My daughter is 19 years old, and she has a history of the irregular period for the past three years and has been taking Dronis 20 as suggested by the doctor for 21 days and to stop for six days, like this for six months. During this time, her period is regular. Now it is again irregular. Is it fine to continue Dronis for another few months?
Welcome to icliniq.com.
I have read the details of the problem about your daughter and can totally understand your concern. The irregularities in the menstrual cycles could be due to the underlying hormonal disturbances or sometimes due to a lifestyle related problem called PCOS (polycystic ovarian syndrome).
I could see that she is definitely overweight for her height. She needs to definitely reduce her weight to get rid of this problem, or else till the time she takes hormonal pill (Dronis 20), she will be getting cycles regularly, but once stopped may face the problem again as like now. As of now she can restart her Dronis 20 (Drospirenone Ethinylestradiol) like taking before for another three months, meanwhile ask her to reduce the weight, and do regular excercises and follow a healthy dietary habits. I hope this helps you. Please feel free to revert back for any further queries or Information.
-LFT (liver function test) or RFT (renal function test),
-75 g glucose tolerance test (fasting, one hour, and two hours).
- HbA1c (glycated hemoglobin) levels,
-Serum calcium, vitamin D, and B12 levels.
-Serum fasting and postprandial insulin levels.
-Serum FSH (follicle-stimulating hormone), LH (luteinizing hormone), free testosterone, Estradiol, Prolactin levels, thyroid profile (T3, T4, TSH (thyroid-stimulating hormone), Anti TPO (thyroid peroxidase)) on the second and third day of the next menstrual period.
- Continue Dronis 20 for next three months.Preventive measures:
-Maintain a menstrual diary.
-Regular exercises at least one hour daily.
-Lifestyle and dietary modifications (consult a dietician).
Thank you very much for your swift reply, which I genuinely appreciate. I have wrongly quoted her weight, which is 74 kg, as 88 kg, mentioned in my earlier chat. She has all the issues that you have listed below. She has acne in face intermittently, unwanted facial hair growth, excess scalp hair loss, frequent headaches with visual changes, excessive lethargy, and sleepiness. We recently got her eye tested, and she is wearing spectacles for the same. We have conducted a couple of medical tests earlier; those reports are attached for your kind review.
I am thanking you in anticipation.
Welcome back to icliniq.com.
Based on her symptoms of irregular periods, acne, and unwanted facial hairs, she is having this lifestyle disorder called polycystic ovarian syndrome (PCOS). Please do not be stressed out, as this is a pretty common lifestyle disorder these days. And it is a lifelong condition, and there is no cure to get rid of this condition. Yes, this problem could be very well balanced if the lifestyle is adequately regulated with proper diet, exercises, and weight management. So as I said, it is a lifestyle-related problem; the problems crop up when a lady puts on weight, has a sedentary lifestyle, or does not have a properly regulated diet. Weight gain does not happen because of PCOS but happens because of the lifestyle changes. So diet regulation and exercises form an essential part of weight management and, thus, balance PCOS-related hormonal disturbances. As you mentioned, her weight is 74 kg, her BMI (Body Mass Index) comes out to be 24.8, which is closer to the higher side of the normal. A normal BMI is considered to be between (19 to 25). A weight reduction of a couple of kilograms would help your daughter get rid of her symptoms, including her acne and unwanted facial hair growth problems caused due to elevated testosterone levels in PCOS. Further, it is said that the insulin resistance development in the body due to inactivity and weight gain leads to all the hormonal changes which disturb the ovulatory function of the woman and lead to disturbed menstrual cycles and patterns of bleeding.
You have not mentioned the details of her irregular periods now, whether delayed cycles, irregular bleeding or spotting, excess flow, prolonged bleeding, etc.
As advised previously, she can start taking Dronis 20 beginning from the third day of her periods and continue for 21 days and take seven days off. Again restart the course from the third day of the next periods. To take this way three times and stop.
The Hormonal treatment given in PCOS is mostly directed towards managing the symptoms and does not address the core problem, for which one has to modify their lifestyle. Until the time she is on hormonal pills, she will get her periods on time as those pills regulate it, but once stopped, if the lifestyle is not corrected, the symptoms are likely to occur again.
I have seen the reports attached (attachments removed to protect patient identity) by you, which were done last year, which were pretty much under control. But it is advisable to recheck them now as she is having symptoms again, and it is essential to determine the hormonal analysis to correct them if required. Please get the tests whenever possible (given COVID-19 and lockdown situation), and get back to me with the reports. If she has any signs or evidence of insulin resistance, she can be started on medications for the same.
