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What Causes Lack Of Withdrawal Bleeding Despite Taking Duphaston?
Question: Hi I took duphaston twice a day from 8th to 12th july ( 5 days) for inducing withdrwal bleeding. Today is 20th july and still no withdrwal bleeding. My progestrone was 7.9 today and endometrial lining was 10.3 mm today Beta hcg was negative. What can be the cause of no bleeding? Am not able to get in toich with my doc and am v worried as I need to start my pcos treatment this month as my periods are v irregular and I want to concieve. What could be reason of no bleeding.
Brief Answer:
Inadequate dose of duphaston
Detailed Answer:
Hello mam, thanks for trusting health care magic.
I understand your anxiety related to the issue.
Since bHCG test is negative pregnancy is ruled out so most common cause of missed period even after withdrawal is inadequate dose of duphaston or missed pills.
What was the dose of duphaston you took from 8-12 July to induce periods?
In general established PCOD patients need higher doses of duphaston for longer intervals to induce periods.
Waiting for your response
Regards
Dr Manisha.
Inadequate dose of duphaston
Detailed Answer:
Hello mam, thanks for trusting health care magic.
I understand your anxiety related to the issue.
Since bHCG test is negative pregnancy is ruled out so most common cause of missed period even after withdrawal is inadequate dose of duphaston or missed pills.
What was the dose of duphaston you took from 8-12 July to induce periods?
In general established PCOD patients need higher doses of duphaston for longer intervals to induce periods.
Waiting for your response
Regards
Dr Manisha.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi normally 2 tablets a day deviry gives me periods within 3 to 4 days. But as I am to start fertility treatment I was advised dupaston as its better if u plan to concive. So do I need to restart medications to get withdrwal bleeding? Also why hasnt progestrone dropped. Why is it still so high. I am looking at ovulation inducing medications in my next cycle and hope no leutal pgase issue is thr also. By when shud I get withdrwal bleed
Hi I took 100 mg twice a day. Two times I took dose a few hours late but I took all 10 pills over 5 days.
Hi I took 100 mg twice a day. Two times I took dose a few hours late but I took all 10 pills over 5 days.
Brief Answer:
Repeat Duphaston for 3 days
Detailed Answer:
You took adequate dosage but it seems like this time you ovulated and that too a little late which is why progesterone is this high.
So you will need to wait for another 5 days at least for the withdrawal bleed.
Yes deviry brings periods early and duphaston at times takes time especially in PCOD patients and I usually prescribe duphaston thrice a day to induce periods unlike deviry which is sufficient in twice a day dose.
So right now all you can do is wait for another 5 day period or take a course of duphaston thrice a day for three days.
On leaving duphaston you will get periods in 3-5 days.
Duphaston is safe in pregnancy and rather helps in growth of pregnancy so there is no harm in taking the same.
Take care
Repeat Duphaston for 3 days
Detailed Answer:
You took adequate dosage but it seems like this time you ovulated and that too a little late which is why progesterone is this high.
So you will need to wait for another 5 days at least for the withdrawal bleed.
Yes deviry brings periods early and duphaston at times takes time especially in PCOD patients and I usually prescribe duphaston thrice a day to induce periods unlike deviry which is sufficient in twice a day dose.
So right now all you can do is wait for another 5 day period or take a course of duphaston thrice a day for three days.
On leaving duphaston you will get periods in 3-5 days.
Duphaston is safe in pregnancy and rather helps in growth of pregnancy so there is no harm in taking the same.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Is there a chance tht I could be pregnant? Can I ovulate while I was on duphaston? Also if yes wen wud I have ovulated? I got a darting pain for 1 min or so yesterday in my lower abdomen and slight mild cramp tha only last a few sec just above pelvis on right side and once on left side. Isnt 7.9 progestrone too low to be pregnant or even get pregnant? Along with pcos hope I dont have leutal phase defect.
Als while I did my sono for lining 10.3 mm doc also told mw that thr was a 22mm folicle but it wasnt healthy as it has septation(or some word like that) how come I had such a big folicle if I ovulated? Dont all folicles die after u ovulate.
Als while I did my sono for lining 10.3 mm doc also told mw that thr was a 22mm folicle but it wasnt healthy as it has septation(or some word like that) how come I had such a big folicle if I ovulated? Dont all folicles die after u ovulate.
Brief Answer:
Possible chances of pregnancy
Detailed Answer:
In my opinion you took duphaston a little before ovulation of this follicle and thus due to higher than required (less than 2 ng) Progesterone levels in your body the dominant follicle failed to rupture and rather got luteinized and thus the size failed to shrink in this follicle.
