I am engaged to be married in 6 months and my fiance and I have agreed to use NFP if possible, because we both believe that it is God's will. The problem is that I experience abnormal bleeding. I have been off and on ortho tri-cyclin 3 times in the past three years. I have currently been off of the pill for about four months, and had regular periods until about three weeks ago. I have been bleeding continuously since then and have experienced a minor level of cramping. (The same symptoms I have experienced previously.) We are about to begin NFP classes in January, and I would like to find a way to become regular again without going back on the pill, as it only provides a short term solution to the problem and is not what we want for our marriage.

I have done a good deal of reading about the issue, and have read many vague suggestions that exercise and diet can play a role in abnormal bleeding.  I exercise about 5 times/week for 30 min and am generally a healthy eater.  I do consume products containing caffeine and aspartame though. I have read that taking 1,000 mg of Flax Seed Oil daily may also be helpful in attaining regulation of my cycle. I would greatly appreciate any suggestions that you have. It is very important to us that my cycle can be regulated because I will be starting medical school in August of 2003 and we would like to be able to use NFP as effectively as possible in our marriage. Thank you.

There are a number of different causes for abnormal bleeding. The nutritional approach your are taking may help with hormonal abnormalities such as low progesterone, but will not help if the bleeding is due to non-hormonal causes. In figuring out why you have abnormal bleeding, a good pelvic exam and ultrasound may help rule out a fibroid or polyp. For bleeding not helped by a hormonal therapy, it might be necessary to do a biopsy or dilation and curettage (especially for women over forty), or hysteroscopy. A hormonal workup to check thyroid levels, androgens for polycystic ovarian syndrome, prolactin levels, and progesterone in the luteal phase of the cycle will help pinpoint the problem. Obtaining estradiol and FSH levels might be helpful.

An alternative to birth control pills is using progesterone (bio-identical progesterone in oral or vaginal capsules) in the luteal phase for ten to twelve days, starting about three days post-ovulation, or from day 18-27 of the cycle if you are not ovulating. Cooperative progesterone therapy of this type will often help straighten bleeding out within two or three months. Sometimes the bleeding will revert to normal cycles after this therapy, but sometimes a woman may need to remain on progesterone to have normal cycles. Over the long term correcting overweight or underweight, as well as the nutritional supplements you outlined can be helpful, but relying on dietary and lifestyle changes may take several months to improve things.