I am newly married for two months and had my last period a month and a half ago. I have done a urine test and blood hCG test that shows no pregnancy. I recently had a transvaginal ultrasound where many issues like fibroids, polycystic ovary, and thin uterus were detected. The ultrasound report with the doctor prescription is attached here. I had a similar incident of not having a period for 45 days before marriage. That happened one year ago, and I consulted a doctor at that time. The doctor suggested the pelvic ultrasound, and everything was fine. The doctor gave me five days of medicine to induce my period. The doctor also said the problem was due to hormonal imbalance. I took medication for 21 days daily until the period came and started to retake it after five days. That medicine continued for three months. After taking all those above medicines, my periods were normal till marriage. These are some specific queries that I have in this case. Which treatment plan will you suggest in this case? Which kind of medicines can be used for the treatment of fibroids? Is there any other test or diagnosis required for fibroids? Which type of treatment or medicine will you suggest for polycystic ovaries? Is it wise to go for surgery with the current size and location of my fibroids? How long can these fibroids be managed without going for surgery? Which is better, going for pregnancy now or wait till the treatment of the above problems? Which kind of protection should be used to avoid pregnancy now? Which option is better among operating fibroids before pregnancy and operating fibroids after a failed pregnancy, and operating fibroids after delivery in this case? Should I take the medicines Valest 2 mg (six tablets a day for five days) and Regestrone 5 mg (three tablets a day for five days) given by the doctor in prescription?
I am looking forward to your reply. Thank you.
Welcome to icliniq.com.
I understand your concern,
1) You have bilateral polycystic ovaries that causes hormonal imbalance which leads to irregular periods.
2) There are three fibroids which are of significant size, one in the anterior wall, one in posterior wall and one in the fundus. These require treatment as they will affect the fertility later.
3) Thin endometrium means the lining of the uterus is thinned out (not the uterus itself) other than that your scan is fine.
Now to answer your questions,
1) The treatment plan has to be three fold to treat the polycystic ovarian syndrome, treat the thin endometrium, and the fibroid.
2) There are many options but the treatment depends on the symptoms the patient presents.
3) No other tests or diagnosis is required as these are benign masses.
4) Polycystic ovaries have to be treated with combined contraceptive pills along with life style changes like exercise and diet. The contraceptive should have antiandrogenic properties like Krimson 35 (Cyproterone Acetate and Ethinyl Estradiol) or Dronis (Drospirenone and Ethinyl Estradiol).
5) It so wise to go for surgery, especially the minimal invasive surgery suggested by your doctor to remove only the fibroid (laproscopic myomectomy) because in future this will cause problems in conceiving.
6) Fibroids can be managed medically, but when fertility is in question it is better to go for surgery, otherwise it will require serial monitoring and medication which may not work even.
7) Waiting till you sort out all problems espcially the fibroids will increase your chances of a sucessful pregnancy. With fibroid there is a chance of miscarriage.
8) The combined contraceptive pill which will be prescribed for pcos will also act as a barrier against pregnancy. Also use of condom is always recommended in combination with other forms.
9) Operating fibroids before pregnancy is better as during pregnancy the fibroid becomes vascular and bleeds a lot. Laproscopy before pregnancy is the best option.
10) Kindly take the medication prescribed by your doctor, it will help to induce your period and also ask if you need to start oral contraceptive pills after your periods start.
I hope this was helpful. Regards.
Thanks for the detailed reply.
I want to take medicine to treat all the problems due to the current pandemic situation and wait for the pregnancy for some time. So which medicine should I take for the treatment of PCOS, thin endometrium, and fibroid? What should be the dosage and duration of the above medication?
I am looking forward to your reply.
Welcome back to icliniq.com.
I cannot provide you a prescription for medication without a video consultation. But for now, you need to take the Valest (Estrogen) 2 mg. This will help thicken your endometrium and Regestrone (Norethindrone), which will lead to the shedding of the thickened endometrium. So that once you stop, you will get your withdrawal bleed (usually occurs within seven days of stopping Regestrone). Once the bleeding starts, on the second day, you will need to start pills. So kindly get back to me on the first day of your period. Meanwhile, kindly get your thyroid profile and fasting blood sugar and fasting insulin levels checked (to diagnose insulin resistance in polycystic ovarian syndrome patients). I hope it was helpful.
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