Dear Dr Fong,

I am in my mid-30s and had Dilation and curettage (D&C ) surgery last August during my first pregnancy. I have not had my period since then.

I have Polycystic Ovarian Syndrome and an irregular menstrual cycle, and have been taking Serophene Clomiphene since 2002.

Is it safe for me to start planning for another baby now? Also, will consumption of Serophene Clomiphene cause a miscarriage?

Christine

Irregular menses and infertility are more common symptoms of Polycystic Ovarian Syndrome (PCOS).

However, other symptoms of PCOS can range from just increased egg follicles (which can be seen on ultrasound scans) to irregular periods, and increased hair growth on the arms, upper lips and chest. In extreme cases, even masculinisation, such as a deepening of the voice and growth of facial hair, can occur.

Women with PCOS have irregular periods because they do not ovulate regularly, despite the fact that many of these 'eggs' are seen on ultrasound scan.

This is because the full development of the eggs or follicles do not take place and the eggs' growth are arrested or 'jammed' midway. Hence if there is no ovulation, there is no cyclical hormone change leading to menstruation. This also causes difficulties in getting pregnant.

The lack of menstrual period also has a detrimental effect by allowing the lining of the womb (endometrium) to build up and remain very thick for a long time (eg 3-6 months without menses).

Over time, this build up of the lining - over a five- to 10-year period - may increase the risk of cancerous change in the endometrium. Gynaecologists would prefer women to have their periods at least once every one to three months. Some patients are given clomiphene to 'induce' the ovary to ovulate.

After a miscarriage, patients are usually advised to wait about two menstrual cycles before trying again.

Besides allowing the lining of the womb to rebuild and be 'receptive' to the embryo again, it is also to allow time for the patient and her partner to recover, both emotionally and physically.

Clomiphene is not recognised as a cause for increased miscarriage, but some scientists believe that women with PCOS may have a higher risk for miscarriage.

Got a question on your reproductive health? Email it to us at Just Woman and we will get it answered by Dr Fong Yoke Fai, a consultant Obstetrician and Gynaecologist at the National University Hospital.