And due to PCOD there was another small follicle which had also matured along with this dominant follicle which ruptured and is releasing a small amount of progesterone which is showing in blood Progesterone levels.
I know this physiology is a little complicated to understand but in PCOD many a times there are more than one follicles which mature and rupture.
Right now there is definitely some chance of pregnancy as well so thats why I want you to take duphaston which will give you a good withdrawal in case of non pregnant state but in case there is pregnancy then it will cover up the low levels of progesterone and support pregnancy in best possible way.
I hope I have answered all your questions but in case of any doubt please feel free to discuss as I basically practice infertility and thus any question about this will be answered via practical and evidence based approach.
Possible chances of pregnancy
Detailed Answer:
In my opinion you took duphaston a little before ovulation of this follicle and thus due to higher than required (less than 2 ng) Progesterone levels in your body the dominant follicle failed to rupture and rather got luteinized and thus the size failed to shrink in this follicle.
And due to PCOD there was another small follicle which had also matured along with this dominant follicle which ruptured and is releasing a small amount of progesterone which is showing in blood Progesterone levels.
I know this physiology is a little complicated to understand but in PCOD many a times there are more than one follicles which mature and rupture.
Right now there is definitely some chance of pregnancy as well so thats why I want you to take duphaston which will give you a good withdrawal in case of non pregnant state but in case there is pregnancy then it will cover up the low levels of progesterone and support pregnancy in best possible way.
I hope I have answered all your questions but in case of any doubt please feel free to discuss as I basically practice infertility and thus any question about this will be answered via practical and evidence based approach.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can I have healthy baby with such a folicle or is baby less smart or development less if such a foliclecauses prgnancy. I would like healthy baby so jst wondering if its poss if egg not healthy
Brief Answer:
Usually a healthy baby
Detailed Answer:
No usually if pregnancy occurs then it is mostly a healthy pregnancy only.
PCOD is a endocrinological disorder and this the problem is the presence of deranged set of hormones in suboptimal concentrations which interferes in conception and not with the development of the baby.
Because once conception occurs whole hormone mileau changes and if progesterone support is provided at right time from outside a healthy pregnancy is there which grows well to give a healthy baby.
So don't feel anxious and just pray for conception.
All the best and may god bless you with a healthy baby soon.
Usually a healthy baby
Detailed Answer:
No usually if pregnancy occurs then it is mostly a healthy pregnancy only.
PCOD is a endocrinological disorder and this the problem is the presence of deranged set of hormones in suboptimal concentrations which interferes in conception and not with the development of the baby.
Because once conception occurs whole hormone mileau changes and if progesterone support is provided at right time from outside a healthy pregnancy is there which grows well to give a healthy baby.
So don't feel anxious and just pray for conception.
All the best and may god bless you with a healthy baby soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doc, Got my sono report today. Sono was done yesterday i.e. 20th July.
Findings are as follows:
Anatomically normal urinary bladder.
Normal anteverted uterus measuring 6.0 x 4.6 x 3.5 cms (Vol. - 53 cc).
Both the ovaries are bulky.The right ovary measures 2.7 x 2.5 x 1.9 cms (Vol. - 7.6 cc).The left ovary measures 3.1 x2 .4 x 2.3 cm (Vol. - 9.4 cc) and shows follicular cyst measuirng 22 mm with septations.
The endometrial thickness is 10.3 mm and shows well defined tiny cystic area of 2.3 cm?Significance.
Is this the reason that taking Duphaston hasnt caused withdrwal bleeding?(Had taken dupaston from (8th to 12th July in a dose of 100 mg twice a day). Yesterday progestrone was 7.9 and Beta hcg was negative.
My sono was last done on 4th July as i wanted to start PCOS treatment.
The report was as follows then:
Anatomically normal urinary bladder.
Normal anteverted uterus measuring 5.2 cms in its long axis.
The endometrium is 6 mm thick.
Both the ovaries are showing few peripheral follicles measuring < 10 mm.
The right ovary measures 2.9 x 2.8 x 2.1 cms (Volume = 9.0 cc).
The left ovary measures 3.4 x 2.0 x 2.2 cms (Volume = 8.0 cc).
No evidence of any ovarian or adenexal mass noted.
CONCLUSION :
Normal anteverted uterus.
6 mm thick endometrium.
Both the ovaries are showing few peripheral follicles measuring < 10 mm suggestive of mild
polycystic ovaries.
Suggest : Hormonal correlation.
