Patient's Query
Hello doctor,
I am a 26-year-old, sexually inactive woman. My present weight is 169 lbs. I have PCOD (polycystic ovarian disease).
Two months back, I tried a weight loss medication, and my last period started on the 12th, two months before. First, I had to spot for ten days and started bleeding heavily after that, and it did not stop.
I consulted a local gynecologist a month later to stop my bleeding, and she suggested Regestrone (Norethisterone), 5 milligrams, one tablet daily for 21 days. My bleeding stopped after having Regestrone within six days. But unfortunately, I had missed Regestrone for three days and started bleeding again.
After consulting my gynecologist again, she prescribed me Regestrone 5 milligrams, two tablets daily for 21 days, to stop this bleeding. Even suggested pausing 500 milligrams as needed. It has been five days since I have been taking Regestrone 5 milligrams, two tablets daily, but my period has not stopped. Do you think my period will stop after taking Regestrone twice, or do I need to stop?
Please advise.
Hello,
I am glad you chose iCliniq for your medical-related queries.
I understand your concern and will try to help you with it.
The bleeding that started after missing Regestrone (Norethisterone) for three days is your withdrawal bleed, where the endometrial shed has started because you missed daily pills.
This endometrium cannot be repaired again by Regestrone once the bleeding has started. So stop Regestrone tablets and start Pause MF tablet (Tranexamic acid and Mefenamic acid) 500/250 twice daily for the next five days. These are antifibrinolytics and shall help reduce and further stop the bleeding.
Please increase your daily water intake to three to four quarts, as dehydration can further cause bleeding and weakness. Once stopped, then you should be started on a PCOD(polycystic ovarian disease) regimen for the next three cycles from day three of your next menses to control your PCOD-induced hormonal imbalance and anovulatory cycles, which are often the causes of prolonged spotting and menorrhagia thereafter in PCOD untreated patients.
Please follow up with your hormonal profile, thyroid profile, serum prolactin, and pelvic ultrasound to assess the severity of PCOD.
Thank you.
I appreciate your trust in icliniq.com and your giving me the chance to serve you.
Our goal is to prioritize your health and help you according to your preferences and needs.
Patient's Query
Hello doctor,
Thank you for the reply.
I will follow up with my reports.
Hello,
Welcome back to icliniq.com.
Ideally, bleeding is controlled in three to four days. But please ensure that the difference between each dose is never more than 12 hours. If the bleeding has increased, you can take it three times a day for the next two days, i.e., every eight hours, one tablet, pause for 500.
For the third day, switch back again to twice a day. For the next day, depending on the response. Ideally, this should stop the bleed. You can continue the dexorange iron supplementation for the next 15 days. It shall help improve hemoglobin.
Once the bleeding stops, you will be required to get an ultrasound pelvis done to check for endometrial thickness, and if it is less than 5mm(millimeters), you can be started on a PCOD (polycystic ovarian disease) regimen with a low dose of pills and myo-inositol supplementation for controlling PCOD.
You may follow up with your USG(ultrasonography) report for a prescription for PCOD. Presently, increase the pause to 500 to thrice a day dosage. Keep yourself well hydrated and just avoid stressors, which can decrease the effect of these tablets.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
As you suggested, I have increased my dosage of Pause 500 from two tablets daily to three tablets and have been taking three tablets daily at an eight-hour interval for the last two days.
Today is my third day with three tablets of Pause 500. Today, I have taken two tablets of Pause 500 and will take the last dose at night. After taking Pause 500 three tablets daily, my bleeding surely reduced. Since this morning, my bleeding has suddenly increased a lot. I am under complete bed rest, but still bleeding has increased.
Do you think I should continue with Pause 500, three tablets daily, for a few more days to stop my bleeding? I think it won't stop by today. Today is my fifth day with Pause 500. I took two tablets daily for the first two days and am continuing with three tablets daily for the rest of the three days until today.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
I received your follow-up just now. Has your bleeding stopped by now?
If yes, then you can be started on PCOD regimen with low-dose OC pills and Myoinositol supplementation. I feel a repeat ultrasound of the pelvis shall be required to check for the endometrial thickness of the uterus now.
Kindly reply.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
As you advised, I have increased my dosage of Pause 500 to three tablets daily at an eight-hour interval for the last two days. Today, I have also taken two tablets of Pause 500 and will take the last dose at night. Taking three tablets of Pause 500 daily has surely reduced my bleeding.
Since this morning, my bleeding has suddenly increased. Do you think I should continue with Pause 500, three tablets three times daily, for a few more days to stop my bleeding, as I think it would not stop by today?
Today is my fifth day of taking Pause 500. I took two tablets daily for the first two days and am continuing with three tablets today. I will surely follow up with my medical reports after my period stops.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
The bleeding has reduced in the last two days with the thrice-a-day dosage, so it is suggested that you continue with the thrice-a-day dosage for two more days and then switch to twice a day until the bleeding stops.
