the fear-mongering that you're spouting.  She has irregular periods - not no periods at all.  She has no idea when to test for pregnancy because she doesn't know when she ovulates each cycle.  I gave her sound and reasonable advice to figure that out.  You are just unnecessarily bringing up cancer and scaring everyone to run to their doctors if their cycles aren't a textbook 28 days. She didn't say she had recurrent, long cycles - she said she had irregular cycles!! 

Who is acting a little irrationally in this thread?  It's not me.  I answered the question.  You took it to a whole new and unnecessary level.  You may be a medical doctor, but I know full well that being a doctor doesn't mean that you know everything about every specialty and this is a frightening bedside manner you offer your patients if it's to always say you need surgery for a hang nail.

Did you read all my posts?! I told her exactly when to take the pregnancy test, to make sure she's not pregnant before taking the Vit A. In one of her latter posts she asked for reasons that she may not be ovulating because her doctor basically didn't explain anything. That is why I explained to her some of the causes of anovulation and talked about Provera. Please, read all the thread before commenting!! It's science! I didn't tell nobody to go run to their doctors! Facts are facts! 

miriandradjr

DebateThis said:

miriandradjr said:

In addition to prevent endometrial cancer in the long run, it also prevents anemia in women who have heavy bleeding due to breakthrough bleeding!  

BTW, anovulation puts you at higher risk for most female cancers. That's why they do it. They're not just "ignorant"! >_>

Maybe, maybe not, but I can't tell you how many OB's I've seen Rx Clomid over the years w/o proper preliminary testing and subsequent monitoring because so many women are blind to the facts of ovulation and want to get pregnant "faster". In fact, I would wager a quick guess that the vast, vast majority of OBs hand it out that way. Frankly, I'd be A-OK if OBs finally owned that they aren't fertility specialists and stopped prescribing it altogether.

Oh, and by the way, cycle lengths of 30, 40, 50 and then 28 days are NORMAL after someone stops taking hormonal birth control. There's nothing in the OP to indicate annovulation at all.

She has a strong history of irregular cycles SINCE SHE WAS A TEENAGER!! This isn't a new problem. 

miriandradjr

miriandradjr said:

Joy2611 said:

miriandradjr said:

I didn't say "at once" for goodness sake! But if you go with a complaint of having recurrent long cycles, he will do a Provera challenge test to determine if you're ovulating and if your aren't he will tell you to take Provera every time you reach CD 35 and have still not gotten your period. This is actually FOR YOUR OWN GOOD!! It prevents the endometrium from growing excessively which increases the risk of endometrial cancer in the long run! I'm not an ObGyn, but I'm a medical doctor and have plenty of menstrual problems myself. I didn't feel it was necessary to recite all the ObGyn guidelines and procedures here. I was just simplifying. 

Why in the world would you take Provera to determine if you're ovulating when there are far easier and less invasive ways to do that?  C'mon now.

I'm fully aware that having your lining build up endlessly is bad and can lead to cancer, but there is a disconnect between what the OP is saying and the fear-mongering that you're spouting.  She has irregular periods - not no periods at all.  She has no idea when to test for pregnancy because she doesn't know when she ovulates each cycle.  I gave her sound and reasonable advice to figure that out.  You are just unnecessarily bringing up cancer and scaring everyone to run to their doctors if their cycles aren't a textbook 28 days. She didn't say she had recurrent, long cycles - she said she had irregular cycles!! 

Who is acting a little irrationally in this thread?  It's not me.  I answered the question.  You took it to a whole new and unnecessary level.  You may be a medical doctor, but I know full well that being a doctor doesn't mean that you know everything about every specialty and this is a frightening bedside manner you offer your patients if it's to always say you need surgery for a hang nail.

Did you read all my posts?! I told her exactly when to take the pregnancy test, to make sure she's not pregnant before taking the Vit A. In one of her latter posts she asked for reasons that she may not be ovulating because her doctor basically didn't explain anything. That is why I explained to her some of the causes of anovulation and talked about Provera. Please, read all the thread before commenting!! It's science! I didn't tell nobody to go run to their doctors! Facts are facts! 