IS everything ok? i am worried about the cystic thing on the endometrium in this sono? why hasnt withdrawal blleding happended? is it anything to do with that?
What is the possible reason? Could it be conception or something else like endometrisis? am v worried
Findings are as follows:
Anatomically normal urinary bladder.
Normal anteverted uterus measuring 6.0 x 4.6 x 3.5 cms (Vol. - 53 cc).
Both the ovaries are bulky.The right ovary measures 2.7 x 2.5 x 1.9 cms (Vol. - 7.6 cc).The left ovary measures 3.1 x2 .4 x 2.3 cm (Vol. - 9.4 cc) and shows follicular cyst measuirng 22 mm with septations.
The endometrial thickness is 10.3 mm and shows well defined tiny cystic area of 2.3 cm?Significance.
Is this the reason that taking Duphaston hasnt caused withdrwal bleeding?(Had taken dupaston from (8th to 12th July in a dose of 100 mg twice a day). Yesterday progestrone was 7.9 and Beta hcg was negative.
My sono was last done on 4th July as i wanted to start PCOS treatment.
The report was as follows then:
Anatomically normal urinary bladder.
Normal anteverted uterus measuring 5.2 cms in its long axis.
The endometrium is 6 mm thick.
Both the ovaries are showing few peripheral follicles measuring < 10 mm.
The right ovary measures 2.9 x 2.8 x 2.1 cms (Volume = 9.0 cc).
The left ovary measures 3.4 x 2.0 x 2.2 cms (Volume = 8.0 cc).
No evidence of any ovarian or adenexal mass noted.
CONCLUSION :
Normal anteverted uterus.
6 mm thick endometrium.
Both the ovaries are showing few peripheral follicles measuring < 10 mm suggestive of mild
polycystic ovaries.
Suggest : Hormonal correlation.
IS everything ok? i am worried about the cystic thing on the endometrium in this sono? why hasnt withdrawal blleding happended? is it anything to do with that?
What is the possible reason? Could it be conception or something else like endometrisis? am v worried
Brief Answer:
Pregnancy may be but not endometriosis
Detailed Answer:
Hi mam, I understand your anxiety related to the issue.
It can be an early conception but chances are not very high.
But it is not endometriosis so don't be anxious about that.
This follicular cyst in ovary is of no clinical significance and will resolve by itself after periods.
Now take duphaston as advised for 3 days and then leave it.
You will get periods in 2-5 days after leaving it most probably.
But in case you still don't get them then do a urine pregnancy test again.
All in all nothing to worry and now you can start with fertility treatment from second day of periods.
Take care.
Pregnancy may be but not endometriosis
Detailed Answer:
Hi mam, I understand your anxiety related to the issue.
It can be an early conception but chances are not very high.
But it is not endometriosis so don't be anxious about that.
This follicular cyst in ovary is of no clinical significance and will resolve by itself after periods.
Now take duphaston as advised for 3 days and then leave it.
You will get periods in 2-5 days after leaving it most probably.
But in case you still don't get them then do a urine pregnancy test again.
All in all nothing to worry and now you can start with fertility treatment from second day of periods.
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Doc I am worried about the defined tiny cyctic area on endometrium of 2.3 cm. Thats almost an inch. Wht is that. Wht wud hve caused it. I also understand tht cyst sometimes doesn't let period come. But pls explain the endometrial cystic thing to me a bit more. It is worring me.
Brief Answer:
nothing much to worry
Detailed Answer:
Yes dear I was discussing about that small cystic structure only that it can be an early pregnancy or just a fluid collection but definitely not endometriosis or anything to worry about.
Endometrial cysts are very common and are just retention cysts like a pimple on skin so most probably will go by itself with periods.
Don't be anxious about it as it is an incidental finding and has nothing to so with periods most likely.
nothing much to worry
Detailed Answer:
Yes dear I was discussing about that small cystic structure only that it can be an early pregnancy or just a fluid collection but definitely not endometriosis or anything to worry about.
Endometrial cysts are very common and are just retention cysts like a pimple on skin so most probably will go by itself with periods.
Don't be anxious about it as it is an incidental finding and has nothing to so with periods most likely.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My gynac is out of town. Her assistance wanted to put me on a 21 day course of contraceptives to get period. And then stat ovulation induction with recagon for a mono folicluar cycle (we dont want multiples)
I told her tht I will start dyphaston instead she said do this. Wht wll get rid of my cysts?
I told her tht I will start dyphaston instead she said do this. Wht wll get rid of my cysts?