I would suggest that you switch to PAUSE-MF (500/250mg), which is Tranexamic acid and Mefenamic acid in combination. It will work better than a plain Tranexamic acid tab (Pause 500 alone). Mefenamic acid is an NSAID (non-steroidal anti-inflammatory drug) that would help the antifibrinolytic (Pause/Tranexamic acid) work better, and you will get early results.
Please mention how many sanitary pads you have changed each day over the last three days; that will help me account for the amount of bleeding.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
As per your information, the day before yesterday, when I started with Pause 500 three tablets, that day there was huge bleeding where I had to change pads after every three hours, and there were also clots and lower abdominal pain. Yesterday, till evening, I changed pads after every four hours, and there were clots.
But after that, my bleeding surely reduced a lot, and since yesterday, I have changed only two times. But today morning when I took my first dose of Pause 500, my bleeding suddenly increased, and I am changing pads every four and a half hours. There are no more clots obtained today, but often, there is pain in my lower abdomen.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Bleeding shall reduce. Switch to Pause-MF immediately. Mefenamic acid will take care of the pain as well. Again, reiterating the fact that keep yourself well hydrated.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
As prescribed by you, I switched to Pause MF, and my bleeding stopped after three days from that day. Now I am feeling much better as bleeding has fully stopped, and I am really very grateful to you for your help and support during my illness.
As you suggested, I have performed my USG (ultrasonogram) test and some blood tests, but I have also performed a USG of the whole abdomen, as I last had one done six years ago.
I am sending you the photo images of all my test reports so that you can help me start with my PCOD regimen. Again, to remind you that I am allergic to certain drugs like PAN D, Norflox, Nortini, and Cifran CT. I am continuing with Dexorange iron tablets as you suggested.
Thank you.
Hello,
Welcome back to icliniq.com.
I have gone through the reports.
It confirms PCOD with mild hepatomegaly and low ferritin levels with anemia. You should be starting on the PCOD regimen from now.
1. Tablet Ginette 35 (Ethinyl Estradiol and Cyproterone combination) once daily for 21 days.
2. Tablet Ovabless-Myo (Myo- Inositol, D- Chiro- Inositol, Chromium, and Vitamin D3)once daily for 30 days.
3. Tablet vitamin D3 60K IU(International units), one tablet once a week for 4 weeks.
4. Sypup Evaton -N (Estriol) 2 teaspoon once daily for 30 days (Olcare Pharma)
5. Tablet Dexorange (Ferric Ammonium Citrate IP 160mg) twice daily for 30 days to restore serum ferritin levels and improve hemoglobin.
After 21 days of Ginette 35, wait for the menses to arrive, and then start the next pack from day three of your menses. A total of 3 packs per 3 cycles have to be taken. Otherwise, myo and syrup Evaton-n will continue regularly for three months. Avoid oily, spicy, fried, and fast foods. Drink eight to 10 glasses of water daily. Brisk walk for 45 minutes daily.
Practice the regimen, and it will help you regularize your menses and control PCOD.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I will surely take the medicines you prescribed. But it is to inform you that I am not getting the Evaton syrup in my city. Is it possible for you to change the medicine? Can you suggest any alternative medicine other than Evaton Syrup? That would really be of great help to me—another thing I want to ask you about is my stretch marks.
Due to my overweight body, I have stretch marks in many parts of my body, like my hands, chest, and tummy. I had used Bio Oil for about two months, but did not get many satisfactory results. Is there no treatment for stretch marks other than laser therapy?
Thank you.
Hello,
Welcome back to icliniq.com.
If Evaton N (Estriol) syrup is not available, then you can instead opt for syrup Amycordial for 30 days, two teaspoons. Stretch marks can be treated usually by pregnancy application of bio-oil. However, obesity and then a sudden loss of weight.
The collagen loss of skin can cause these stretch marks, so collagen-based moisturizers have shown some promise, but still, encouraging results have been obtained by laser therapy.
Regards.
Patient's Query
Hello Doctor,
Sorry to disturb you at this time.
As suggested by you, I have been taking Ginette 35X, Tablet Ovabless Myo, Deoxorange, and vitamin D as prescribed by you for one week. Though I have not started taking Amycordial syrup, but will start taking it soon.
Sir, this is to inform you that now I am on an outing and am having frequent loose motion, acidity, and abdominal pain. Does tablet Ovabless myo lead to these side effects? If yes, then can I stop tab ovabless myo for some days till I complete my tour?
I don't want to stop taking Ovabless myo completely as I don't have a problem with loose motion when I reach my home. I will continue with Ginette 35X, Dexorange, and vitamin D throughout my tour.
Thank you.
Hello,
Welcome back to icliniq.com.
Loose motions are not a side effect of Ovabless -Myo. The likely cause is probably infectious either water or outside food intake.
If there is no fever, then you can opt for conservative management of diarrhoea with supplementation of water loss with ORS (oral rehydration solution) sachet (one sachet in one litre of water). You can opt for a short course of tablet Oflox-Oz (Ofloxacin and Ornidazole combination) twice daily for 5 days to control diarrhoea, which is an antibiotic. There is no need to stop Ova bless-Myo.