Joy2611 said:

miriandradjr said:

I didn't say "at once" for goodness sake! But if you go with a complaint of having recurrent long cycles, he will do a Provera challenge test to determine if you're ovulating and if your aren't he will tell you to take Provera every time you reach CD 35 and have still not gotten your period. This is actually FOR YOUR OWN GOOD!! It prevents the endometrium from growing excessively which increases the risk of endometrial cancer in the long run! I'm not an ObGyn, but I'm a medical doctor and have plenty of menstrual problems myself. I didn't feel it was necessary to recite all the ObGyn guidelines and procedures here. I was just simplifying. 

Why in the world would you take Provera to determine if you're ovulating when there are far easier and less invasive ways to do that?  C'mon now.

I'm fully aware that having your lining build up endlessly is bad and can lead to cancer, but there is a disconnect between what the OP is saying and the fear-mongering that you're spouting.  She has irregular periods - not no periods at all.  She has no idea when to test for pregnancy because she doesn't know when she ovulates each cycle.  I gave her sound and reasonable advice to figure that out.  You are just unnecessarily bringing up cancer and scaring everyone to run to their doctors if their cycles aren't a textbook 28 days. She didn't say she had recurrent, long cycles - she said she had irregular cycles!! 

Who is acting a little irrationally in this thread?  It's not me.  I answered the question.  You took it to a whole new and unnecessary level.  You may be a medical doctor, but I know full well that being a doctor doesn't mean that you know everything about every specialty and this is a frightening bedside manner you offer your patients if it's to always say you need surgery for a hang nail.

Ahh and BTW, here's an explanation of how Provera is used to determine causes of infertility. Hope you can understand it. >_> Because I'm just not in the mood of explaining anything else. 

Progesterone Withdrawal Test - Progesterone Challenge
A Diagnostic Test for Secondary Amenorrhea 

Page author Richard Sherbahn MD

• The progesterone challenge test is is also referred to as a progestin challenge
• It is done by givng a progestin medication and seeing if this induces a menstrual period
• This same protocol of giving a progestin is often used to induce a period in women with irregular periods:
  • if she has not had a period for a while
  • if she skipped a period
    

How the Test Works

The progesterone challenge test is done by giving oral medroxyprogesterone acetate (Provera) 10 mg daily for 5-10 days or one intramuscular injection of 100-200 mg of progesterone in oil.

A positive response is any bleeding more than light spotting that occurs within 2 weeks after the progestin is given. This bleeding will usually occur 2-7 days after the progestin is finished.

Withdrawal bleeding will usually be seen if the patient's estradiol level has been over about 40 pg/ml.

Possible Outcomes of the Test

• If the patient experiences bleeding after the progestin she has estrogen present but is not ovulating (anovulation).
• If no withdrawal bleeding occurs, either the patient has very low estrogen levels or there is a problem with the outflow tract such as uterine synechiae (adhesions) or cervical stenosis (scarring).

Women with Withdrawal Bleeding

• The test has demonstrated that she builds up a lining in the uterus.
• She bleeds after progesterone is withdrawn - showing that it is the lack of ovulation that is causing her not to have periods.

Possible Diagnoses for Women with Withdrawal Bleeding

• Anovulation
• Polycystic Ovarian Disease (PCOS)

---

Women without Withdrawal Bleeding

Possible Diagnosis

• Hypothalamic hypoestrogenism (low estrogen levels)
• Compromised outflow tract - either Asherman's syndrome (adhesions) or cervical stenosis (scarring)
• Premature ovarian failure

---

The Next Step: Give Estrogen and Progestin to Distinguish Between Hypoestrogenism or an Outflow Tract Obstruction (Asherman's Syndrome or Cervical Stenosis)

Give estrogen to ensure endometrial proliferation, followed by a progestin to induce withdrawal bleeding. A course of 2.5 mg of Premarin for 21 days including 10 mg of Provera on days 17-21 should be adequate.

• If bleeding occurs, amenorrhea is due to hypoestrogenism (hypothalamic amenorrhea or premature ovarian failure).
• If bleeding does not occur, then most likely it is an outflow tract obstruction - either Asherman's syndrome or cervical stenosis.

