…The anticlimax

So sorry for leaving you hanging! I finally had the gynae appointment last week and it was a little bit of a roller coaster of a day, I needed some time to wind down and process afterwards, and then things got busy with work…but I’m back with my update although to be honest it’s a bit of an anticlimax.

I went to Guy’s Hospital in London for the appointment and I was pleased that I had an early appointment before the clinic had a change to start running late. The appointment letter had said to allow up to 3 hours as they’d try and do any investigations on the day if they could, so I dragged my mum along to keep me company, but I didn’t end up being there anywhere near that long

The doctor took the usual medical history and I went over everything from all of the doctor’s visits in the past 6 months (NHS and private). I had been anxious waiting for the appointment as I’d be hoping that the “specialists” would be able to come up with some diagnostic test my GP hadn’t known about, or maybe even hear what had been happening and say “yes, seen this before, it’s XYZ”. No such luck.

Once he’d taken the history the doctor basically said at this point all the tests had been indicating “nothing wrong” anatomically or hormonally, and since all of my tests had been so recent and there was no indication that my body was going through the different stages of the menstrual cycle there was no point repeating any of them. He also said it was too soon to think of doing any other types of tests for hypothalamic/pituitary problems since my hormone levels were “normal” and there were no other symptoms. Basically the only abnormal thing was that the Progesterone Challenge hadn’t worked (I had no withdrawal bleed), so the next step would be to try giving oestrogen alongside progesterone to see if that could induce a regular cycle.

The plan was to put me on the combined pill (the pill? But I want to conceive!!) for 3 months which would hopefully create a regular (albeit “fake”) cycle, and then see if my natural cycle kicked in on month 4. So he gave me the prescription and booked an appointment for March (coincidentally the month that I’ve been hoping to start TTC). I left feeling a bit disappointed that he hadn’t been able to give me a “diagnosis” but a bit happier as we had some kind of plan… I relaxed too soon!
During the course of my appointment the doctor had asked about any additional medical conditions and I’d given him details, so I assumed what he’d prescribed was OK for me to take with my other medications; even so, I’m one of those people who reads the patient info leaflet before I start to take anything and it’s a good thing I did.

wpid-wp-1447429115953.jpgIt turns out the doc had missed a screening question before issuing the script. I’d told him I suffer with migraines but he hadn’t asked if I get an “aura” – I do. So it turns out that I can’t take the combined pill because of the oestrogen.

Apparently those who suffer with migraine (with aura) are at a slightly higher risk of stroke, and taking oestrogen puts you at a slightly higher risk of stroke – individually these risks are tiny and generally not an issue; however put the two together and it compounds the risk. The risk is still very small, but it’s unnecessary (there are plenty of other methods of birth control after all) so the combined pill is not given to people with my condition. So… that was then end of that plan! I called my GP and the hospital’s medical helpline and they both said not to take it.

The doctor I saw gave me a call and apologised for prescribing it as it was his mistake in not asking about my migraines. He’s still waiting to confer with the consultant in charge of the clinic to see if there’s a “plan B” but it’s unlikely since there’s nothing else they can do hormonally 😦 It’s quite a bummer as I was hoping for answers!

Dr A is back at my GP surgery and she’s also trained in gynaecology so she suggested I try a second Progesterone Challenge using Norethisterone instead of Provera as she sees better results that way. The doc at the hospital said he wasn’t sure a 2nd challenge would help, especially if my uterine lining is thin as without additional oestrogen there’s nothing to build it up and have something substantial to shed, but I thought I’d try it anyway. I’ve finished the course Dr A prescribed me, and she said to expect a bleed within 48 hours…we’re now approaching the 36 hour mark and nothing yet (surprise surprise).

All of this leaves me wondering:

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