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Dr. Tim, MD
Dr. Tim, MD, Board Cert. OB/GYN
Category: OB GYN
Satisfied Customers: 1027
Experience:  General OB/GYN, complicated obstetrics, complicated GYN
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Jus bit concerned about upcoming withdrawal from

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Hi, jus bit concerned about upcoming withdrawal from Northeristone. Due soon, stopped day 28 of cycle. Had fibroid embolised last November, all good re shrinking and no blood supply. I get very anxious re menstrual loss and panic. On Northeristone to help me but came off for 3 weeks, had withdrawal then a period 12 days on. Kept spotting and light bleeding, so doctor advised me to go back on. Too anxious not to take this. Took med for 17 days in line with 28 cycle Concerned as to what this withdrawal will be like? And is it s withdrawal from Northeristone? What does it do to the lining? Can I expect a heavy bleed. I am very anxious and do not trust my periods at all, despite UFE. Thanks
Assistant: Have you been keeping a personal medical record?
Customer: As required
Assistant: Anything else in your medical history you think the doctor should know?
Customer: No other than above

Thank you for the question and I am sorry that noone has responded to you!

Please let me know if you still need an answer and I will be happy to help.

Dr. Tim

Customer: replied 9 months ago.
Hi there, yes I do still need a response to my Gynae questions, thanks
Customer: replied 9 months ago.
No I have already paid, a message is good, thanks
Customer: replied 9 months ago.
Can I have a response. I have paid my fee.
Customer: replied 9 months ago.
I need an answer from this service. Which I have paid for in good faith re an important question. What kind of service this? Very poor and disappointed. If you cannot answer, I demand my fee returned, or I will report this to trading standards!!!!!
Customer: replied 9 months ago.
Please review and answer my question, thanks

I am terribly sorry that I did not respond sooner and you are understandably frustrated. The details of your menstrual history are slightly confusing but here is what I can offer:

1. In normal cycles, day1 is the first day of menstrual flow

2. The ovaries produce estrogen which grows the lining and this also triggers ovulation on day14

3. After ovulation, the ovaries produce progesterone which prepares the lining for pregnancy

4. If pregnancy does not occur, progesterone levels fall and the lining sheds

5. The use of progesterone is sometimes necessary to induce a period

6. What it does, especially in someone who might not be ovulating, is it takes the lining that has grown in response to estrogen and 'changes' it to a state that is not only conducive to pregnancy, but allows it to shed if pregnancy does not occur and after cessation of the progesterone and subsequent drop in progesterone levels

7. In women who have not ovulated in some time, the bleeding that occurs with progesterone can be quite heavy

8. If the bleeding is confusing, it might be important to get an ultrasound to make sure that there is not something else present that would affect bleeding (I am assuming that this has been done).

9. In women who are not ovulating, we often give them progesterone to induce a period and then consider ovulation induction medications to improve the chance of ovulation (clomid for example). If this produces ovulation, then the use of progesterone to induce the period becomes unnecessary.

Does this help? What questions do you have. If you responds I will get back to you soon / today and we will resolve your questions!

Dr. Tim

Customer: replied 9 months ago.
Hi thanks for your response.
I had an intramural fibroid embolised November 2017. So have had many investigations etc. This was successful, however I was put back on Northeristone to help me cope with menstrual blood loss. As I am very scared of this and have a fear. I take this for 5 to 26 days but can also take for 7 weeks, however, this is too long for me. I am concerned if Northeristone taken this way reduces blood loss, because I am confused and have been told it increases bleeding, uterine lining and pain. My last periods which I did check with my IR as I have had good results, have been sore to start with, heavier, which scares me then tapers off. Does Northeristone cause this and does it build the lining? Is it a forced bleed as known as a withdrawal? I would like to be brave enough to come off it. These are my question s. I have been well examined, mri etc, but still scared of blood loss. I am beginning therapy for this soon. Thanks.

Thank you for the follow up. First of all, the medication is called Norethistrone. It is also known as norethindrone. Basically it is a progesterone only form of hormonal therapy. Yes, it might act as a form of birth control, but in most cases (unless someone is breast feeding), I would consider it a poor choice of birth control otherwise and in terms of getting control of your uterus and bleeding, it would not typically be used in such a prolonged fashion. It would be similar to being on the depo shot, which, arguably, would be a better medication for controlling your cycle. Yes, it can be used to stop bleeding, but at some point, the lining must be shed. Given what little I know about you, a reasonable plan for someone like you would be:

