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Spotting before periods, taking Norethisterone. Will this medication hinder ovulation if taken after I have ovulated?

DOCTOR OF THE MONTH - May 2013
May 2013
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I have recently experienced 10 days of spotting before a full 5 day period. This has now been happening for the last 3 months. I am 31 years old and my husband and I are trying for a baby. The doctor has prescribed Norethistreone 5mg from day 16 of my cycle for 12 days.

Will this medication hinder ovulation or the chances of getting pregnant if taken after I have ovulated? I am also not sure what the benefits of taking this medication will be from day 16 for 12 days and if it is necessary or I should hold of taking the medication.

Many Thanks,
CM
Posted Sat, 22 Sep 2012 in Women's Health
 
 
Answered by Dr. Sree Gouri SR 1 hour later
hi,
Thanks for the query.

according to your description there is possibility of hormonal fluctuation called irregular ripening, in which spotting starts few days before period due to deficiency of the hormone progesterone which is necessary for the maintenance of luteal phase of the cycle,
so because of that your doctor prescribed norethisterone which is progesterone,
usually in case of regular cycles by 16th day ovulation will occur and luteal phase starts, so norehisterone will help in maintenance of luteal phase thereby preventing the spotting and in case of pregnancy it will help in implantation also.
so you can use the tablets, if pregnancy test comes positive then with your doctor's advice you can stop the tablets or can shift to another form of progesterone if required.

Hope I have answered your query. I will be available to answer your follow up queries. If you are satisfied with all my answer, please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
Follow-up: Spotting before periods, taking Norethisterone. Will this medication hinder ovulation if taken after I have ovulated? 31 hours later
Hi, thank you for your response.

I understand that spotting can usually occur a few days before a period, but it is usual to happen 10 days before my period? Can you let me know of any possible reasons that this may happen ( as this has only started to happen in the last 3 months?)
The only changes that have occurred in these months are the fact that myself and husband are now trying for a baby, and I have started taking pre-pregnancy vitamins and vitamin c.

Does this condition of irregular ripening stop occurring naturally or will norethisterone need to be continued long term?

Also if I have not ovulated by day 16 then could the medication stop ovulation? What is the best way of making sure that this medication is taken to increase my chances of becoming pregnant, and not hinder in any way, shape or form.

Many Thanks,
CM
 
 
Answered by Dr. Sree Gouri SR 2 hours later
hi,

I told few days for description purpose but that can be ten days also depending on the deficiency,
hormonal fluctuations can happen due to many factors,
like temporary causative factors like nutritional deficiencies, stress etc,
and other causes are anemia, obesity etc.
continue to take vitamins and mineral supplements which will help in decreasing the problem,
by continuing the norethisterone for 3 to 4 cycles there is possibility for restoration of the function of hypothalamo-pituitary-ovarian axis which will lead to normal hormonal level, if that happens you can stop the tablets.
usually by 16th day ovulation will occur in case of regular periods with length of around 28 days, if you want you can track the ovulation with ovulation kit then after confirmation start tablets,
according to studies and literature progesterone hormone will help in maintenance of luteal phase and implantation, best way is positive pregnancy test only, but better to stop Norethistreone after confirmation of pregnancy and if needed go for other type of progesterone like susten which comes under B category in pregnancy.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.

Above answer was peer-reviewed by
 
Follow-up: Spotting before periods, taking Norethisterone. Will this medication hinder ovulation if taken after I have ovulated? 12 hours later
Thank you again for your prompt answer. I have subscribed to the multiple question choice on XXXXXXX as I feel I have a lot of unanswered questions from my own doctor.
It is the first cycle that I am using
WWW.WWWW.WW
I understand that this fertility monitor detects estrogen as well as a surge in LH. Unfortunately I am not sure that I am actually ovulating. I started using the monitor on day 6 when the monitor asks for a sample. It read low fertility on day 6. From day 7-12 it was showing high fertility? (this is unusual and does not comply with what is in the user manual). I am testing the 1st urine of the day, and the monitor seems to be working.

I have also stopped producing cervical fluid in the last 3 months since I have had this problem with pre-menstrual spotting, and I worry that this may also hinder the chances of falling pregnant. I used to have at least 2 days of egg white cervical fluid, but during the last 3 months I have stopped producing this. Is there anything I can eat/medication to increase cervical fluid?

If the monitor does not detect a surge in LH during this cycle (and therefore no peak fertility days), what tests would you recommend that I have to check that I am actually ovulating? What advice would you give me for further steps I can take, and what information I can go to my doctor with?

Many thanks for your continued help and advice.

CM
 
 
Answered by Dr. Sree Gouri SR 10 hours later
hi,

I verified the link given by you,
in that they mentioned 'how to find ovulation days' in page WWW.WWWW.WW but that is not exactly correct as they mentioned cycle length as 28 days and given ovulation on around 20th day,
normally in menstrual cycle the postovulatory length remains almost constant as around 14 days,
means if ovulation occurs on 20th day then the cycle length should be around 34 days,
and in case of 28 days cycle the ovulation will occur on around 14th day,
so as you are taking your cycle as 28 days cycle, the ovulatoy period is around 14th day,
usually in the menstrual cycle after regrowth of endometrium in first week, in the second week the estrogen levels rises so from seventh day you are getting fertile period, as LH surge appears 1 to 2 days before ovulation, till 12th day monitor showing as your fertile period,
in ideal circumstances spermatozoa can remains alive in the female genital tract up to 7 days, so the monitor is showing fertile period like that.
cervical mucus characteristics can fluctuate depending on hormonal status sometimes you cannot notice because of associated presence of spotting, so no need of any medication,
you plan intercourse between 10th to 16th day, at least on alternative days which will increase the possibility of pregnancy,
other method is you can go for follicular study by ultrasound to detect the ovulation and can plan intercourse accordingly,
if that shows absence of ovulation you can go for ovulation induction drugs with your doctor's advice.
so you can ask for follicular study by consulting your doctor, if she recommends you can go for it, or if she says ovulation monitor is enough, you try this cycle with that possibly it will work.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
Follow-up: Spotting before periods, taking Norethisterone. Will this medication hinder ovulation if taken after I have ovulated? 14 hours later
Thank you doctor. I am closer to the end of my queries. It is now day 13 and I am still not at PK on the monitor and it is still showing HF. As the medication for my norethisterone states take from day 16 for 12 days, should I wait until day 20 to take the medication? (just in case I ovulate later than day 16).

Or should I take the medication from day 16 - (will this medication after a few cycles regulate my periods)?

Many Thanks,
CM
 
 
Answered by Dr. Sree Gouri SR 10 hours later
HI,

you continue monitoring, when the monitor shows peak fertility plan intercourse around that time and after 2 days of peak fertility start taking norethisterone, if even after 20 days monitor doesn't show peak fertility better go for ultrasound to monitor the follicular growth and proceed accordingly.
after taking the tablets for few cycles when hypothalamo-pituitary-ovarian axis function normalizes then possibly you can get regular periods.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
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