Regards
Patient's Query
Hello Doctor,
Thank you for your advice.
I will not stop Ovabless - Myo (Myo- Inositol, D- Chiro- Inositol, Chromium, and Vitamin D3). I am allergic to certain drugs like Norflox (Norfloxacin), Nortini (Norfloxacin and Tinidazole), Pan D (Pantoprazole), and Cifran CT (Ciprofloxacin and Tinidazole). So, will there be any problem if I take Oflox OZ (Ofloxacin and Ornidazole)?
Thank you.
Hello,
Welcome back to icliniq.com.
In that case, you can opt for tablet Cefi-O (Cefexime 200mg + Ornidazole 500mg ) twice daily for five days. This shall help. Continue ORS (oral rehydration solution) fluid supplementation, and you should be fine.
Take good care regarding food and water hygiene during your tour to avoid recurrence during the trip. Continue on PCOD (polycystic ovarian disease) regimen as advised.
Regards
Patient's Query
Hello Doctor,
This is to inform you that I am now taking my third packet of Ginette 35X capsules. As prescribed by you, I should be taking Ginette 35X till my third cycle for PCOD. I am also taking Ovabless myo and Evaton syrup along with Ginette 35X. What will I do when I finish this third packet of Ginette 35X? Will I stop taking Ginette 35X after that and continue with Ovabless myo and Evaton syrup? There is good news that after taking these medicines, I have lost five kg in two months. When I consulted with you, my weight was 77kg, and now my weight is 72kg, though I have not maintained a proper diet every day. I am happy.
Hello,
Welcome back to icliniq.com.
It is good to learn that you have lost five kgs (kilograms) (11 pounds). That is nice to hear, but diet, exercise, and water intake are the key to treatment for PCOD (polycystic ovarian disease), so maintain that strictly.
After this third cycle of Ginette 35 (Ethinyl Estradiol and Cyproterone), once you get a withdrawal bleed of the cycle after finishing Ginette, we would stop all medications completely for next month and allow your menses to arrive naturally for next month.
If it does, then the break from medicines continues for another cycle, and if they too arrive on time, then treatment would not be required further, but you should be maintaining your diet, weight control, avoidance of fried and fast foods, exercise, and water intake to maintain regular cycles.
Hence. PCOD is like diabetes, a lifestyle disease; the less you control yourself, the more it will flare up anytime. Ovabless-Myo (Myo- Inositol, D- Chiro- Inositol, Chromium, and Vitamin D3) and Evaton syrup too shall be stopped along with Ginette. Just complete the total 90-day dose of theirs, i.e, three months.
Regards
Patient's Query
Hello Doctor,
Thanks, doctor, for your advice. This means after this cycle of Ginette 35 X, I will stop this medicine and wait for one more month to see if my menses occur naturally and continue with Ovabless myo and Evaton syrup till a month's course. I will try to maintain my diet, but you know, doctor, I gain weight very easily. If one or two days I am unable to control my diet, my weight increases drastically, and it becomes very difficult for me to reduce it. When I stop these medicines, my weight will again increase rapidly. So my request to you is, can you please suggest to me some medications that will help me control my weight along with diet and exercise? Please...
Hello,
In that case, just continue Ovabless-Myo (Myo- Inositol, D- Chiro- Inositol, Chromium, and Vitamin D3) and Syrup Evaton-N (Estriol) for another month, a total of four months since the start, after stopping Ginette (Ethinyl Estradiol and Cyproterone). Diet is primary, and you have to follow it. You will not gain weight if your water intake remains 10 to 12 glasses a day and you completely avoid oily, fried, spicy, and fast foods.
Eat healthy green veggies, including microgreens, and citrus fruits. prefer roasted fish or chicken, instead of curry-based dishes.
Try to maintain a 2000-kilocalorie or 1800-kilocalorie diet. I am attaching a diet plan for you to follow, and it will be helpful for you. I am sure you would follow religiously if you are motivated to stay healthy and get rid of PCOD (polycystic ovarian disease).
Regards
Patient's Query
Hello doctor,
This is to inform you that I am taking the medicines regularly as suggested by you. But for a few days, I have been feeling quite weak and having a little dizziness. Today I was not feeling well, and just now I measured my BP through the Omron digital pressure machine, and my BP came down to 96/53. Is it anything to worry about?
Hello,
The blood pressure is low indeed and is the likely cause of your feeling weakness and dizziness. This is not the side effect of medicines. You need to improve your water intake and, if possible, take a satchel of ORS (oral rehydration solution) in a liter of water and drink it over the next hour; this should help improve your blood pressure and improve your symptoms. If the body ache is present, then you may opt for an NSAID like Tablet Crocin 650 (Paracetamol) single dose start. I am attaching the diet plan with this. Last time it did not get uploaded.
