Can PCOS/PMOS and Phentermine cause heavy periods?

Question

Hello, doctor,

I have PCOS or PMOS. I just started my period yesterday, and it is heavy. I just want to make sure I am fine. Because a couple of years ago, I had to go to the ER with severe bleeding, and found that I had a 1.18-inch cyst on my ovary. Also, I am taking Phentermine medicine.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Thanks for sharing this. I understand this can feel scary. Let us walk through it carefully. You are dealing with PCOS (polycystic ovarian syndrome), now known as polyendocrine metabolic ovarian syndrome (PMOS), have a history of severe bleeding and an ovarian cyst, and you are currently on Phentermine. You are now experiencing very heavy bleeding during your period.

Here is the answer to your question: Is it normal to have heavy periods with PCOS/PMOS?

Heavy or irregular bleeding can happen with PCOS/PMOS due to infrequent ovulation. When ovulation does not happen regularly, the uterine lining can build up for a long time and then shed all at once, leading to heavier or prolonged periods. However, this does not mean it should be ignored, especially given your past ER (emergency room) visit.

Key warning signs to watch for (seek medical attention immediately if you notice):

Soaking through a pad or tampon every hour for several hours in a row.
Passing large clots (larger than a quarter or more than an inch).
Feeling faint, dizzy, or weak.
Shortness of breath or heart racing.
Bleeding lasting more than seven days.

About your history and risks: The 1.18-inch ovarian cyst is generally not concerning by itself unless it ruptures or causes pain. However, if the cyst is hemorrhagic (bleeding), it could contribute to your bleeding.

Phentermine is not directly related to menstrual bleeding, but it can increase blood pressure and heart rate, so if you are feeling unwell, lightheaded, or have a rapid heart rate, that could be more concerning.

I suggest you do the following:

Track your bleeding. Make a note of how many pads or tampons per hour, the size of clots, and how long it is lasting.
Hydrate enough and rest well.
Avoid NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen if you suspect cyst rupture, but they can help reduce bleeding if that is not the case (best to ask your doctor).

You should go to the ER or urgent care if:

You are soaking a pad every hour.
You are passing large clots frequently.
You are feeling faint, dizzy, or unusually tired.
The bleeding feels similar to your previous ER episode.

Consult a gynecologist about possibly using hormonal therapy to regulate bleeding (for example, birth control, progesterone). To check if the cyst has changed, they might also advise an ultrasound to reassess the ovaries and uterine lining.

Follow up with me if you would like help drafting questions to ask your doctor, or want to track your symptoms in a specific way to show them. I can help you with that.

I hope this helps.

Thank you.