1. Cease the progesterone and call the first day of bleeding day 1

2. Start the progesterone on day14 and take daily for 10 days

3. Expect a withdrawal bleed 2-3 days after ceasing the progesterone

4. Repeat this cycle monthly

An even better way to get control of your cycle would be to do #1 and #2 above and then switch over to a regular birth control pill (that contains estrogen and progesterone). This would give you much better control of your cycle and should be a consideration if you are not trying to get pregnant. If you ARE trying to get pregnant, then the plan would be:

1. Using progesterone to induce a period

2. Call the first day of bleeding day1

3. Start clomid, for example and take on days 5-9

4. If no period and a negative pregnancy test at day35, then you repeat this cycle and increase the clomid dose.

So in answer to your question, Norethistrone does not cause a buildup of the lining, rather it prepares it for shedding. The withdrawal is the 'forced' bleed that occurs when you stop the progesterone - just as occurs naturally during a cycle.

Does this answer your questions?

Dr. Tim

Customer: replied 9 months ago.
Hi, thank you, I do know more now. I have asked for Depo but was told no' presently due to bone loss etc. I will ask again. I have thought about combined pill but I am now 50 and was told it would be too risky. DVT etc. I would be keen on this regime of taking the Northeristone that you mentioned. I am really trying to stop bleeding or minimise it, as I go through such high anxiety before and after. I take it that now I have had UFE and it has worked and I take Northeristone I can no longer bleed badly? This is my fear and still is.
Customer: replied 9 months ago.
Forgot to ask why is pain in my legs and back at start of period, it can be uncomfortable and more since Northeristone? Thanks

That is very helpful to know your age. In a woman who is 50 years of age in whom bleeding is abnormal and difficult to control, the following should happen:
1. Usually we have an update ultrasound - this is done
2. You should have an endometrial sampling done to rule out pre-cancerous changes
3. Consideration should be given to a type of ultrasound called a sonohysterogram - this is where fluid is infused and you can easily see if there are polyps - which are extremely common
4. If there is evidence of a defect in the uterine lining based on #3, then you could easily correct this with a hysteroscopy (camera in uterus to remove polyps)

With regard to the Depo shot, the loss in bone mineral density comes with prolonged use (>8 years) and is a reversible finding. Regardless, it just seems wrong to not evaluate this further in someone your age. To just keep throwing hormones at the problem is really just a bandaid to get the bleeding under control but does not really address the underlying problems that might exist.

I am hoping that this answers your questions - please let me know if that is the case.
If you are satisfied with the answer, please provide a POSITIVE RATING so that I can get credit for my time.

Dr. Tim

Customer: replied 9 months ago.
H, I have had. Countless examinations, biopsies, MRI, twice, Smear test, I had an intramural fibroid and an enlarged womb. I was also checked for polyps. 9 months later I am post UFE and received very reassuring positive results from my Gynae, my IR and her boss in a teaching hospital in Scotland. I was reassured all was well and no cancer at all. I only bleed at withdrawal, no other time. I have a severe phobia of menstrual blood loss and find periods very difficult. I would prefer not to bleed at all.
I appreciate your advice and time, but I am now very scared I have something hideous, though I have been checked every other month sincere this all began. I also had a pipelle biopsy and so many investigations prior to UFE. Thanks.

Thank you - that is very helpful information. Assuming that there is no concern (which is almost 100% certainly the case based on what you have said) then this is just a matter of controlling irregular bleeding that is NORMAL when women are per-menopausal. In patients of my own, if the idea of any menstrual bleeding was intolerable for whatever reason AND in whom I was not worried about pre-cancerous changes AND who had failed conservative management with hormones, I would offer them surgery. This would involve either:

1. Hysteroscopy with endometrial ablation - simple, safe, outpatient and in most cases would stop your bleeding for good
2. If you were not a candidate for an ablation (based on an abnormal uterus which can be the case in the setting of fibroids), then a hysterectomy would be indicated.

So, the most definitive therapy would be to take your uterus out. This would fully address the continued problems with bleeding related to oral progesterone therapy. As an alternative, though, I would also consider the depo shot as I do believe that it would be a better option in your case if you were not interested in surgery.

Dr. Tim

I mean to say PERI-menopausal

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Customer: replied 9 months ago.
OK, thanks for your time and detailed explanations, I appreciate this very much and understand much more. Period type bleeding, though I have been assured is normal is awful for me. Despite the ufe and Northeristone, as I have to have withdrawals at some point. I will consider the ablation now the fibroid has shrunk with no blood supply. Or likely the Depo, as I believe it has positive affects after it settles. Hopefully menopause Is around the corner, as this has been a long journey.
Thank you for helping me with my many questions.