Regards
Patient's Query
Hello doctor,
It has been one week since my period stopped after taking Ginette 35X. This was my third and last cycle of Ginette 35x. Now, from today morning, my period has again started. Now, I am only taking Tablet Ovabless myo and Evaton syrup. What do I do, doctor? Should I let this period complete, or should I take a Pause MF?
Hello,
This is likely a mid-cycle bleed or ovulation bleed, which is usually darkish brown in colour and less in flow. It would be important to learn how much has been your weight lost since last month.
If the bleeding is more than two pads in a day, then you can start Pause MF (combination of Tranexamic acid and Mefenamic acid) one tablet twice a day for two days; otherwise, if the flow is less, then you may opt out. After your bleeding stops, please get an ultrasound pelvis and review. Are there weight loss present?
Please mention.
Patient's Query
Hello doctor,
Sorry for the late reply. Actually, today I was busy with some of my personal problems, so I could not reply. Yes, doctor, since last month I have lost at least two kg. Today, my bleeding was like the third day of my period cycle, and I have changed pads two times today.
Hello,
In that case, you may use Pause MF (combination of Tranexamic acid and Mefenamic acid) twice a day for three days, and this is irregular shedding.
You may have to start Ginette 35 (Ethinyl Estradiol and Cyproterone combination) again for another three months after the review of the USG (ultrasonogram) pelvis to learn the status of ovarian volume. The weight loss is less, as you too would understand.
Stress has to be tackled at your end, as it can easily derange your hormonal balance. So, once bleeding stops, get an ultrasound and if the volume of the ovaries is more than 10cc, then you would have to start Ginette again, along with Ovabless-Myo (Myo- Inositol, D- Chiro- Inositol, Chromium, and Vitamin D3) to continue for another three months. Evaton (Estriol) syrup can be stopped. Weight loss should be focused on.
Regards
Patient's Query
Hello doctor,
This is to inform you that my last period cycle ended month's end after taking a Pause MF as suggested by you. That was my period, which started one week after the last menses ended. Unfortunately, from today again my period has started. I am now continuing with ovabless myo tablets only. What do I do now? Will I start taking Pause MF tablets to stop this period?
Hello,
This is likely breakthrough bleeding. You need to get an ultrasound done by tomorrow. You can take a Pause MF for today to stop the bleed and then get the USG done. You may have to start Ginette again post-ultrasound, depending on endometrial thickness and ovarian volume.
Regards
Patient's Query
Hello doctor,
My period has stopped after having Pause MF. I have performed my USG of the lower abdomen. I am attaching here the photo image of my USG of the lower abdomen report. Will I have to start with the Ginette 35X tablet again? Then for how many cycles? Do I have to take Ovabless Myo also along with the Ginette 35X tablet?
Hello,
I am afraid I do not see any ultrasound report being uploaded. Please upload the report and pictures for an opinion. Also, please mention your present weight. Last I learnt, it was 72 kgs (158.7 pounds). I hope you are following the diet chart that I had sent you.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Sorry doctor,
Now my weight is 73kg (160.9 pounds). This is because i was in stress and stayed in a hotel for about six days, and had to eat spicy and oily hotel food. For this, I gained 2kg (4.4 pounds) in weight, and my weight became 74kg (163.1 pounds). But now, when I came back home and followed a proper diet, I have lost 1kg and am now weighing 73kg. I will surely now follow the diet as you say, as I am now home.
I am uploading my USG report. Last time there was a network problem, so it could not be uploaded. Sorry for the inconvenience.
Another thing I want to ask you, doctor, you know, since the last few months, my complexion has been growing darker. Yes, I have to go out in the sun every day during the summer. I use Lakme SPF 50 sunscreen, umbrella, but still I can not prevent this darkening of my skin tone.
I had consulted a dermatologist and am using Glyco A cream every day ,and even apply turmeric and chandan paste about four days a week before bath, but still there is no significant improvement in my darkened skin colour. Can PCOD lead to skin darkening?
Hello,
As I can see the report, the endometrial thickness is 5.1mm, which is low for the day of your cycle, and both ovarian volumes are still more than 10 cc, even in the proliferative phase, which does indicate that PCOD persists and has reduced over the last four months. You would have to continue on Ginette 35 again with Ovabless Myo again for another three cycles now, along with dietary restrictions, plenty of water, and moderate exercises.
As far as pigmentation of skin is concerned, yes, PCOD per se increases melanin content of the skin and also relative testosterone levels, thus causing acne, acanthosis nigricans ( darkening of skin). So I would say continue with SPF 50 in sunlight along with PCOD regimen. However, the turmeric and chandan paste would act as an antiseptic and is unlikely to bring a glow to the skin. But increased water intake and better skin blood circulation can rejuvenate the skin faster and help reduce melatonin by actually acting as an antioxidant.
Regards
Patient's Query
Thank you, doctor, for your advice.
Yes, doctor, I had pimples on my skin before. But after taking Ovabless myo and Ginette 35X, all my pimples are gone, and I have gained a glow on my skin after taking these drugs.
