How can I regulate my periods in PCOS/PMOS without Yasmin?

Question

Hello doctor,

I have PCOS/PMOS, hypothyroidism, and pituitary Cushing's disease. I am taking Yasmin, Glucophage 850 mg, and T4 150 mg. As I have to take Metyrapone for Cushing's, my doctor recommended stopping Yasmin.

But if I stop it, I do not have a period for months, and I get acne all over my body. What can I use instead of Yasmin in order to control PCOS/PMOS? Can I get it cured by removing the ovaries?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Metyrapone (Metopirone) is an orphan medication that holds the FDA approval (Food and Drug Administration) for the diagnosis of Cushing’s syndrome and is occasionally used off-label for short-term treatment of Cushing’s syndrome prior to surgery. Metyrapone prevents cortisol synthesis by inhibiting 11 β-hydroxylase, the enzyme responsible for the conversion of deoxycortisol to cortisol.

The restricted access and adverse reactions of Metyrapone are associated with increased androgen and mineralocorticoid production, which limits the use of this medication for the treatment of Cushing’s syndrome. It can cause a negative feedback increase of ACTH (adrenocorticotropic hormone), leading to acne, hirsutism, excessive male pattern hair growth, and hyperkalemia.

However, Yasmin (Drospirenone and Ethinyl Estradiol) is a low-dose sequential pill that has been given to regularize your cycles. They really do not actually affect the cortisol levels due to Cushing's, and they do not really interact with Metyrapone either. It is often associated with weight gain.

So, for that, you may opt for Ginnete 35 (combination of Ethinyl Estradiol and Cyproterone acetate) tablet monthly for the next 6 months to regularize cycles and balance hormones. There is no need at all for oophorectomy for PCOS/PMOS (polycystic ovarian syndrome/polyendocrine metabolic ovarian syndrome). It is never indicated. It can be controlled by medication as advised and revised now.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, I suggest Ginette 35. It is a nonsteroidal oral contraceptive pill and can be safely used. It will regulate your cyclical menstrual bleeding and will control the androgen, as well as keep your acne and hirsutism low.

Metyrapone, as I mentioned, is advised for long-term use as a treatment, but again, there have to be break cycles to disallow a negative feedback after prolonged usage for Cushing's. So, evaluation has to be made every six months, ideally in your case, with regard to ACTH (adrenocorticotropic hormone) and other hormone levels.

I hope this helps.

Take care.