Brief Answer:
Best approach to start 21 day pill pack
Detailed Answer:
Hello, hormones for 21 days is a very good option in case you want to opt for monofollicular phase because this 21 day cycle will normalize the hormonal upheaval and restore the normal mileau.
So you can start them from tomorrow and on stopping them you will get periods and then start the follicular phase as desired.
All the best.
Best approach to start 21 day pill pack
Detailed Answer:
Hello, hormones for 21 days is a very good option in case you want to opt for monofollicular phase because this 21 day cycle will normalize the hormonal upheaval and restore the normal mileau.
So you can start them from tomorrow and on stopping them you will get periods and then start the follicular phase as desired.
All the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Also forgot to asl earlier. I am getting pain above right leg near pelvis. Is it bcos of the endometrial cystic thing? Can it be cured? Its a dull pain and I feel it more post walk or activit less when inactive. Its not so strong tht I cant go about things. It was more yesterday less today. But comes and goes
Brief Answer:
Due to follicular cyst
Detailed Answer:
No mam it is not due to endometrial cyst and is rather due to friction of peritoneum and the follicular cyst of the ovary along with pelvic congestion which is common in missed or delayed periods.
Rest is the best treatment but if bothersome take paracetamol or combiflam as and when required.
Due to follicular cyst
Detailed Answer:
No mam it is not due to endometrial cyst and is rather due to friction of peritoneum and the follicular cyst of the ovary along with pelvic congestion which is common in missed or delayed periods.
Rest is the best treatment but if bothersome take paracetamol or combiflam as and when required.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi my period still not come. Btw in sono report thr eas a mistake the tiny cytic area is just 2.3 mm not cm. But the cyst (22 mm folicle with echoes is there on left ovary as reoort said.
My progesterone on 20th was 7.9 on 22 it was 11.79 and today it was 19.50. My beta hcg today was negative? Is cyst causing progesterone rise? And is it that withdraw al bleed has not happen after so many days bcos of that? (As u know I stooped duohaston on 12th july) pls guide...what u feel is reason and what treatment u suggest
My progesterone on 20th was 7.9 on 22 it was 11.79 and today it was 19.50. My beta hcg today was negative? Is cyst causing progesterone rise? And is it that withdraw al bleed has not happen after so many days bcos of that? (As u know I stooped duohaston on 12th july) pls guide...what u feel is reason and what treatment u suggest
Brief Answer:
Repeat pregnancy test
Detailed Answer:
This endometrial cyst is insignificant if just a few millimeters in size so pregnancy is largely ruled out.
Now as far as rising progesterone levels are concerned they are most likely due to the other follicle which has ruptured and thus releasing progesterone.
Right now just do a urine pregnancy test and if negative take duphaston as advised and hopefully this will resolve by itself.
Don't be anxious as this unusual ovulation and menstruation patterns are very common in PCOD patients but are usually not problematic in the long run.
Take care
Repeat pregnancy test
Detailed Answer:
This endometrial cyst is insignificant if just a few millimeters in size so pregnancy is largely ruled out.
Now as far as rising progesterone levels are concerned they are most likely due to the other follicle which has ruptured and thus releasing progesterone.
Right now just do a urine pregnancy test and if negative take duphaston as advised and hopefully this will resolve by itself.
Don't be anxious as this unusual ovulation and menstruation patterns are very common in PCOD patients but are usually not problematic in the long run.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had done beta hcg yeterday. So I doubt if urine test will come positive. But will do. Should I do beta hcg blood test again? Also if I dont take any medicine will I get period in 3 or 4 days?
Is there a chance of pregnancy?
Is there a chance of pregnancy?
Brief Answer:
Repeat bHCG after 48 hours
Detailed Answer:
No mam, its better to take the medicines for support of pregnancy in case you want to continue the pregnancy.
Leaving the medicine can accelerate the abortion process and may or may not result in periods but can cause fetal death inside the womb.
If possible repeat bHCG test after exactly 48 hours of the previous test and in case value doubles then a viable intrauterine pregnancy is confirmed and thus needs extra care as explained.
Wish you all the best.
Repeat bHCG after 48 hours
Detailed Answer:
No mam, its better to take the medicines for support of pregnancy in case you want to continue the pregnancy.
Leaving the medicine can accelerate the abortion process and may or may not result in periods but can cause fetal death inside the womb.
If possible repeat bHCG test after exactly 48 hours of the previous test and in case value doubles then a viable intrauterine pregnancy is confirmed and thus needs extra care as explained.
Wish you all the best.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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