Brief Answer:
Progeterone should help you to get your menses

Detailed Answer:
Dear XXXXXXX

Welcome again on this Healthcare Magic forum. I thank you for expressing your faith in me again by asking another Direct question to me.

If I remember correctly your age is 40 years. So I shall continue my discussion considering this age of yours.

Now let me discuss your issues one by one.

Your concern of priority appears to be about having your menses. Since by different investigations, you are proved to be non-pregnant, and even after 55 days you are not getting your menses, you would naturally be concerned about it. The first suspicion that comes to mind is about premature menopause considering your age; however your ultrasonography has revealed that you are having secretory endometrium. Endometrium becomes secretory only after ovulation has taken place. So it proves that you are ovulating and hence not in menopause. However, on 55th day, a secretory endometrium of 8.2 mm is rather thinner endometrium though not very thin. It seems this endometrium has not responded to the hormonal withdrawal changes in the body and thus is not getting broken to cause menstruation.

Your right ovary is showing a cyst. It is likely to be undegenerated corpus luteum which has undergone cystic changes. This may lead to delay in the menstruation if this corpus luteum continues to secrete oestrogen and progesterone.

At this stage, you may take Tab. Deviry for 5 days. This is a Progesterone preparation. After discontinuation of the pills, you will get withdrawal bleeding within 4-7 days. Since your endometrium is not very thick, the bleeding may not be very heavy. Once you get the menstruation, one stress is taken care of and one issue is over.

If you do not get any withdrawal bleeding even after Deviry also, please inform me so; then I may suggest you further options. Let us go step by step.

Your second issue is about failure in conceiving. I had discussed this issue in my previous communication with you and had suggested to you to undergo certain examinations and investigation for the assessment of:

1. Egg release (ovulation)
2. Patency of the complete genital tract
3. Hormonal assays
4. Semen examination

It seems you are rather hesitant to get them done.
XXXXXXX please try to understand that the conception is coming together of two cells, one from the woman and the other from the man. Unless all these factors required for successful conception are not evaluated, it will not be possible for any Gynecologist to opine on the cause and management of difficulties in conception. I would urge you to undergo these investigations and upload the images and reports so that I will be well informed about the medical information. Then we can discuss the issue further. If you want me to enlist the required investigation, please let me know.

Till that, I feel this should help you. If you need any more information, please free to ask me. I am always available for you, XXXXXXX

DR. Nishikant Shrotri

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Brief Answer:
Please take informed decision.

Detailed Answer:
Dear XXXXXXX

Let me answer both your follow up queries one by one.

Whether to wait expectantly for few more days or not depends upon your patience. Though I would not say that you cannot get the menses naturally, I would not guarantee for that also. Since now it is 55 days since you have got your menses, the chances of natural menses are rare, though not impossible. Since you are under stress of this delayed menses in spite of no pregnancy, I thought, it is better to have withdrawal bleeding and sort out one concern. Still, if you feel you wish to wait for few more days, you can. However, I would keep my fingers crossed on this decision of yours.

Well, the answer to your second query was addressed previously also. If all other factors are normal as proved by the different investigations, the only stone which remains unturned needs to be investigated. The tubes can get blocked even by subclinical infections also. You cannot diagnose whether they are blocked or not by clinical examination. No Gynecologist can opine against the need of tubal patency tests when there is problem in conceiving; it would be unscientific. I would repeat my previous statement XXXXXXX "Since you have limited period left in your reproductory life, I, as a Gynaecologist, would not advise you to waste more time in just a natural expectation of conceiving." You have tried sufficiently and it has failed. Now let your Gynaecologist work on it.

I hope I succeed in counseling you about undergoing the investigations for infertility at the earliest.

I would be more than happy to resolve any of your further queries to help you to get the best results.

Dr. Nishikant Shrotri

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