Hello,
Laser treatment offers a permanent solution for removing tattoos and birthmarks, but not so for treating tan and melasma. In laser treatment, the concerned skin is exposed to a concentrated beam of light. Due to its high energy, the excess melanin is broken down and dispersed by the natural immune system in the skin. As a result, healthier and brighter skin appears. This treatment is also known as laser peel or laser-abrasion. The laser treatment helps in effectively reducing concerns like skin pigmentation, dark spots, sun tanning, dull skin etc, However, in your case, I would suggest getting treated for PCOD first and controlling your hormones, which too would help bring in your natural skin tone and reduce skin blemishes and tanning. If the results are not satisfactory, then later you can keep laser lightening as an option.
Regards.
Patient's Query
Hello doctor,
This is to inform you that now I have finished my three cycles of Ginette 35 X as suggested by you last time, and am continuing with Ovabless myo tablets. My menses after this last cycle of Ginette started yesterday. Doctor, this month, I am travelling to the places that I visited last time and had severe diarrhoea. I could find no other option than this travel agency, as we had problems with dates with other travel agencies. So, as a measure of safety, can you recommend some antibiotic medicines for diarrhoea in case I fall sick from taking bad quality food and water supplied by this travel agency?
Also, doctor, will you please recommend me some anti-vomiting medicines when I have to travel a long distance by bus, as last time when I travelled, the Avomin tablet did not work for me. I had taken an Avomine tablet two hours before my bus journey, but still I vomited when the bus took turns during the journey in the hilly region, and the tour managers and others were angry with me. Last time it was really a very bad experience for me and my family with this travel agency. We received no help from them when we were sick throughout the journey. I am allergic to certain drugs like Norflox, Nortriptyline, Cifran CT, and Pan D.
Hello,
Welcome back to icliniq.com.
It is good to know that you have completed three cycles of Ginette (Ethinylestradiol and Cyproterone acetate combination) now. How have you been feeling with your menses, acne and weight?
You have not mentioned anything. This cycle would be a break from Ginette. Continue and finish Ovabless Myo. During the trip,
Regards
Patient's Query
Hello doctor,Thank you for your reply.
Yes doctor I have finished my last cycle of Ginette. At first I had reduced much weight when my weight came down to about 71kg (156.5 pounds) from 73kg (160.9 pounds) but a few days ago, it was my birthday and there was a party at my home and I ate to my hearts content for which my weight increased about 800gm (1.76 pounds) and now my weight is 71.8kg (158.2 pounds). You know doctor, I gain weight very easily.
When I follow a proper diet my weight rapidly gets reduced, then as soon as I stop following the proper diet my weight increases rapidly. One day if I eat only one pastry or a chocolate the next day I put on 500gm (1.1 pounds) of weight. Now when I am going on an outing I will again gain weight for taking the oily food supplied by this travel agency.
Regarding my pimples, one to two pimples have come out on my face.
Another thing I want to ask you doctor i.e. my mother is a patient of hypertension and she had a hysterectomy operation done a long time ago. She takes olmezest CH 20 for hypertension and is not allergetic to any drug. As she is also travelling with me in this tour, so can she also take the anti vomiting and anti diarrhoea medicines recommended by you for me?
Hello,
You may use Ginette for another month, and it would keep you tension-free with regards to menses, but take a break next month for sure. For your mother, you may use the same meds if required for nausea and diarrhoea as advised to you. As far as food is concerned, you need to consciously make an effort to avoid junk and oily food to keep your weight in check. Also, your prime motivation should be water intake. Please get an ultrasound pelvis during this cycle after 15 days to evaluate the status of the ovaries and review. Regards
Patient's Query
Hello doctor, This is to inform you that I have finished my last cycle of Ginette 35 and it's been one week that my menses have stopped. As suggested by you I have performed my USG of lower abdomen and am sending you the photo images of my report. Now my weight is 71kg (156.5 pounds) and I have stopped taking both Ginette 35 and Ovabless,Myo tablets. Do I need any further medications for PCOD? Another thing I want to ask you doctor that is my blood sugar level has nearly come to borderline and now I am having 102 fasting sugar level. Many members of my family are diabetic so now I have completely stopped taking sugar in my food as well as tea. But I eat sweets twice a week so that my sugar level does not fall. I want to know:
Hello,
As you have already completed the course for PCOD, its time for break. Wait for your cycles to arrive naturally. I am afraid I do not see any images uploaded at your end for comment. However, with weight reduction and decrease in sugar levels, things should have improved.
I don't agree to your habit of eating sweets twice a week for it simply nullifies your efforts with sugar so cut down in terms of calories eaxh day to control sugar levels.
The diet planned i had shared earlier was apt for the same. Maintain a menstrual calendar for next three cycles and continue exercising and diet restriction. please attach your latest USG images and even the report for evaluation.
Thanks
Patient's Query
Hi,
I have seen the reports. The endometrial thickness and the ovarian volume is near normal now. Ideally the volume should be less than 1cc (cubic centimeter) of each ovary, but its much better now. So stop the meds for this cycle and maintain a menstrual calendar for next three months.
