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spanky77 
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 Topic: gynaecology specialist consultation
Posted: 07 January 2010 at 3:11pm |
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hey there, has anyone seen a gynae consultant and can tell me what the first visit entails?
In a nutshell, I have spotting from 1 DPO up to AF, variable amounts and colour. Luteal phase is variable, anything from 8-14 days, usually on the shorter side.
GP has done bloods at CD2 and 7DPO and all seems ok, apart from a ridiculously high prolactin level
Scans all looked ok, nothing unusual. No cysts or fibroids etc. Smears and STD all clear.
Am quite keen to start actively TTC (missed MC last August) as soon as but GP has advised against until I have seen gynae and got the all clear. Am on waiting list as 'semi-urgent' with a potential wait of 2-6 months.
I guess I'm wondering if the first visit is going to be a sit and go over 'history of presenting condition' yet again and this could be what I am waiting 6 months (or less) for.
Empty arms and ready to climb back on again vs listening to/waiting for the professionals . . . .
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Shezzey
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Joined: 24 January 2009
Location: Swanson, West Auckland
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Posted: 07 January 2010 at 10:47pm |
Spanky...my first appointment she went through my history and then she did an internal scan that day.
Prolactin can have an effect on fertility... it can prevent ovulation. I have high prolacting and my GP referred me to a endinocrinologist who did a brain scan for tumours on my pituitary gland and it came back all clear, although he prescribed medication to reduce the prolactin.
Edited by Shezzey
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Shezzey
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Posted: 08 January 2010 at 12:30pm |
Spanky... thought you may want to read this...
Some women have a condition known as Hyperprolactinemia. This refers to unusually high levels of prolactin in a woman who is not pregnant . Hyperprolactinemia can create specific problems in regard to fertility. It can cause a woman to produce an inadequate amount of progesterone during the luteal phase after ovulation.
Hyperprolactinemia does not directly cause miscarriage. However, Hyperprolactinemia may contribute to luteal phase defect. The luteal phase is a part of the menstrual cycle. It is the time between ovulation and the start of the next period. Most of the time, the luteal phase lasts for between 10 and 14 days. If your luteal phase lasts less than 10 or more than 14 days, it is referred to as a luteal phase defect.
If you conceive and you have a luteal phase defect, you may an early miscarriage. This is because that a luteal phase defect cannot sustain a pregnancy because the uterine lining in these women begins to break down, bringing on the menstrual bleeding and causing an early miscarriage.
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spanky77
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Posted: 08 January 2010 at 2:38pm |
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hey Shezzey (spoke to you before in one of these forums *waves*), will be getting another blood test in the next week to check the prolactin levels. I heard recently that the pit. tumours give results in the thousands (although I know its not all cut and dried like that).
TBH, I started getting nipple leakiness 3 weeks after the mc, which is when I think my body realised there was no baby anymore (preggy symptoms went away), and thats carried on for the last 5 months, so I kinda thought levels would be up.
The luteal phase thing I think is an issue though (might even have been you that also mentioned this in another thread).
When you say internal scan . . . is that the feely one, or ultrasound (already had ultrasound referred from GP but hey, if it helps, I'll take another)?
When I had the dating scan for the pregnancy, she dated it at 8w1 (I had no idea of dates whatsoever, preg was out the blue) good heart beat, and said the lining was good and thick ( I remember being a bit "what, does that matter?" thicko and in shock anyway). The missed mc was dated as 8w1, but preg symptoms decreased at 9 weeks. With LPD, doesn't the mc usually start before 8 weeks though? Doesn't progress past 8 weeks, I read
I got to 13w6 before I found out, only got it out with Miso, could have gone on for god knows how long before it came out naturallly
according to my temp charts I'm ovulating though, they're definitely biphasic (I think that was my last thread here) although quite alpine.
The 7DPO bloods gave a prog level of 47 too.
Its mad, cos I kind of know dribs and drabs about whats normal etc, but not really how to put the pieces together necessarily in the right order. Want to be able to ask the docs the right questions and push in the right direction, instead of accepting whatever they tell me. You know, that informed patient thing!
Edited by spanky77
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Shezzey
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Posted: 08 January 2010 at 9:41pm |
Hi Spanky...
The nipple leakiness is definitely a symptom of high prolactin.... it may not be high enough to prevent ovulation but high enough to cause a LPD IYKWIM. Try and get a blood test for prolactin on the day when your temp drops. If it is really high then you know that the prolactin caused the drop in progesterone.
I think Vitex would be good for that because it reduced prolactin.
The internal scan with me was with the ultrasound probe thingy to check ovaries and uterus and lining.
