Pain in both knees after back FUSION with FORAMINOTOMIES.

Hello,
Thanks for posting your query at DoctorSpring.com
Metformin basically regulates cycles and symptoms in women in PCOS.
It is not responsible for any alterations in the cycles.
I think it is just coincidental that the cycle irregularity started when you started Metformin.
The abnormal spotting and altered cycles could be an indication that PCOS could be kicking in again.
What you can do, is stop the Metformin and observe the cycles for a couple of months.
If they are still irregular, it means that PCOS is symptomatic, and you need Metformin for cycle control .
May I ask you for your height and weight also please ?
Looking forward to hearing from you.

Feel free to discuss further,
Regards.

Hello!
Thank you for your response. I am 5'4" and 175 lbs. Apart from being overweight...I don't really have any of the issues of pcos. Most of my weight is not around my abdomen, I don't have excess body hair or acne, etc. Until recently my cycles were regular.
Couple of questions :-)
- Could my pregnancy/the birth of my son have somehow "reset" my system so I did not have pcos anymore? I'm wondering because before my son, my cycles were 34-38 days, but after my cycles were until recently always 26-28 days.
- Could taking metformin while having regular cycles affect my blood sugar (and hormone levels) to make my periods even shorter in duration? I have never, ever had a short period....and twice now, my body has selected an egg, my lining looked good and then on the day I should have ovulated I started a menstrual cycle (the first time being light and 10 days long and the current one much more normal)
- Before I started metformin my ob gyn checked my hormone levles...fsh was good, progesterone day 21 showed I ovulated, she mentioned my androgen levels were just slightly elevated but that was it. Is it customary to prescribe metformin in that type of situation just because I had irregular cycles and pcos before I was pregnant? I love my ob gyn. but I know obstetrics is not her focus. She does not deliver babies, she performs gynecological surgeries primarily...so I'm not sure how much she keep up with fertility problems.
- I'm sorry for so much info and if I repeated myself....I am just completely blown away that I went from regular cycles to 15 day cyles 2 cycles in a row. I have never had a short cycle...I guess I could understand the pcos being the cause more if I was going back to long cycles...but starting menstruation on the day I should be ovulating (when an ultrasound even showed a good uterine lining and a selected egg just 2 days before) completely confuses me.
Thank you so much for your assistance!
Krista

Hi again Krista, I understand your confusion. Let me elaborate.
PCOS is generally characterized by delayed cycles.
However, it is also characterized by irregular spotting and bleeding.
The lining of the uterus does not get completely shed off, and hence erratic spotting and bleeding ensues.
The hormones show it was a new cycle, but that is impossible, if you were close to ovulation !
Something is not right here ( either the blood work or the imaging ).
I assume follicular monitoring ( serial scanning of the ovaries and uterus) was employed to track ovulation, was that how you came to know that ' an egg was selected '?
If yes, then the hormones were faulty.
Because if the follicle was recruited and close to ovulation ( it would be atleast 18 mm big close to ovulation ), then you cannot ' menstruate ' . It would be spotting, more common with PCOS due to progesterone insufficiency.

ALso, was ovulation documented once you started the spotting , or did the selected egg just disappear ?
There are some gaps here, and I would love it if your OB could fill them.
Pregnancy is curative for PCOS temporarily, and yes , that could make your symptoms of irregular cycles disappear.
Again, PCOS is basically many egg follicles in the ovary, as age advances, that number of follicles diminishes, so PCOS ' improves ' in a sense.

WIth regular cycles, there is no rationale for prescribing Metformin ( it does aid in weight loss which is critical for PCOS, so maybe that is why she gave it ).
But no, it does not affect hormone / sugar levels to shorten a normal cycle.
If you took Metformin even though you were NOT a PCOS patient, it would not affect your menstrual cycle or shorten it.

Yes the two do not fit - having ovulated ( confirmed on scan ) and having ' menstruated ' that day.
I hope you can reach your OB GYN and ask her to clarify.
Keep me posted, pl feel free to discuss further.
Take care.

Hello! Thank you for your response. I am 5'4" and 175 lbs. Apart from being overweight...I don't really have any of the issues of pcos. Most of my weight is not around my abdomen, I don't have excess body hair or acne, etc. Until recently my cycles were regular. Couple of questions :-) - Could my pregnancy/the birth of my son have somehow "reset" my system so I did not have pcos anymore? I'm wondering because before my son, my cycles were 34-38 days, but after my cycles were until recently always 26-28 days. - Could taking metformin while having regular cycles affect my blood sugar (and hormone levels) to make my periods even shorter in duration? I have never, ever had a short period....and twice now, my body has selected an egg, my lining looked good and then on the day I should have ovulated I started a menstrual cycle (the first time being light and 10 days long and the current one much more normal) - Before I started metformin my ob gyn checked my hormone levles...fsh was good, progesterone day 21 showed I ovulated, she mentioned my androgen levels were just slightly elevated but that was it. Is it customary to prescribe metformin in that type of situation just because I had irregular cycles and pcos before I was pregnant? I love my ob gyn. but I know obstetrics is not her focus. She does not deliver babies, she performs gynecological surgeries primarily...so I'm not sure how much she keep up with fertility problems. - I'm sorry for so much info and if I repeated myself....I am just completely blown away that I went from regular cycles to 15 day cyles 2 cycles in a row. I have never had a short cycle...I guess I could understand the pcos being the cause more if I was going back to long cycles...but starting menstruation on the day I should be ovulating (when an ultrasound even showed a good uterine lining and a selected egg just 2 days before) completely confuses me. Thank you so much for your assistance! Krista