Lifestyle modifications to continue along with exercise and water intake. You may follow up if you miss your next menses by more than 15 days. Please be strict with your lifestyle.
Regards
Patient's Query
Hello doctor,
My menses are going on. This is my second period cycle from the last time I consulted with you. My first mense cycle after stopping Ginette started on 1 month back and the cycle lasted only for two days and the bleeding was very less.
My second period cycle has started from today, after 17 days gap. From today morning, my bleeding was normal, but since evening my bleeding has increased a lot, where I am having to change pads after every 2.5 hours.
I am also getting very big sized clots. Before this huge bleeding, there was pain in my lower abdomen and even back pain was there. But now the pain is not there. The clots are about the size of a marie biscuit and even quite thick. I am really very scared.
Will I let this bleeding continue or will I switch to Pause MF?
I have a job exam on Saturday afternoon, so I am getting more tensed seeing this huge bleeding.
Hello,
The present bleed is a mid cycle bleed typically heavy indicating that you have not ovulated again and there is endometrial shedding occurring which are heavy clots. You should be starting on Progesterone for next 10 days to allow this endometrium to venture into secretory phase . This would stop the bleed and also the clotting.
Start one tablet Deviry (Medroxyprogesterone acetate) 10mg twice a day for next 10 days. Also you may take Pause MF tablet twice a day for three days to control bleed. The next cycle shall occur after ending 10 days course of Deviry.
Regards
Patient's Query
Hello doctor,
I am consulting with you after quite a long time since my last consultation. My third cycle of menses has ended about 8 days ago. I had my three mense cycles after stopping Ginette 35. I did not take pause MF or tablet Deviry as suggested by you last time as my bleeding decreased automatically for my second cycle after I had consulted with you last time.
Now, I am facing a health issue so I am consulting with you. Now my weight is 71kg (156.5 pounds). My weight had increased to 73kg (160.9 pounds) once during my menses.
Since last five days, I am having a protein supplement for weight loss. Its name is Herbalife, which comprises of a tea, a formula 1 powder and a protein. These are usually meal supplements. I have used this product for five days and have lost 2 kgs (4.4 pounds) weight. I have purchased this product from a Herbalife distributor near my house.
Now, everyday in the morning in empty stomach I take this Herbalife tea. After that I skip breakfast and take their protein shake comprising of this formula 1 and protein powder . Then I take early lunch comprising of rice, 2 types sabzi, fish, salad. After that I am taking a guava or popcorn or 2 cookies if I feel hungry. I am taking early dinner by 8.30pm comprising of 2 roti and 1 type sabzi as they have asked me to take animal protein once in a day. After that at about 11.30 at night I again take their protein shake. This diet plan was suggested to me by that Herbalife distributor.
But this product is nearly draining me away. My BP has come down to 90/50 after taking this product. I am feeling quite weak and drowsy. After taking this product everyday I am having stomach pain, backpain. There is also pain in my lower tummy, in my uterus portion, and even kidney area.
Today I took ORS water as my BP was 90/50 about two hours ago. I had informed that Herbalife distributor about my health issues after taking this product, but she is saying nothing to worry.
My mother is very angry on me as I am taking this product for weight loss.
Hello,
I would just suggest stop their protein shake completely but you can stick to the diet plan as it's healthy. Instead of tea which they offer increase your water intake with electrolytes supplementation twice a day with ORS fluids. This would keep your dehydration away and undue abdominal cramps as well. Herbal life has been heavily promoted but it's not a product of choice among medical fraternity.
Regards
Patient's Query
Hello doctor,
I am really quite tensed since last few days because of this serious case of COVID 19 in our country. Our maids are not coming since last 10 days and the whole workload is on me and my mother. I am always in contact with water as I have to wash utensils, sweep the house and many other household duties. I am having a little cold and dry cough since last few days.
Yesterday I even had about 100 degree F fever and I took Calpol. Then my fever came down to 99.2 F in the evening. Today in the morning, my body temperature was normal, 98.5 F, so I washed utensils and took bath in hot water and my body temperature again became 100 degree F. Then I again took calpol and my body temperature reduced to 99.6 F. I am very tensed.
I have not shared the news of my illness to anyone as they will create a hue and cry about it and may even call police. I dont have breathing trouble or pain in my throat. I am also quite energetic now. I think this illness of mine has occurred due to work pressure at home as I am not habituated in doing so much work.
As for your information me and my family has never been outside in last few months. We have also not been in contact with any person who has made any foreign tours. We have also not gone to any social gatherings in last two months. We had gone to market near our house sometimes. But all these news channels are making me paranoid. I think I am becoming more sick out of tension.
Yesterday I could not sleep throughout the night out of tension. I dont know how come am I having fever as I am sweating a lot. I am allergic to certain drugs like Pan D, Cifran CT, Norflox, Nortini.
Please help.
Hello,
You need not panic at all. If there has been no contact with a possible COVID-19 suspect or any travel history, then chances are low again if you are strictly following the lockdown. Nextly, exertion in itself can cause rise in body temperature with exhaustion.
