ADVERTISEMENT

Q. I am unable to reduce weight and have hormonal acne. Kindly help me.

Answered by
Dr. Thiyagarajan T
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Aug 22, 2021

Hello doctor,

I am concerned about a possible hormonal, adrenal, or thyroid issue. My gynecologist and PCP dismissed my symptoms last year, and I cannot see an endocrinologist until two months, but I would like to get healthier sooner. I included my current symptoms, medications, and last week's blood work reports.

I am a 30-year-old female of height 165 cm and weight 230 lbs. I am taking Spironolactone 100 mg per day (50 mg for three years, then raised to 100 mg three months ago).

In transvaginal pelvic ultrasound taken last year, there were no abnormalities reported.

My symptoms are difficulty in losing weight when eating 1200 calories a day (weighing portions), whole-body inflammation with joint pain that worsens when eating carbohydrates, edema in the lower legs and feet, hormonal acne, cold hands and feet, anxiety and irritability, an adrenaline rush or fight or flight panic every afternoon like clockwork between 3:00 to 7:00 PM that comes from my lower chest with no triggers, rash or hives on arms and chest, long light periods for two weeks on and two weeks off, and lower left pelvic or ovary pain during ovulation.

Kindly help me.

#

Hi,

Welcome to icliniq.com.

I understand your main concerns are that you are not able to lose weight, you have joint pains, edema, acne, cold hands or feet, and mood symptoms like anxiety, mid-afternoon panic attack-like symptoms, and irregular periods with pain during ovulation.

From the laboratory reports (attachments removed to protect the patient's identity) I gather, that you have slightly elevated TSH (thyroid-stimulating hormone), high total testosterone, and higher LH: FSH (luteinizing hormone: follicle-stimulating hormone) ratio, others in the normal range.

I need a bit more information:

1) Do you have excessive hair on the face, arms, chest, or thighs?

2) Do you have a long history of irregular periods?

3) Are you taking OCPs (oral contraceptive pills)?

4) Do you get headaches, nausea, vomiting, or easy bruising?

You likely have PCOS (polycystic ovarian syndrome). If you do not desire to get pregnant, I recommend you take OCPs along with Spironolactone, and it will likely help you with acne and irregular periods. Repeat TSH (ultra-sensitive) with FT4 and anti-TPO (thyroid peroxidase) antibodies. Nobody nowadays does T4, T3 uptake, and Free T4 index anymore.

Based on physical exam, may consider doing the following tests:

1) 1 mg Dexamethasone suppression test.

2) Fasting glucose with fasting insulin.

3) 24-hour urine Metanephrines

All the above three tests only after much more history and physical exam by an endocrinologist.

Intensive behavioral, dietary and physical activity program for losing weight with medicines (there are newer medicines like Semaglutide), please discuss with your doctor.

I hope this was helpful.

Hi doctor,

Thank you.

I will bring up the additional tests during my local endocrinologist visit. I get bruised easily but do not have a long history of irregular periods, excessive hair, headaches, or nausea.

I was on Aurovela Fe 1-20 OCP from three years till the end of last year. When I began to have bad side effects (vaginal atrophy, hair loss, hot flashes), I stopped taking it. So if possible, I hope to manage my condition through lifestyle changes or non-OCP medication.

I forgot to mention I do have a lymph node on my neck that has been hard for 16 months now. I am not sure if it was caused by a previous HSV-1 outbreak (they make all my lymph nodes hurt) or a chronic neck muscle sprain (or if the lymph node is causing the neck pain now). I figured to bring this up since the thyroid is in the neck, but you can ignore this if it is not important. I plan to have the local endocrinologist check it out as well.

Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

Although less likely, ruling out certain conditions like Cushing's syndrome and NCCAH (Non-classical congenital adrenal hyperplasia) with tests like 1 mg Dexamethasone suppression test and 17-OHP (hydroxyprogesterone) may be considered. Same with pheochromocytoma, 24-hours urine metanephrines.

The lymph node in the neck may be related to the thyroid. When you see the endocrinologist, they will palpate your thyroid and can make a recommendation whether you need an ultrasound scan of the neck.

I did not answer the rash or hives part since I do not think this falls under the scope of other things we discussed. I could be wrong.

I again want to emphasize the importance of weight loss and intermittent fasting, ketogenic diet, LCD (low-calorie diet), or VLCD (very low-calorie diet) programs and medicines like Semaglutide may be helpful for you.

I hope this was helpful.


Was this answer helpful?

 | 

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!



Related Questions:
Acne - Causes, Types, Home Remedies and Treatment Strategy

.. common condition encountered among teens and adults. To decide the protocol for the treatment of acne, it is important for us to know the causes, conditions associated, sites of acne, the cause of acne and factors affecting the onset of acne. Many...   Read full

I always get red painful acne before a week of my periods. Is it because of hormonal imbalance?

.. your symptoms, the diagnosis is acne vulgaris (grade 2). Do not apply Mometasone cream over the face, as it is a steroid cream. Please get an ultrasound of the abdomen and pelvis during the second and third days of the menstrual cycle to rule out ...   Read full

Acne vulgaris, a Social Problem.

.. social problems encountered by teens as well as adults due to acne .. ...   Read full

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read


What Is ADHD and How Is It Managed?
This article discusses ADHD, whether it is a real condition, features of ADHD, how to recognize and manage this common c...  Read more»
Does a cold sore indicate cervical cancer?
Hi doctor,Can a cold sore virus cause cervical cancer? I never had sex before, but I have caught a cold sore from one of...  Read more»
I am experiencing abdominal bloating and severe acidity. Are these side effects of antibiotics?
Hello doctor, I have been experiencing bloating and acidity during the menopause years. After experiencing a burning se...  Read more»

Ask your health query to a doctor online?

Ask an Endocrinologist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website.