Meanwhile, she can focus on her weight reduction, lifestyle, and diet modifications.
Also, it would help if you understood the future implications of this condition, which is essential. A person with PCOS is at risk of developing diabetes, cholesterol problems, hypertension, and heart problems, and they can appear little early in life if the lifestyle is not regulated.
I hope this information helps you. Please feel free to revert anytime. I would be happy to help.
- Continue Dronis 20 for three more cycles.
- Can consider a consultation with a dermatologist for acne and unwanted facial hair growth problem for cosmetic purposes.
- Reduce weight and avoid weight gain in the future.
- Do regular exercises at least one hour daily.
- Avoid eating junk, oily foods, high carbs, or high sugary foods (consult a dietician for diet plans).
- Avoid a sedentary lifestyle.
- Keep track of the menstrual cycles by maintaining a diary.
- Follow-up with the reports as advised (hormonal tests to be done on the second or third day of the periods.
Thank you, doctor, for your reply.
We have taken the test as suggested last week and waiting for reports. I will upload those reports as soon as I receive the same. Thank you very much for your follow-up here, and I genuinely appreciate your follow-up despite this pandemic.
Welcome back to icliniq.com.
No problem at all; take your own time and get back to me with the reports.
Have a nice day.
Thank you so much for your reply.
I am attaching a copy of the medical reports for your review and perusal.
Welcome back to icliniq.com.
I have gone through all the reports (attachment removed to protect patient identity) of your daughter.
As I said previously, based on her symptoms, she is a person with the polycystic ovarian syndrome. Even the ultrasound finding is suggestive of the same and substantiates the diagnosis, although it is not always necessary that the ultrasound show polycystic changes every time. So there is no point repeating the scan, again and again, to check if she still has polycystic changes, as it is just one of the condition's findings.
And as advised previously, she needs to focus on her lifestyle modifications by reducing weight and having a proper healthy diet and regular workouts or exercises. Exercises tend to prevent insulin resistance development, which is the main culprit of all the hormonal disturbances in PCOS. Based on her test results, she does not have insulin resistance (although borderline fasting insulin - recheck after a year).
Also, I approve the treatment suggested by your doctor, as your daughter has been found to severely deficient in Vitamin B12 levels; she needs injectables to replenish the levels as vitamin B12 is an essential constituent for the nerve function regulation. If injectables are not feasible at present, she can go for oral therapy for three months as suggested and recheck her levels after that to see if they have been corrected or not. She is also having insufficient Vitamin D levels, for which supplements have been suggested by your doctor already.
Regarding her thyroid levels, her TSH levels point towards hyperthyroidism, which needs further evaluation. She needs to check her free T4 and free T3, and Anti TPO levels and consult an endocrinologist. Based on the free hormone levels, it will be evident if she has clinical hyperthyroidism or not and whether she needs any medications to correct the thyroid levels. Because total hormonal levels may be in the normal range many times, the active hormone, that is, the free hormonal levels determines their function. Also, most commonly, hyperthyroidism can have an autoimmune origin of causality, so that is anti-TPO antibodies levels are essential in such cases. As advised, please get these three blood tests and consult an endocrinologist to evaluate the thyroid gland and further management accordingly.
Her lipid profile is borderline, and nothing majorly abnormal. This could be corrected by maintaining a proper diet and doing regular exercises. If possible, consult a good dietician to get a diet plan for your daughter.
Her prolactin levels, DHEAS (Dehydroepiandrosterone sulfate), free testosterone levels, blood sugars, HbA1c level, hemoglobin, liver, and renal functions are fine, and nothing to be worried about.
Also, the LH: FSH ratio is around 2:1, which explains her menstrual irregularities. This should be ideally <2:1. But this is nothing to worry about and does not need to be followed up by rechecking it as they are expensive to test and do not help much in further management. A course of Dronis 20 for three months should be good enough for her, and in the meantime, if she reduces her weight and does regular exercises, once she stops Dronis, she will get her periods on time. Also, acne and unwanted facial hair growth will reduce on their own.
I hope I have explained everything to you in detail.
Please feel free to revert anytime.
All the best for your daughter's future.
PCOS and hyperthyroidism.Investigations to be done:
- Free T4, free T3, Anti TPO antibodies.Treatment plan:
- Course of Dronis 20 for three months and then stop and watch for spontaneous periods.Preventive measures:
- Reduce weight.
- Diet modifications.
- Regular excercises at least one hour daily.
- Maintain menstrual diary.
- Follow-up with an endocrinologist for evaluation of hyperthyroidism.
- Check GTT (glucose tolerance test) and lipid profile at least yearly once, and thyroid profile as advised by your endocrinologist.
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