any advice on post mc metformin/polycystic ovaries/short luteal phase misery?

[snowdrop2011]

I wonder if anyone can help me. I have just started to chart my temperatures following a miscarriage last December, and being diagnosed with polycystic ovaries soon after that. It had taken us about 18 months to conceive, I only had 9 periods in that time though as my periods didn't come back for 7 months after stopping the pill. Generally my cycles seem to be on the long & irregular side (30-45 days). The consultant has put me on metformin (although I am not overweight), I've been on it for 3 weeks or so. I've just completed my first charted cycle and it has flagged up a couple of things that are making me worry even more than usual. The main one being that my luteal phase was only 9 days.

My question is, given that the books say that luteal phases only vary by 1-2 days every month, does this first cycle result mean that I have a luteal phase defect? Or should I wait to see if it occurs regularly? Does anyone know whether short luteal phases are more common with PCOS? And might this have been a reason for the miscarriage? How long does metformin usually take to have an impact on normalising the cycle?
Help appreciated. I don't think I've ever felt so miserable. It's the fact that I can't talk about it to friends, and have to keep it all buried deep at work. Not coping very well, even though doc says we should be encouraged by the fact that we conceived naturally before. Am off work with stress at the moment as I didn't take extra time off after the mc (was over Christmas) and am just not coping now. No-one knows what happened at work and I just end up stewing in my own misery and not doing my job properly, which makes me even more stressed. Hideous vicious cycle.
Does anyone have a similar experience or advice to give? Either emotional or practical or both. :(

hi snowdrop, so sorry for what you are going through, it sounds like you have had a hideous time and totally understand the stewing and thinking at home in ones misery. I'm sure someone will be along with some personal experience but i was having a long conversation with a girlfriend recently who has very long cycles like you. She has pcos (not overweight) and she had a 7 day luteal phase. She was put on to Metformin which is often used as a diabetic drug. Her LP went up to 9 days the firs month and the second month it went up to 16 days and so it took a few cycles to kick in. It has seemed to regulalise her around 40 days - are long cycles a symptom of pcos?. What she has been told by her gynae is and this may be worth flagging up or investigating that when she gets pregnant, she needs to immediately go to her gynae to get progesterone suppliments to support the pregnancy.

Out of interest, how far along were you when you had a m/c? If your LP was 9 days or even less , this is highly likely to cause an early m/c and would explain why it took you 18months to conceive.

I would see what your LP is like next month and if it hasn't increased, you should definitely talk to your consulant. Don't let them fob you off with 9 days LP is fine etc etc this can make it very difficult to get and stay pregnant.

Hopefully now you are on Metformin and are monitoring cycles, it will give you a stronger LP and it won't take you 18months again.

I'm obssessed by LP and have probably done far too much research on it. Half the medical community think it is very important, the other half don't. Also there is the progesterone argument where there hasn't been enough research in to its prevention of m/cs but my friend's gynae obviously thinks it is vital.

TTC is really stressful, m/c's just make things utterly worse especially if you had added problems. I hope someone is looking after you.

Thanks so much joycep. It is really comforting to know that it might take a few cycles for the LP to lengthen and that it won't necessarily stay at 9 days.

I was 9 weeks when mc. In fact I should probably say 8.5 as it was a mmc. Do you think that means it might have been to do with a short LP?
Yes long cycles definitely seem to be a part of PCOS. Looking at my chart for this last cycle it looks as though my body prepared to ovulate at the right time but didn't quite make it and eventually ovulated on day 24. That seems to fit conceptually with how PCOS works.

The charting is great because of the depth of understanding it gives you about what your body is or might be doing but goodness it doesn't help with the stewing. :)
Thanks again for posting. It helps.

Just curious, snowdrop - were you diagnosed with polycystic ovaries, or PCOS (ie, the actual syndrome, wtih hormonal imbalance)? I ask because I also have long cycles and a scan showed cysts, but my doc wouldn't refer me because bloods came back as normal...

Hi ChateauMargot, in fact the consultant was pretty non-committal about that. I initially had blood work done about a year ago which came back within normal ranges, like you, and then after the mc the consultant said that he could see very clearly that my ovaries were polycystic and that is why he put me on metformin, as he said that having polycystic ovaries does increase the chance of mc and there is evidence that metformin reduces it.

I have some other symptoms of the syndrome, such as acne, dark body hair, etc. But blood work was normal and the consultant's explanation was just that it is a spectrum disorder and I appear to have a mild version of it. He doesn't seem to be taking it less seriously because of the blood result.
If you are having trouble conceiving then I would definitely push for a second opinion. Unfortunately out of the 4 doctors I have seen so far (3 GPs & 1 gyny) all have said different things. So far I am trusting the gyny ;)

Well i have read on here that women have had normal pregnancies with 9/10/11 day LPs so i think it is difficult to tell whether that was the cause as you don't know what it was before Metformin. 8.5wks though is quite far along to immediately think it was the LP that caused it as i think they tend to happen earlier. But every woman is different.

I know what it's like to wonder what the reason for the m/c was, you want to prevent it happening again when you next get pregnant. We are always told that it is most likely a chromosome abnormality that causes them but I have spent the last 9months obsessing whether my 10day LP caused my #1 to mc at 7wks. A normal LP range is 12-16days. I think i will insist on getting my progesterone levels checked when//if i ever get pregnant again.

