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Why hasn't my wife got her periods after pregnancy?

Q: My 24 years old wife had a c-section delivery last year. She took injection Depo-Provera early this year. Two months back, we contacted a doctor for lactational amenorrhea who prescribed these medicines to my wife -- DUB-5 and Heamup-c, Lynoral, Sysron-N and Atlax. My wife has not got her periods since then. As per the ultrasound report, her uterus measures 5.8 X 2.9, the right ovary measures 3.1 X 1.8 and the left ovary measures 3.0 X 1.9. Is my wife suffering from some serious problem?

A:Regular and predictable periods depend on two factors, a normal level of female hormones - oestrogens and progesterone, and the monthly cyclic changes in their levels. Breast milk is secreted under the influence of a hormone called prolactin which is secreted by the pituitary gland and is present throughout the time you breast feed. The major stimulus for the secretion of this hormone prolactin is pregnancy itself and it is sustained by suckling and periodic emptying of the breast. Prolactin virtually blocks the cyclic release of female hormones so important for regular periods. Nature has provided this as a natural method or spacing between children. This method is effective. The absence of periods thus while breast feeding is called lactational amenorrhoea. While it is true that menstruation and ovulation (making of eggs) is virtually blocked during breast feeding it is not 100% so while most women get no or irregular periods while breast feeding, you still can conceive as you will never now when you get periods as you will never know when you ovulate, or which days are safe! Stopping breast feeding stops the stimuli for the release of Prolactin, this stops the secretion of breast milk and menstruation is resumed. Unfortunately amenorrhoea(absence of periods) which can last months or up to an year or more is a problem with long acting progesterones like provera. This should have been explained to you by the doctor who prescribed this drug to you. This is because it affects both the levels of female hormones and loss of cyclicity, all important for a regular menstruation. This was the main problem when Provera like injections were used as a trial in early nineties in India in an ICMR trail for family planning. It was considered unsuitable for use at a population level without adequate medical supervision. It is being used fairly commonly however despite opposition from women's groups, and without informed consent and proper medical supervision to monitor all side effects and complications. You have not written why your wife took it but I guess it was for contraception. Since you call it a lactational amenorrhoea, I assume she is still breast feeding. I am not sure it is a very good idea since your baby is over an year old now. Well you may not get periods as long as you keep breast feeding. That is normal and physiological. Some women have regular bleeding and many have none during breast feeding, both are normal. The only problem will be that you will never know you will get pregnant again as I explained already. So if avoiding pregnancy is a priority with you, please use other methods of contraception like condoms. At this stage she should get a pregnancy test done first. If it is negative just stop breast feeding and wait, and she should get periods and it should all be OK. Please do not take hormones like lynoral till you stop breast feeding. In case you do not get periods despite stopping breast feeding for 6 weeks please see a specialist and try bringing on periods with common oral contraceptives taken one daily for 21 days and then waiting for about 2 weeks. If despite stopping breast feeding and taking the oral contraceptive you do not get periods, you need a full evaluation by a specialist.

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