DebateThis

miriandradjr said:

DebateThis said:

miriandradjr said:

In addition to prevent endometrial cancer in the long run, it also prevents anemia in women who have heavy bleeding due to breakthrough bleeding!  

BTW, anovulation puts you at higher risk for most female cancers. That's why they do it. They're not just "ignorant"! >_>

Maybe, maybe not, but I can't tell you how many OB's I've seen Rx Clomid over the years w/o proper preliminary testing and subsequent monitoring because so many women are blind to the facts of ovulation and want to get pregnant "faster". In fact, I would wager a quick guess that the vast, vast majority of OBs hand it out that way. Frankly, I'd be A-OK if OBs finally owned that they aren't fertility specialists and stopped prescribing it altogether.

Oh, and by the way, cycle lengths of 30, 40, 50 and then 28 days are NORMAL after someone stops taking hormonal birth control. There's nothing in the OP to indicate annovulation at all.

She has a strong history of irregular cycles SINCE SHE WAS A TEENAGER!! This isn't a new problem. 

Teenagers having irregular cycles isn't uncommon. In fact, it's pretty much the norm. Also, she's been on BC for a decade, which means she probably hasn't had several months of unmedicated cycles SINCE she was a teenager. Her body's learning its "new normal".

And all the advice remains the same. Take a pregnancy test now. Take one per week until either AF starts or she gets a + test. If she really wants to start Retin A, go back on birth control. If she decides to TTC and through charting sees a pattern of many cycles of annovulation/cycles lasting longer than 60 days, see a doctor and find out what's causing it.

You are assuming right out of the gate that the OP is having issues. There is still nothing to indicate she is. (And, by the way, she posted this almost identical post back in March and was given identical advice. @Joy2611 gave her awesome advice in that post, as well.) There is no reason to assume she has PCOS or any other issues at this point.

tlc35

Progesterone Withdrawal Test - Progesterone Challenge
A Diagnostic Test for Secondary Amenorrhea

That may be an appropriate work up for someone who has amenorrhea, but the OP doesn't have amenorrhea per her own statement.  She says that she has periods but her cycles vary in length.  Personally I have had ovulatory cycles between 27 and 37 days since I have been off birth control.

OP I agree that you should not take retin A unless she is on birth control and if you want to know when to test for pregnancy take @joy2611's advice and start temping.

miriandradjr

DebateThis said:

miriandradjr said:

DebateThis said:

miriandradjr said:

In addition to prevent endometrial cancer in the long run, it also prevents anemia in women who have heavy bleeding due to breakthrough bleeding!  

BTW, anovulation puts you at higher risk for most female cancers. That's why they do it. They're not just "ignorant"! >_>

Maybe, maybe not, but I can't tell you how many OB's I've seen Rx Clomid over the years w/o proper preliminary testing and subsequent monitoring because so many women are blind to the facts of ovulation and want to get pregnant "faster". In fact, I would wager a quick guess that the vast, vast majority of OBs hand it out that way. Frankly, I'd be A-OK if OBs finally owned that they aren't fertility specialists and stopped prescribing it altogether.

Oh, and by the way, cycle lengths of 30, 40, 50 and then 28 days are NORMAL after someone stops taking hormonal birth control. There's nothing in the OP to indicate annovulation at all.

She has a strong history of irregular cycles SINCE SHE WAS A TEENAGER!! This isn't a new problem. 

Teenagers having irregular cycles isn't uncommon. In fact, it's pretty much the norm. Also, she's been on BC for a decade, which means she probably hasn't had several months of unmedicated cycles SINCE she was a teenager. Her body's learning its "new normal".

And all the advice remains the same. Take a pregnancy test now. Take one per week until either AF starts or she gets a + test. If she really wants to start Retin A, go back on birth control. If she decides to TTC and through charting sees a pattern of many cycles of annovulation/cycles lasting longer than 60 days, see a doctor and find out what's causing it.

You are assuming right out of the gate that the OP is having issues. There is still nothing to indicate she is. (And, by the way, she posted this almost identical post back in March and was given identical advice. @Joy2611 gave her awesome advice in that post, as well.) There is no reason to assume she has PCOS or any other issues at this point.

