What is the reason for irregular periods?

Hello

Welcome to iCliniq.

I understand your concern.

We will pay close attention to your worries and address all your questions with the utmost care. The ultrasound scan report (attachment removed to protect the patient's identity), which you have posted, shows a single follicle dominant, which may be in the right ovary. The endometrial thickness and uterus seem to be of normal size.

This does not appear to be a polycystic ovarian syndrome with normal size ovaries. So, PCOS may not be a cause for the irregularity. I suggest you attach the complete written ultrasound report in the follow-up. I also suggest you run the following tests.

1. Thyroid profile.
2. Serum prolactin levels.
3. Serum progesterone levels on day 21 of your cycle.
4. Serum testosterone.

If you have already done, kindly share the reports for evaluation or else get them done. Also, please mention the details of your menstrual cycles in the last three months, along with the dates, to understand the pattern of bleeding.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

I have checked your ultrasound scan and the written reports (attachment removed to protect the patient's identity). Your TSH (thyroid-stimulating hormone) levels are normal, and the rest of the ultrasound is also normal. The dominant follicle is seen in the right ovary as marked in the scan report.

So, there is a likelihood that the written report has mistakenly mentioned the wrong ovary. So, stay informed. The reports are fairly normal, and we should wait for the prolactin levels to be available. Please provide the details of your last three menstrual periods to help us understand the irregularity.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

The single episodic delay in a month is likely to have been due to stress induced during the cycle. Stress is the most likely and commonest cause of delay among females in the reproductive age group when no other obvious causes are present, whether hormonal or organic (such as fibroids, polyps, and adnexal masses). As your last menses arrived on the 16th of last month, this month your menses should be between the 16th and the 19th.

Hence, you should wait until this month. Ideally, if three of your menstrual cycles are irregular, it is considered irregular menses (oligomenorrhea). I feel this irregularity in your case is more likely to be stress-induced, and hence, maintain a menstrual calendar for the next three months. We should wait for the prolactin results.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

It would be better to get the ultrasound of the pelvis repeated to check the endometrial thickness and to detect the presence of any ovarian cysts (if any). Also, please share your serum prolactin reports.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

I have gone through the USG (ultrasound sonography) report and the prescription (attachments removed to protect the patient's identity). It confirms that you have polycystic ovaries with each ovarian volume more than 10 cc which is the cut-off. Also, multiple small follicles are seen in each ovary which are immature follicles and there are no dominant follicles which indicates anovulation or no ovulation during the cycle. This leads to delayed or no menses or scanty anovulatory cycles (which is endometrial shedding following non-advancement towards the secretory phase in the absence of progesterone-secreted after ovulation).

PCOD (polycystic ovarian disease) is purely a lifestyle-based disease and can flare up anytime during the reproductive period when guards are brought down with regards to eating and exercise habits. Weight gain increases insulin resistance and further contributes to PCOD. You can continue the tablet Primolut (Norethisterone) for five days and then wait for withdrawal bleed. However, tablet Formitol (D-chiro-Inositol, L-methylfolate, Mecobalamin) can be started from now itself daily for the next three months. Also, I suggest you start low dose oral contraceptive pill like tablet Ginette 35 (Cyproterone and Ethinyl estradiol) once daily from day three of your cycle till 21 days and then take the next pack from day two of your next menses after you stop the first pack. This again for three cycles in all. Along with this drink plenty of water, do brisk walking daily for 45 minutes, and avoid fatty, spicy and fried foods.

Three months post treatment, kindly connect with me for a follow-up.

I hope I have resolved your queries.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

The hemorrhagic cyst does not indicate ovulation, and neither does 0.47 inches of endometrial thickness. These indicate anovulation. Ovulation is indicated by the presence of fluid in the pouch of Douglas and a corpus luteum cyst, and not a hemorrhagic cyst.

The endometrium grew in response to the unopposed estradiol effect. Your weight is controlled. I guess you need to maintain a healthy diet and drink plenty of water. Stress-inducing factors should be avoided. Just follow the prescription, and you should be doing well.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

If you are not keen on starting the hormones now and would like to give yourself a chance to regulate ovulation naturally, then I appreciate that. You may continue with tablet Formitol alone for three months post your tablet Primolut-N induced withdrawal bleed and get your basal hormonal levels checked by day three of your cycle.

Polycystic ovarian disease (PCOD) is like diabetes; it needs to be controlled to prevent it from flaring up. Anyone who is predisposed would have to be strict on weight control and lifestyle modifications. Diet and exercise play a major role in this for sure, but significant reliance should be on adequate water intake, which shall help improve your metabolism and also help reduce your insulin resistance (which Formitol shall help as well).

Stress is a significant contributor (about 85 %) to causing irregularity in menses across the world, and the symptoms overlap with those of PCOD. It is often seen that women who overcome stress in the next few cycles have their cycles regularized, and the features of PCOD diminish. Hormones do not make your cycles habitual unless you are not following a proper diet, exercise, and adequate intake of water completely.

The regimen is for three months, followed by a one-month break to allow natural menses. If the next menses arrive on time, the lady is switched to a natural treatment regimen without any medications. So, if you want to give yourself a try, which is good, I suggest you give yourself at least two months' time.

Do not over-exercise, just 45 minutes of brisk walking twice daily shall suffice, as you are already 138 lbs. Over-exercising can rebound at times. Also, maintain a menstrual calendar for the next three months.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Did you take Ginette 35 (Cyproterone and Ethinyl Estradiol) oral contraceptive pill as well, or just take Formitol tablet? If you had taken the tablet, Ginette (a combination drug0, then once the pack ends, you should get your menses within the next three to five days. If not started, given the withdrawal bleed, menses should naturally start within the next five days if you have been eating healthy foods, drinking plenty of water, and following regular exercise.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

In that case, when you had a normal period post-withdrawal bleed, you should wait for your menses to arrive naturally for another five days. Menstrual periods are usually not on time for women; however, some women have been lucky. A delay of three to four days, or even occurring in advance, is not considered irregular.

So, for now, wait for your menses, and if they do not arrive naturally in the next five days, then we would have to consider progesterone withdrawal again, and then you would have to be on hormonal pills as well.

The onset of acne indicates that your testosterone balance is being disrupted despite your lifestyle changes. Perhaps they are inadequate, which would call for incorporating Ginette (a combination drug). PCOD cannot be treated without Cyproterone acetate pills.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Good to hear that your menses has arrived and is just three days late compared to the date of your last menses. So, you can avoid Ginette during this cycle and continue taking the Formitol tablet for another month. The flare-up of acne can be conservatively managed by using a neem face wash three times a day and increasing daily water intake.

Drink 10 to 12 glasses of water a day to improve BMR (basal metabolic rate) and local facial blood circulation. By following this, there is a chance your acne will improve within a week or so. Antibiotic cream for acne is not recommended until natural methods for oily skin and acne control have been exploited (keeping in view your age).

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

You do have a flare-up of acne on your face, and your skin appears oily. Considering your cycles to be regular now, we are not contemplating a PCOD regimen. The acne (which is pustular) can be treated with local treatment or through a short course of antibiotics. I suggest you do the following:

1. Take tablet Augmentin 625 mg (Amoxicillin + Clavulanic acid) twice daily for five days.
2. Keep your face oil levels low by using neem face wash three times a day.

I do not advise dermatologist treatment as of now since they would advise Retinoic acid, which would flare up the redness and cause peeling. So, take this short course and see the difference. Continue with water intake.

I am extremely grateful for allowing us to help you maintain a healthy lifestyle.

I hope this helps you.

Thank you.