The fever can be because of a possible urinary tract infection even which would need evaluation or just due to upper respiratory tract throat infection or pharyngitis . Keep your water intake high to keep well hydrated to boost immunity. Strictly follow quarantine and eat healthy. If the cough headache and fever persists, then you may need to be evaluated.
Regards
Patient's Query
hello,
Good to hear from you,
Regarding the white discharge per vaginum , the most common reason which is seen in most women is when they use some chemical soaps like Dettol, Cinthol or any other bathing soap to clean the vaginal area. Ideally, this should be strictly avoided and nothing but plain water should be used .
However, if the vaginal discharge is persistent then you should go for using alkaline vaginal wash like V-wash or Intowash to clean both externally and internally. This would surely help.
If the discharge is accompanied with foul smell, then there is an element of bacterial infection as well and then you shall need a short course of antibiotics for seven days at least. Nextly regarding anti-aging, antioxidants should be used to clear the free radicals from under the skin. Ideally speaking water is the best anti-oxidant, so its intake should be liberal and three to four liters per day is mandatory. Also you can opt for vitamin C (10 mg one tablet twoce a day for 15 days) and D3 supplementation (one tablet once a week for 8 weeks) along with B-complex capsules (1 tablTAB TWICE A DAY for MONTH) along with CAP EVION ( VITAMIN E 400MG ONCE A DAY FOR 15 DAYS). I hope this would help. Regards
Patient's Query
Hello doctor,It hasbeen quite a long time since I had consulted with you. As you know that I was suffering from PCOD and had irregular menses. I was put on some medications for PCOD by you. I was even quite oerweight. Now my menses have become quite regular and I am having my menses regularly every month. But you know I have again put on weight and now my weight is 72kg. This has happened as in this pandemic situation I am completely at home and there is lack of much activity. So, I have put on weight. I have purchased KETO tablets and am consuming them for weight loss.My recent problem is that itching is occurring in my vagina. The itching is prevalent mostly on the outside part of my vagina than inside. The itching is quite less in the inside of my vagine but it is immense on the outside of vagina. It maybe due to my panty, I cannot ascertain the reason. Now I am completely at home but still this itching problem has occured. I never had any sexual contact with anyone.I am regularly cleaning my vagina once with lactacyd vaginal wash during bath time but still this itching of vagina is prevalent. There is no bad odour from my vagina. Please help. I am allergic to certain drugs like Norflox, Nortini PAN D, Cifran CT.
Hello,
It is good to hear from you again. The fact that you have vulval itching despite using alkaline vaginal wash daily indicates that there is a possible external fomite that is causing this allergic reaction, possibly a fungal infection, as characterized by itching. it is recommended that you start using antifungal dusting powder each time after you use your washroom to keep the local area dry I which would help prevent any secondary growth of any fungal spore. You can use it 4 times a day for at least the next 7 days, and I am sure you will be helped. Please use cotton undergarments without lace to avoid any such vulvovaginitis infection. You can take a short course of tab itraconazole 200mg once for three days as antifungal therapy.
Regards
Patient's Query
Hello doctor, I have been consulting with you after quite a long time. If you may remember, then I was a patient of PCOD, overweight, and was put under the treatment of PCOD by you. You had prescribed me tablets Ginette 35X, tablet Ovabless myo, and several other medications for PCOD. After continuing these medications for about 6 months, my monthly period has become quite regular. They now happen every month. My last period occurred 2 months back. It has not yet occurred this month till now. My present problem is that for the last few days, I have been experiencing a sharp pain in my vaginal area. This pain occurs when I try to sit or during urination. It is hard to apply pressure during urination as I experience pain in my vaginal area. This pain occurs in the inside portion. Doctor, I swear I have never been in sexual contact with anyone ever. I am still unmarried. But you know, about 10 days a,o I went to the cinema hall to watch a movie, and after this, the pain started. I regularly wash my vaginal area with Lactacyd vaginal wash, but still, this pain is there. It is hard to apply pressure due to this pain. Also,o you know, doctor, I have not performed my USG of the lower abdomen for a long time due to this ongoing pandemic situation. But now I will definitely perform my USG test if you prescribe as the COVID situation is quite stable, and I have been vaccinated with 2 doses of the COVID vaccine(Covishield).