Hello,
I have received a duplicate message. It must be an error. Please feel free to follow-up.
Best Regards

Hello!
Yes, I apologize...I think I accidentally clicked on a button when I read your last message.
Thank you so much again for your help! Things are becoming more clear now. Below is some additional info to hopefully clarify some things. Please let me know what your opinion as to what is going on at your earliest convenience!
November 2011 - went to obgyn when my husband and I had trouble conceiving. I was diagnosed with pcos after seeing my swiss cheese ovaries on an ultrasound and reporting I had 35 day cycles. I was prescribed metformin and clomid.
January - while still on metformin and clomid I became pregnant. Low progesterone levels were noticed.
April - the fetal heartbeat stopped...possibly due to low progesterone levels...and I had to have a D&C
June - I was put back on metformin and clomid. I also started acupuncture.
August - I became pregnant. I actually became pregnant without clomid...just metformin and acupuncture. My ob gyn also put me on crinone 1 time per day because my progesterone was low again.
I stayed on crinone until approx 14 weeks gestation, metformin for about 20 weeks and acupuncture for the duration of the pregnancy
May 2013 - I had a healthy baby boy!
July 2014 - I stopped breastfeeding and began regular cycles. These regular cycles continued until the end November
November 2014 - I started visits with my ob gyn and started acupuncture to prepare for conceiving in December. All ultrasounds and blood work looked good. A couple of the results I remember are that my progesterone on day 21 showed I had ovulated (I believe it was around 10.5) and my fsh on day 3 was about 6. The only thing out of the ordinary was that my androgen level was only slightly elevated. My doctor started me on metformin even though my cycles were normal because she said "once you have pcos you always have pcos"
November 27 - had a normal cycle (5 days, 3 with heavy bleeding)
December 4 - my estrogen elevated in accordance with a normal cycle
December 10 - spotting started. First light, but increases to heavy spotting by day 3 or 4. Spotting continued for a total of 10 days. I have never had spotting mid cycle before so this really made me wonder what was going on
Dec 12 - had appt with my ob gyn because of the spotting. An ultrasound showed a thin uterine lining. Bloodwork she said showed that I was pre-follicular.
Dec 18 - had appt with my obgyn because I was still spotting. Bloodwork showed I was still pre-follicular so she wanted me to take clomid to "jump start" my system.
Dec 19-23 - I took clomid
Dec 29 - ob gyn appt. Ultrasound showed a perfect trilaminar lining and a selected egg. She did not measure its size, but said I should ovulate soon.
Dec 31 - spotting started which led to the full menstruation currently
Hope that wasn't too much info, but I figured too much than too little! Basically, I am fairly certain I had a real menstruation (based on the type of flow) on Nov 27 and Dec 31. The 10 days of spotting did not seem like a real cycle to me at all, although my ob gyn said my hormones said a new cycle was starting?!
Here are my questions:
- What are your opinions on the info above? Would it have been possible to have a good uterine lining/see a large selected egg...and then start menstruation 2 days later? I saw the ultrasound myself...and I am defintely heavily flowing now.
- Can metformin cause heavy spotting? Or low blood sugar which could cause any of my issues recently?
- Does metformin ever cause heavy spotting when you first start taking it?
- Would you recommend I stay on metformin or discontinue its use since I had normal cycles before?
Thank you SO much! Now that I am starting another cycle, I hope my system forgets all of last month (the clomid possibly mid cycle, spotting, etc) and starts anew. I'm just trying to decide if I keep going with the metformin or discontinue using it. If you tell me there is absolutely now way that metformin could be causing any of my issues, then I will continue and hope it was just my body adjusting to the metformin. If you think it is better for me to come off of the metformin I will try that. I just want to do whatever will help me to become pregnant quickly and stay pregnant safely.
Thanks again!
Krista

Dear Krista
Thank you so much for the indepth and detailed update.
Once again, am impressed by your thoroughness , insight and inherent intelligence.
Few doctors are as succint in case histories as you are !
I am very much convinced that the spotting you had was NOT a period.
Here is what I think happened.
Yes, you were pre follicular, with PCOS that often happens - the pre follicular phase is lengthened at times.
And the spotting was because the lining was not completely shed off, but was doing so in parts.
That would still show as a thin uterine lining on scan.
Do you have access to the blood work that showed you as pre follicular ?
I think giving you clomid at that time was not a good move, because you were pre follicular, which is not the same as being just post menstrual, which is the best time to have Clomid .
I do not think Metformin is in anyway implicated in the erratic spotting or bleeding, it has no such effect.
Taking it or stopping it is not such a big deal, if you continue to try weight loss with reasonable diet and exercise.
What you should do now is take nothing ( no hormones ) and watch your next cycle ( stopping or continuing Metformin is your call, I would have continued it to see what happens to the spotting this month ).
Do nothing this cycle ( give your system a break from the hormones )
Next cycle onwards, start Clomid from day 2 of your period for 5 days ( your proper period, which is best judged by a heavy flow ).
Regarding your other questions.
YEs, it is possible to menstruate 2 days after a good thick lining, because a thick lining is a must before periods start.
Regarding the selected egg, I have to know the dimensions.
Anything from 6 - 7 mm to 15 mm is a selected egg, and with the earlier dimensions, yes, a period is still possible 2 days later.
As is clear, there are various gaps here ( the blood work and the egg size ) that only your doctor can fill.
And no Metformin does not cause heavy cycles even in the first month.
Hope this clears the air a bit.
Regards.