Will I be able to have children?
Dr Mitchell,
I’ve been seeing a gynaecologist who told me, after doing ultrasounds, that my uterus is small. I don’t have a regular period and must take contraceptives (the last one I was on was progylotun) to regulate my cycle. Whenever I give the pills a break for a while, my period doesn’t come. When I’m on the pill, my period comes regularly. I’m married now and I want to know, will I be able to have a child? Do I have premature ovarian failure?
Worried
Dear Worried,
Firstly, progyluton is not a contraceptive pill. It is usually prescribed for women who have abnormal uterine bleeding to regulate their menstrual cycle. The dose of oestrogen and progesterone is quite low, but it does not prevent pregnancy. It is safe for young girls and older women who have irregular menstrual periods because it tends to be less frequently associated with the usual side-effects of birth control pills.
The fact that you do not have regular periods unless you take contraceptive pills or progyluton suggests that you do not ovulate. The small size of your uterus may also suggest a congenital problem which may be associated with abnormal ovaries – hence the irregular nature of your menstrual periods.
It is quite possible that you have premature ovarian failure. This is a cessation of ovarian function before age 40. It causes an end or pause in menstruation, the onset of menopausal symptoms and a decline in the production of oestrogen and eggs. This subsequently results in the inability to conceive.
With premature ovarian failure, up to 50 per cent of women may become pregnant. There may also be an associated autoimmune thyroid dysfunction. Premature ovarian failure is a rare disorder and affects 10 per cent of women by the age of 40. The average age of onset is 27. Symptoms include hot flushes, irritability, sleep disturbances, decreased sexual drive, hair coarseness, moodiness and vaginal dryness. It may also manifest as intermittent ovarian failure, with the period not coming for several consecutive months.
The cause of this condition is unknown, but up to 40 per cent of cases may be due to genes. Other causes include pelvic surgery, cancer therapy (chemotherapy and radiotherapy) and viral infections of the ovary. Anorexia nervosa may also contribute to this.
Premature ovarian failure may go undetected for several years if the patients are taking oral contraceptive pills, which usually mask the symptoms. Early indications include menstrual cycles that are fewer than 21 days, infrequent or light periods and the absence or cessation of the period.
You will need to have a detailed history taken, a physical examination and appropriate hormonal evaluation done to investigate your ovarian function. If the problem is due to an endocrine disorder such as hypothyroidism, then this can be treated successfully with the return of your ovulation.
If the hormone evaluation shows that you have premature ovarian failure, then the ovaries will not respond to fertility drugs. It is still possible to conceive, but you will need to do in vitro fertilisation (IVF). If your uterus is abnormally small and not suitable to carry the fertilised egg, you may opt to use a surrogate mother.
Premature ovarian failure may lead to osteoporosis and cardiovascular problems due to the chronic low levels of oestrogen, so you will need treatment even if pregnancy is not being considered.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.
