Miscarriage, irregular periods and ovulation problems

Dear Dr Mitchell,

I was pregnant last year and had a miscarriage at almost five months.This was my first baby, so I did not know much. I was in New York when I got pregnant and when I went back to Toronto I found out that the baby had died in me a few weeks back.

I thought that I could never get pregnant. I have been having problems with my period for years now. I’m 32 and I continue to have irregular periods. Will this prevent me from ever getting pregnant again? Can I get ovarian cancer from having irregular periods? I don’t ovulate.

When a foetus dies in the uterus like this, it is called a missed abortion. A missed abortion may be due to several factors. This includes infections (bacterial and viral), medical complications in the mother, and foetal abnormalities.

Infections such as toxoplasmosis, rubella, cytomegalovirus infection, herpes simplex type II, syphillis and HIV should be looked for by doing a blood test. Toxoplasmosis is an infection which is transmitted from consuming food infected with cat litter. Keeping cats as pets during pregnancy is not a good idea. Syphillis, herpes simplex type II, and HIV are all sexually transmitted infections. Syphillis can be cured by the use of penicillin and this will prevent complications in a subsequent pregnancy. Herpes simplex type II infection can be controlled by the use of Acyclovir or Valtrex, but cannot be cured. There is no cure for the HIV infection, but the use of antiretroviral treatment can be used to control the disease.

A foetal abnormality may also be the cause of the underlying death of the foetus. Sometimes the foetus may be grossly abnormal and this is readily detected on ultrasound, but in some cases the abnormality is not obvious and may be missed.

An abnormality in the heart or a chromosome abnormality may be the cause of the sudden death. A detailed examination of the foetus by a pathologist and sending a tissue for chromosomal testing is usually helpful in determining the underlying cause. Medical conditions such as uncontrolled diabetes mellitus, hypertension, lupus anticoagulant positives, sickle cell disease or systemic lupus erythamatosus (SLE) may also cause a missed abortion.

It is important for you to have a detailed physical examination and investigations done to determine the underlying cause of the death of the foetus, so that treatment can be given to prevent recurrence of the problem in a subsequent pregnancy.

The irregular periods that you have are due to the fact that you do not ovulate regularly and hence the delay in your ability to become pregnant. You will probably need to have ovulation induction done after being investigated to determine the underlying cause of your inability to conceive for almost a year.

Irregular periods do not cause you to be at risk for ovarian cancer. If there is a long period of time between menstruation – usually in excess of three months – then this increases your risk of cancer of the body of the uterus. This is because there is a long period of exposure to oestrogen with very little progesterone which protects the lining of the uterus from abnormal changes which eventually lead to cancer. It is a good idea to be put on treatment to induce regular menstruation even if pregnancy is not desired, as this will help to reduce the risk of cancer of the uterus in the later years.

Incessant ovulation increases the risk for ovarian cancer. This is seen in women who have early onset of the menstrual period, late onset of the menopause, women who have their first child at an advanced age or have few children and women who undergo induction of ovulation using drugs such as clomiphene or other ovulation induction agent as is used in in-vitro fertilisation (IVF).

Protective factors for decreasing the risk of ovarian cancer include the use of the oral contraceptive pills or other hormonal contraceptives such as the Depo Provera, Norplant or the Mirena IUCD.

Consult your gynaecologist who will do the necessary examination and evaluation.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via e-mail to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.