No period for months with rapid weight gain. Please help.

Question

Hello doctor,

I am an 18-year-old female. I have a history of rapid weight gain over 3 months with severe stretch marks over the breasts, fullness around the face, and the upper body. At the time of blood work, I was taking a low-dose birth control pill (Blisovi 24 Fe) and a multivitamin and biotin. I continued taking biotin for some hair loss. But I stopped both after having my blood test. I did not get my period until now.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I just read your query. There are three differential diagnoses: drug-induced Cushing syndrome, polycystic ovarian syndrome, and pregnancy. For Cushing's syndrome, a 24-hour urinary free cortisol low-dose Dexamethasone suppression test is suggested; if positive, then a high-dose Dexamethasone suppression test is recommended. For polycystic ovarian syndrome diagnosis, an ultrasound of the pelvis, LH (luteinizing hormone), FSH (follicle-stimulating hormone) ratio, testosterone levels, and TSH (thyroid-stimulating hormone) are recommended. For pregnancy, a serum beta hCG (human chorionic gonadotropin) test is recommended. Once these tests are done, the diagnosis will be clear.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, if the offending drug has been stopped and still, the symptoms mentioned persist. The cortisol levels remain high, then it can still be Cushing's, and the type of Cushing's has to be identified using the low dose Dexamethasone suppression test and high dose Dexamethasone supression test as well to rule out the pituitary cause, adrenal cause, or ectopic cause. Also, alcohol consumption and PCOS cannot be ignored here.

I hope this clarifies your concern.

Please feel free to reach out if you have any further questions.

Have a great day ahead.