I never said she had PCOS... and I'm not assuming anything. Most likely is just a hormonal imbalance, which can be caused by the BC pills, themselves, or by anything else. You guys make such a big deal out of something that is so common. Anovulation is what it is. You can have 10 ovulatory cycles in one year, and still those 2 when you didn't ovulate, are called anovulatory cycles. It is not a forever diagnosis. Actually, after pregnacy, some women can go on to have perfect 28d cycles, after having struggled with infertility and anovulation. Our body is constantly changing. 

tlc35

SNIP

I never said she had PCOS... and I'm not assuming anything. Most likely is just a hormonal imbalance, which can be caused by the BC pills, themselves, or by anything else. You guys make such a big deal out of something that is so common. Anovulation is what it is. You can have 10 ovulatory cycles in one year, and still those 2 when you didn't ovulate, are called anovulatory cycles. It is not a forever diagnosis. Actually, after pregnacy, some women can go on to have perfect 28d cycles, after having struggled with infertility and anovulation. Our body is constantly changing. 

You are assuming that she is not ovulating and there is nothing in her OP to indicate that she is not ovulating.  Based on what you posted a provera challenge test will not tell her is she is ovulating.  It will only show that she has an appropriate response to progestin withdrawal.
The standard is to take provera after 60 days without a period.  35 days is way too soon to take provera.

DebateThis

miriandradjr said:

DebateThis said:

miriandradjr said:

DebateThis said:

miriandradjr said:

In addition to prevent endometrial cancer in the long run, it also prevents anemia in women who have heavy bleeding due to breakthrough bleeding!  

BTW, anovulation puts you at higher risk for most female cancers. That's why they do it. They're not just "ignorant"! >_>

Maybe, maybe not, but I can't tell you how many OB's I've seen Rx Clomid over the years w/o proper preliminary testing and subsequent monitoring because so many women are blind to the facts of ovulation and want to get pregnant "faster". In fact, I would wager a quick guess that the vast, vast majority of OBs hand it out that way. Frankly, I'd be A-OK if OBs finally owned that they aren't fertility specialists and stopped prescribing it altogether.

Oh, and by the way, cycle lengths of 30, 40, 50 and then 28 days are NORMAL after someone stops taking hormonal birth control. There's nothing in the OP to indicate annovulation at all.

She has a strong history of irregular cycles SINCE SHE WAS A TEENAGER!! This isn't a new problem. 

Teenagers having irregular cycles isn't uncommon. In fact, it's pretty much the norm. Also, she's been on BC for a decade, which means she probably hasn't had several months of unmedicated cycles SINCE she was a teenager. Her body's learning its "new normal".

And all the advice remains the same. Take a pregnancy test now. Take one per week until either AF starts or she gets a + test. If she really wants to start Retin A, go back on birth control. If she decides to TTC and through charting sees a pattern of many cycles of annovulation/cycles lasting longer than 60 days, see a doctor and find out what's causing it.

You are assuming right out of the gate that the OP is having issues. There is still nothing to indicate she is. (And, by the way, she posted this almost identical post back in March and was given identical advice. @Joy2611 gave her awesome advice in that post, as well.) There is no reason to assume she has PCOS or any other issues at this point.

I never said she had PCOS... and I'm not assuming anything. Most likely is just a hormonal imbalance, which can be caused by the BC pills, themselves, or by anything else. You guys make such a big deal out of something that is so common. Anovulation is what it is. You can have 10 ovulatory cycles in one year, and still those 2 when you didn't ovulate, are called anovulatory cycles. It is not a forever diagnosis. Actually, after pregnacy, some women can go on to have perfect 28d cycles, after having struggled with infertility and anovulation. Our body is constantly changing. 

I feel like you don't understand how to post on the internet. Read your other posts, and then read this one. You have directly contradicted yourself. YOU are the one who brought up PCOS and testing and provera. YOU are the one assuming she is not ovulating. YOU are the one who thinks she has issues because over a decade ago she had a few funky cycles.

Please, go reread these posts. There is NOTHING wrong at this point. There is no reason to ASSume that she's got anything wrong because her cycles aren't even that big of an "irregularity". She wants to take a damned test so she can go back on BCP and start Retin-A.

And, seriously, ALL the LOLs that you're attempting to teach ME about ovulation. Ha.