I really wish you the best of luck. It is an emotional journey when things go wrong.

That's interesting, snowdrop - thanks...

Between 10 and 16 days can be considered normal and not of consequence. And actually there is a lot of debate over whether a shorter lp than this is an issue. Certainly, I have a 9/10 day lp and have no problems conceiving. Likewise, my cousin's is consistently 8 days and she has had 2 healthy pregnancies with no problems conceiving. I have several other friends who have lps around the 9 day mark without fertility issues.

I can't say with any degree of confidence whether a 9 day lp is a problem (though I suspect in isolation it isn't) but I think your fertility picture is more complicated than just your lp. Certainly, a variable cycle length of the scope you describe points at problems most likely with ovulation (as is confirmed with the polycystic diagnosis).

I don't think you can say that an lp of 9 days is 'highly likely' to cause a mc at the time you experienced it as there's no evidence for this (in fact plenty of evidence to the contrary) and it suggests a link/reason for worry for any woman who has an lp on the shorter side of normal.

And if a shorter lp phase is theoretically assumed to not allow a pregnancy to implant in time or the lining not to be adequate, then what you would expect is a very early miscarriage before 6 weeks.

If you were 8/9 weeks pregnant then it implanted properly and the reason for mc is unlikely to be linked to a luteal phase defect.

Joycep I'm so sorry you had to go through the same thing. I don't feel like I will ever be the same person that I was before it happened. It is crazy that such a traumatic thing is experienced by so many women. I read a book called 'Miscarriage: what every woman needs to know' - have you heard of it? I'm not sure whether I would fully recommend it as I found some of the detail very upsetting, but if you are after information and some explanation then it does offer some clues, including likely causes at different stages of foetal development. I will have to go back and pay more attention to what it says about luteal phases now.

thanks snowdrop. I know what you mean, it is incredibly emotional and distressing even at an early stage. I feel I will be able tto move on when I get pregant again but i feel until that point i am stuck in this weird world of limbo where worry and stress exists. I think a miscarriage on your first can rob you of your pregnancy naivety where there is amazement and excitement - i know i won't be like this ever again.
Thanks for the name of the book - I haven't heard of it. Something tells me not to read up any more info though! ShowofHands sounds much more rational and sensible on the LP front. I am very good at self diagnosing myself and probbly other people too .
If you are interested, This is the best article i have found about Luteal Phase
www.inciid.org/printpage.php?cat=infertility101&id=7

I read somewhere that taking vitaminB6 (50-100) every day can help increase the luteal phase.

Hi!
Sorry for your loss snowdrop, it will take time. This may help it may not but this is what is happening to me I have cysts on my ovaries so i think i have PCO not PCOS, I miscarried in October after fertility treatment, I have low progesterone which causes can short LP and m/c but also I have an underactive thyroid which also causes LP defects and m/c. I dont want to scare you!! It might be worth getting these checked out just so you can make sure everything is ok. One positive you must take from this you conceived naturally. I do not have many symptoms of an underactive thyroid or anything else i am underweight and do not suffer in any other way than annoying periods and infertility. Best of luck on your journey as questions please fire away, sending you lots of wishes.

Thanks babypops that is interesting, as the other thing I have noticed from the charting is that my basal temperatures are quite low and I had heard that this can be a sign of hypothyroidism. I will get it checked out. I really hope your next treatment goes well...
Thanks for the article joycep. I feel exactly the same as you and know that if I feel miserable now I will probably just go to feeling terrified if I get pregnant again. Funny how I don't look forward to it and yet it's the only thing keeping me going. I hope it all comes good for you. (It really helps to 'talk' to others in the same boat as I don't know any close friends who have been through this - so I hope it helps you in the same way).

ShowofHands us self-diagnosers really appreciate your calm logic thank you.

I'm with you on that snowdrop. When i feel despair or worry, i have turned to MN to get some support from people who are either going through the same thing or been there and come out of it in one piece. I never thought of myself as someone who would turn to a virtual environment for that(!) but like you i have no friends who have had a m/c. I know they're suppose to be really common but all my friends have conceived quickly and breezed through their pregnancies.
I try and give myself a break from MN for a few weeks every month though because it can lead to slight obsessiveness ...and just adds to me thinking about it all the time . I hope you are feeling less stressed this afternoon. You need to give yourself time to grieve.

Oh calm logic only comes later.

I miscarried my first pregnancy after over a year of trying and it was a bloody awful time. I did worry then that it was my lp that caused it but now know logically and with the benefit of hindsight (and successful pregnancies) that it can't have been that (the pregnancy implanted just fine but failed later). I know now that miscarriage is sadly very common, that often we don't know why it happens and that generally it's just one of those things. I also know that it is normal for it to take 1-2yrs to conceive. But when I was going through it? No. Panic, sadness, manic reading up to find a reason for that which I now think is inexplicable.

I think you are doing exactly the right things by looking into it, by trying to maximise your chances. I remember the drive behind trying to achieve something you want so desperately. Calm logic is not often wielded by a woman who has suffered the devastation of a miscarriage.

I wish you the very best of luck with ttc.