This is my (very basic) understanding of it ... so i am by no means qualified and your specialist can fill you in with the technical details...
With a early MC normally you start bleeding after the HCG is no longer being produced by the embryo. Normally HCG "signals" progesterone to be produced. So if there is no HCG, the progesterone levels drop down to zero and causes the lining to deteriorate because it doesnt have any progesterone to "maintain" it.
I think in your case it may still have been producing some HCG even though it had stopped growing and therefore prog was still present for your lining. You may have had to take Miso (causes uterine contractions) to expel it so that no more HCG (and prog) is produced and thus cause you to bleed.
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spanky77
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Posted: 08 January 2010 at 11:14pm |
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the day my temp drops? you mean in the luteal bit?
I think I'll be about day 11 when I go for bloods next week. The last one was took on Day 2.
Yup, had the internal scan about 6 weeks ago (on about CD 8) and she was happy with thickness of uterine lining.
Am taking a womens multi, which has B6 in already (50mg) and 125 mg Chaste tree - is that the same as berry? Been taking this for ages (apart from a short break in Dec cos the GP wanted to know my natural iron level, and I didn't want supplement to skew that)
Is it normal practice to monitor progesterone levels throughout the luteal phase via bloods? Pincushion status.
I read the only way to accurately diagnose LPD was 2 separate biopsies into the uterus, on different cycles.
But if theres corpus luteum insufficiency thats causing the LPD, would that not be looked at more than the lining?
This is why I get myself tied up in knots here!
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Shezzey
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Posted: 08 January 2010 at 11:34pm |
Spanky... is it a set amount of days that you have to have the next prolactin test?
I also read somewhere that high prolactin can indicate thyroid problems... have you had that tested?
I think the first step is to do a blood test, then they can scan or do a biopsy...and a certain amount of layers are needed for a adequate lining. Actually the lining is formed before ov but the progesterone thickens and prepares it to make it suitable for implantion (and also for lining maintenance). There are a few reasons for LPD...
Read this :)
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spanky77
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Posted: 09 January 2010 at 11:47am |
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No set amount of days, but GP said to do bloods in the first half of January (not sure why, maybe I misheard) and as usual I've left it till late. She's away atm. I think she just wanted to see if my prolactin was still high after a few weeks.
TSH was on the bloods referral form for CD2 but she never mentioned the results of that, so am assuming the level is nothing concerning. Low thyroid is in the family so I have always kept an eye on that - the symptoms are similar I know
My temp drops at different points after ov, so couldn't pinpoint it earlier than the actual morning.
Thanks for that link, its great, explains it really well. I've printed it out to refer back to. Really not fancying that endometrial biopsy and hoping I don;t end up having to inject myself with stuff, I've got a thing about needles.
You're a goldmine of info (but I appreciate, its often for reasons that we'd probably prefer not to have to know this stuff)
Thank you
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Shezzey
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Posted: 09 January 2010 at 5:43pm |
If she is away for a few weeks.... then maybe do the test when your temp drops in the luteal phase to see if the prolactin is high. Prolactin inhibits progesterone production. The prolactin maybe is causing the drops in progesterone and hence drops in temperature.
Also, the low thyroid (hypothydroidism) may be causing the high prolactin... so you may need meds to sort out your thyroid which will in turn sort out your prolactin levels.
I used to have a thing about needles... but after IVF am not so afraid anymore... the needles were so thin you could barely feel them... so maybe you will get thin needles.
I get all my knowledge from doing heaps of googling LOL
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spanky77
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Posted: 10 January 2010 at 6:47pm |
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I think she's back round about now.
I really think the hyperprolactinaemia started after losing the baby, as I never had the leakyboobies before. But the weirdo bleeding was there for probably 6 months before I conceived.
Prolactin weirdness didn't come up on the bloods I have had done before (I'm presuming, cos nothing has been said)
Thyroid would have been flagged by the GP if it was out of normal limits. I will double check next time I see her though.
Needles, yeah, I KNOW its all in my head too, I have even had acupuncture. Its the thought of the metal sliding through the skin, the piercing bit. I know now to just lie down and look the other way, and make sure I've eaten beforehand (bloodsugar) and I'm ok.But in terms of sticking them in myself, god, that will take some doing.
I google heaps too, so get an overview on things, but I'm also quite discerning re sources, ie discussion boards are useful but usually focused on a specific issue. Medical research is often not available outside an abstract and a payment to access the article.
That link you posted was cool though - could follow the terminology without it getting too into physiological gobbledegook!
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gynaecology specialist consultation