Is prolonged bleeding after Norethisterone normal?

Question

Hello doctor,

I did not get my period for three months, so I took withdrawal pills (Norethisterone) and started bleeding. It has now been 15 days, and I am still bleeding. The bleeding started with bright red blood that did not have any odor, but now it has a foul smell, and the color has turned dark red, almost brown, but not exactly. The flow had decreased for a while but has picked up again.

In addition, I have gained weight and developed acne. Something similar happened six months back, but that time I only missed one period, and my cycle returned naturally the following month. Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am here to help explain polycystic ovary syndrome (PCOS) in detail. The diagnosis of PCOS is typically based on the Rotterdam criteria, which requires the presence of at least two out of the following three features:

Oligomenorrhea (infrequent menstrual periods) or amenorrhea (absence of menstrual periods).
Clinical or biochemical hyperandrogenism (excess levels of male hormones, leading to symptoms like acne, hirsutism, or elevated androgen levels in blood tests).
Polycystic ovaries on ultrasound – more than 12 follicles in each ovary, with each follicle measuring more than 10 millimeters in size.

Recommended Investigations:

Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) on the second day of your menstrual cycle.
Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free Triiodothyronine (FT3).
Serum prolactin levels.

Management Plan:

Weight loss through a combination of a healthy diet and regular exercise.
Metformin 500 mg, to be taken twice daily (morning and night) for six months.
Dydrogesterone 10 mg (an oral contraceptive pill), to be taken starting from the 2nd day of your menstrual bleeding. Take one tablet in the morning and one at night for 21 days, followed by a seven-day pill-free interval. Then repeat this 21-day cycle, followed by a seven-day break.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.