QUESTION:
I'm 28 years old and have recently been referred to an OBGYN for recurring ovarian cysts. My most recent pelvic ultrasound suggests that I may also have a slightly thicker than usual uterine lining. My new OBGYN has prescribed a birth control pill (Alesse-21) for paroxysmal but intense pain associated with the cysts, as well as to thin out the lining of the uterus. I havent filled the prescription yet, as I am trying to learn more about its indications prior to doing so. My OBGYN instructed me to take the pills everyday for three months, then take one week off, during which I should get my period. I am supposed to continue on this schedule for at least one year. She did not explain WHY I should take the pills for three MONTHS, then one week off, as opposed to the usual three WEEKS on and one week off. Can you suggest any reason she would perscribe the medication in this way?
Further, I am expected to have a hysterosonogram next month. I was instructed to call in on the first day of my July period in order to schedule the appointment, as they need to make sure that the uterine lining is at its thinnest for the test. However, I will not be having a period next month because I will on the birth control pill (for three months straight). Therefore, does it matter when I schedule the hystersonogram? If I start taking the pills on the first day of my period this month (June), will the lining of my uterus be thin enough at ANY time in July, or should I wait a certain amount of time before scheduling the test?
Finally, I hope to eventually get pregnant. If I thin the lining of my uterus now, and control the growth of the ovarian cysts, does this increase my chances of getting pregnant once I stop the pill?I would really appreciate some knowledgeable guidance. I thank you in advance for your assistance.
Sincerely, M. from Ontario, Canada
Answer:
Hello M. from Canada,
Without reviewing your medical records it will be difficult for me to know exactly what your doctor is thinking and planning. It would be a good idea for you to ask her directly to explain the treatment plan in detail.
If you were found to have an ovarian cyst, there are many types of cysts. The most common type of cyst is a physiologic ovarian cyst and treatment with the birth control pill will help it to go away. However, this should take no more than one month. If the cyst does not resolve after one month on the pill, then there is a likelihood that this is some form of tumor (mostly benign forms) and so surgery will then be required to remove the cyst/tumor.
If the endometrial lining is thickened, there is the possibility of a disorder called "endometrial hyperplasia." Some forms of this can be atypical or precancerous so an endometrial biopsy is indicated. If the biopsy is negative for cancer, then it can be treated with the birth control pill to thin the lining. However, this treatment is NOT done until after a biopsy is taken because you DON'T want to use the birth control pill if precancerous cells or cancerous cells are present in the endometrium. With the birth control pill it can take 1-3 months to thin the lining but the standard treatment is to have a period each month so that the lining can be shed and NOT to use the every 3 month sequence. That sequence is only used for people that need contraception and don't want to have a period every month. So, again this does not make any sense to me.
In terms of the sonohysterogram, once you are on the birth control pill for at least one month, the lining should be thin enough to have it done at any time.
In terms of your fertility, this treatment plan does not work for or against your chances for pregnancy unless you have an endometrial cancer that is missed and then requires a hysterectomy.
I would urge you to speak with your doctor.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
COMMENT: You have given me a lot to think about. Thank you for being so thorough in your response. As this doctor of mine seemed to be heading in her own direction with this treatment as opposed to offering any alternatives or discussing the possible risks (as you have outlined here), I am very much inclined to seek a second opinion from another OBGYN. Thanks again for your outstanding assistance.
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