At 46, do psoriatic arthritis symptoms worsen with time?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I have gone through your query and your reports, and as I can see, your serum prolactin, LH, and serum testosterone levels are high. Additionally, you have mentioned that you are an established case of polyendocrine metabolic syndrome (PMOS, the current name of PCOS). However, there is no ultrasound report attached, which is mandatory for confirmation. You are trying to conceive naturally, and as I can see, you are relying on MPA 10 mg for your menses. There are so many things that you are doing wrong.

You are 23, and you wish to start on letrozole (a prescription aromatase inhibitor) 5 mg for ovulation induction once you plan to get your menses after the MPA (medroxyprogesterone acetate) tablet, as I understand. You have irregular anovulatory cycles; you are not ovulating regularly. The present menses, which you experienced after months, were likely scanty and darkish brown in color and may have even contained clots, indicating anovulation again.

You need to get an ultrasound of the pelvis done first to check if you have enlarged follicles already in the form of ovarian cysts, because taking letrozole blindly on your own can even lead to an emergency called OHSS (ovarian hyperstimulation syndrome). Also, your prolactin levels must be lowered before any ovulatory drugs can be suggested, or your trial on your own will be futile.

Things important in your case for a natural conception:-

• Normal husband's semen analysis report.

• Normal prolactin

• Normal testosterone levels and regular healthy cycles with healthy pinkish non-clotting flow

• Normal ultrasound.

Ideally, treat PCOS first to regularise your cycles, then try for natural conception; however, even after your efforts, results may not be achieved.

Therefore, get these blood tests done too.

I hope this information helps you.

Take care.

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I have carefully reviewed the ultrasound images you shared. Based on what I can see, here are my impressions:

Diagnosis of polyendocrine metabolic ovarian syndrome (PMOS). Both ovaries are polycystic with multiple small follicles in each ovary, and the volume of each ovary is> 10 cc, which supports the diagnosis of PMOS.

There seems to be free fluid in the pouch of Douglas. This finding can suggest a chronic vaginal infection that has progressed to pelvic inflammatory disease (PID). Do you have a foul-smelling, thick, white curd-like vaginal discharge that is worse after intercourse? Your answer is important because a mixed vaginal infection needs prompt treatment. Untreated pelvic inflammatory disease can affect fertility and create an environment that is not friendly to sperm survival. This infection should be treated before ovulation induction or an attempt at conception by natural means.

The ultrasound also suggests that your uterus is enlarged and has features of adenomyosis. Adenomyosis is a condition in which tissue similar to the lining of the uterus grows in the muscular wall of the uterus. It is closely related to endometriosis and can cause changes in the uterine muscle, resulting in the endometrial lining appearing irregular on ultrasound. The endometrium is not trilaminar, is not well-defined, and is generally considered more favorable for embryo implantation.

Considering the findings on your ultrasound scan, I would recommend that these conditions be treated before you plan to become pregnant. The management order would be as follows:

• First, treat the pelvic inflammatory disease and vaginal infection.

• If the high prolactin level is confirmed, it should be corrected.

• Start treatment for polycystic ovary syndrome.

If you wish, I can also guide you through a step-by-step treatment plan based on your ultrasound findings, symptoms, hormone levels, and your goals for pregnancy.

I hope this information helps you.

Take care.