If I need to perform USG test then I will surely require a recent prescription from my doctor as here the clinics show patients mua ch attit,ude if we don't go without recent prescriptions for doing medic, al tests. Also, your prescription please prescribe me some blood tests along with USG test, and also ECG and ECHO test of heart if po, possible please. I have not performed any medical tests for a long time due to COVID. I will surely follow up with,h you with my medical reports. I am allergic to certain drugs like Norflox, Nortriptyline, PAN D, and Cifran CT. If possible, please provide me with an online prescription at my WhatsApp no. My age is 29 years. Regarding my weight, my present weight is 72kg. You know doctor I have been trying since long to reduce my weight but can't. I have stopped taking chocolates, pastry, ice cream, and fast food for a long. Time Itforrua a time I don't work out at all or go to the gym. Now I am completely at home and pursuing my dourse online and there is lack of much activity so that's why maybe my weight is not coming down. I am sharing my regular online course with you. In the morning for breakfast, I eat 2 besan chilla with ketchup or poha or upma or veg chowmein with omelette. At lunch, rice, 2 types of sabzi, one piece of fish curry, and raita. In the evening, I take 6 almonds, 4 walnuts, and 4 dates. For dinner, I eat 2 apples and Oziva nutritional meal shake for women. I have stopped taking white sugar completely. Instead, I take Sugarlite in foods. But in spite of this, my weight has been stuck at 72kg for a long time. Doctor, you know I really need to reduce my weight. Now I am quite aged, my mother is planning for my marriage, and in today's society, every groom wants a slim bride for himself. It will lead me to rejection by many.
Please help.
Hello, Thanks for the query, The symptoms appear that of possible Urinary tract infection relapse or there may be a vaginal cyst which is causing pressure while urination or you may have developed a bartholin cyst. You shall need a proper physical gynaecological examination to rule out the above. The weight being a concern in your case here. You need to start doing some physical exercise like brisk walking twice a day fro 45 min and keep your hydration status good to help you reduce your weight. It is suggested that you meet a dietician as well to help you control and reduce your weight. I have prescribed investigations. You may follow up with reports. Regards
The Probable causes
Investigations to be done
Regarding follow up
Patient's Query
Hello doctor, Thanks for your reply.
In order to perform these medical tests, I will require a recent prescription. Can you please send me a prescription mentioning these tests? The clinics hesitate to let patients perform medical tests without a proper prescription. I will definitely follow up with you with my medical reports. So kindly send me a prescription of yours so that I can perform the medical tests prescribed by you easily.
Hello, The prescription has been attached and its waiting approval from the website. We cannot connect directly with you on any other platfrm as its against the website policy. you shall get the prescription on this platform once it gets approved. Regards
Patient's Query
Hello, I have gone through the reports. It is good to see that ovaries have returned to their normal volumes and polycystic features are no more present. The remaining reports are normal except the urine analysis report. The urine report shows calcium oxalate crystals, which indicate that you have a propensity towards developing possible calculus or renal/ ureteric stones, so you have to increase your daily water intake and avoid dehydration as much as possible. The hepatomegaly is mild and not of concern here. The pain during menses can be controlled with Tab Meftal Spas three times a day for three days.
This is an antispasmodic which specifically helps during dysmenorrhoea ( painful periods). You have already undergone the tests and no further need of tests is seen here. I shall be sending you prescription for the pain relief. Maintain a menstrual calendar and keep drinking water. The weight reduction shall need exercises. Regards
Patient's Query
Hello,
You can add:
1. Tablet Biotin 10mg once a day x 60 days. ( Proanagen tab already has 5mg per tablet, which you are already on)
2. Tablet vitamin D3 60K IU once a week for six weeks. Back pain seems to be postural, and yes, weight here is definitely an issue. The issue that needs to be addressed by you sooner the better.
Regards
Patient's Query
Hello doctor, I am consulting with you after a long time. If you may remember, I had PCOD and was under treatment. After consultation with you and following your treatment, my cysts were gone, and my period was regularized. But since the last seven months, my period has again become irregular. My last period happened at a gap of three months, and for the last two months, I have not had a period. I even experience extreme pain and cramps during my period. I recently did my USG of the whole abdomen, and some abnormalities were found in the USG of the lower abdomen, like cysts, and my right ovary has even become enlarged. My weight has again increased a lot.
My current weight is 73 kg and height is 152cm. I do not eat much fast food or junk food. But whatever I eat, my weight keeps increasing. I am even having excessive hairfall. I feel tired seldom. I am still unmarried. Can these abnormalities found in USG of the lower abdomen, like an enlarged ovary, be cured by treatment? I am allergic to certain drugs like Norflox, Nortriptyline, PAN D, and Cifran. Kindly advise. I am attaching herewith my USG report.
Hello,
Yes, I can see that we have not spoken for a long time indeed. I have gone through your reports and would add that Pcod is back again, but considering your irregularity and tiredness, feeling of fatigue, and hairfall, it calls for evaluation of Thyroid profile and also serum prolactin levels. If possible, do a self-check and examine your breasts to see if there is any watery discharge from the breast nipples or not, as galactorrhoea, as well, can cause irregularity in cycles, which can be easily treated. In the meantime, I can offer you a withdrawal bleeding with progesterone to allow you to resume your menses. You may follow up with those reports as well, and from day three of your menses, we can start your PCOS cycle again for three months. For the pain, you may take an antispasmodic and increase water intake, as I always advised. Rx:- 1. Tablet Norgesterone 5mg twice for five days. You should get your menses in the next five to seven days after ending medications.
Regards
Patient's Query
Same symptoms don't mean you have the same problem. Consult a doctor now!
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