WOMENS-HEALTH Messages for November, 2000: Re: Can someone explain to me how the endometrial lining of the uterus works?

Re: Can someone explain to me how the endometrial lining of the uterus works?

From: D. Ashley Hill, MD (anonymous@obgyn.net)
Sat, 25 Nov 2000 07:42:54 -0600 (CST)

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At Fri, 24 Nov 2000, Anna wrote: >
>2 weeks ago, I saw my doctor and moved from Ortho/Novum 1/35 to
>Low-Ogestrel-28. The next day I started a very heavy period, which
>lasted 5 days. 7 days after the end, I started another period. Last
>night, I was soaking through a pad an hour. I call my doctor's
>answering service and a doctor called me. She said since I had been
>taking Ortho/Novum 1/35 back-to-back for over a year and had not had a
>period in that length of time, that this was just "breakthough bleeding"
>because of the length of time I had gone without a period. She advised
>me to stop taking the Low-Ogestrel, if the period lessened by Sunday
>night I should start taking them again

Here is a summary of normal menstruation (not taking any hormones): The endometrial lining responds to increasing levels of estrogen (from the ovaries) and thickens. After ovulation (about day 14 in the cycle), assuming no pregnancy, a cyst about the size of a golf ball forms on an ovary, called a corpus luteum cyst. This cyst makes progesterone. The increasing progesterone levels cause the lining to slough, causing a period. The average period yields 35 or so cc of blood (a little over one ounce) and lasts 4-5 days.

Here is what happens when taking oral contraceptives "back-to-back:" since pills are progesterone-dominant, they cause the lining to thin, sometimes excessively. Although not dangerous (it actually probably helps prevent uterine cancer), it can cause spotting and bleeding. This occurs because the tips of the blood vessels become exposed, and irritated, due to the extreme thinning of the endometrium.

If a patient calls me with a similar history, I usually advise to either stop the pill for a week, or add a little estrogen to the pill, for a week or so. This usually thickens (stabilizes) the lining of the uterus and relieves the bleeding. This assumes she has taken her pills "religiouisly" and is not pregnant. If the above does not alleviate the bleeding, I then consider investigating whether or not a polyp or fibroid is present in the uterus. Fortunately, this is usually not necessary.

Best wishes,

-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida

The above is general medical information, and should not be construed as specific treatment advice. Due to time constraints, I am unable to answer individual emails. Thank you.

Next message: Janet: "medication for hjot flashes"
Previous message: Kimberly: "Uterus and cervix on the left"
In reply to: Anna: "Can someone explain to me how the endometrial lining of the uterus works?"
Next in thread: Carla: "Re: Can someone explain to me how the endometrial lining of the uterus works?"

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