My daughter has PCOS/PMOS despite taking Dronis. How to treat it?

Hello,

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/PMOS (polycystic ovarian disease/Polyendocrine metabolic ovarian syndrome).

• Does she have any recent weight gain? Excess weight gain can also lead to disturbance in hormonal levels.
• Does she face any acne, unwanted facial hair growth, excess scalp hair loss, or any frequent headaches with visual changes or excessive lethargy, sleepiness?

I could see that she is 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 ethinyl estradiol) like before for another three months. Meanwhile, ask her to reduce her weight, do regular exercises, and follow healthy dietary habits.

Also, I suggest the following investigations to be done:

1. Hemogram.
2. LFT (liver function test) or RFT (renal function test).
3. 75 g glucose tolerance test (fasting, one hour, and two hours).
4. HbA1c (glycated hemoglobin) levels.
5. Serum calcium, vitamin D, and B12 levels.
6. Serum fasting and postprandial insulin levels.
7. Serum FSH (follicle-stimulating hormone), LH (luteinizing hormone)
8. Free testosterone.
9. Estradiol.
10. Prolactin levels.
11. Thyroid profile (T3, T4, TSH (thyroid-stimulating hormone), anti-TPO (thyroid peroxidase) on the second and third day of the next menstrual period.

Kindly continue Dronis 20 for the next three months. And follow the below suggestions to prevent PCOS/PMOS:

1. Reduce weight.
2. Maintain a menstrual diary.
3. Regular exercise for at least one hour daily.
4. Lifestyle and dietary modifications (consult a dietitian).

I hope this helps you.

Please feel free to revert for any further queries or information.

Thankyou

Hello,

Welcome back to icliniq.com.

I understand your concern.

Based on her symptoms of irregular periods, acne, and unwanted facial hairs, she is having this lifestyle disorder called Polycystic ovarian disease/Polyendocrine metabolic ovarian syndrome (PCOS/PMOS). Please do not be stressed out, as this is a pretty common lifestyle disorder these days. 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, exercise, and weight management.

1. 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.
2. Weight gain does not happen because of PCOS/PMOS, but happens because of lifestyle changes.
3. So diet regulation and exercises form an essential part of weight management and, thus, balance PCOS/PMOS-related hormonal disturbances.
4. As you mentioned, her weight is 163 lbs; her BMI (body mass index) comes out to be 24.8, which is closer to the higher side of normal. A normal BMI is considered to be between 19 to 25.
5. A weight reduction of a couple of pounds 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/PMOS.
6. 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, and so on. As advised previously-

1. She can start taking Dronis 20 beginning from the third day of her periods and continue for 21 days, and take seven days off.
2. Again, restart the course from the third day of the next period.
3. To take this way three times and stop.

The hormonal treatment given in PCOS/PMOS 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 the patient's identity) by you, which were done last year, and 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. I suggest to her the following:

1. She should continue taking Dronis 20 for three more cycles as previously advised.
2. It would also be helpful to consult a dermatologist for her acne and facial hair concerns, especially for cosmetic management.
3. She is encouraged to exercise for at least one hour every day to support weight management and hormonal balance.
4. It is important to avoid junk food, oily items, high-carbohydrate, and sugary foods, and she may benefit from consulting a dietitian for a tailored meal plan.
5. Keeping a menstrual diary and avoiding a sedentary lifestyle are also key to managing PCOS/PMOS effectively.
6. If she has any signs or evidence of insulin resistance, she can be started on medications for the same.
7. 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.
8. A person with PCOS/PMOS is at risk of developing diabetes, cholesterol problems, hypertension, and heart problems, and they can appear a little early in life if the lifestyle is not regulated.
9. Hormonal tests should be repeated on the second or third day of her next menstrual cycle.

Once the reports are available, please share them for further evaluation and guidance. Meanwhile, her symptoms and weight should be regularly monitored to track progress.

I hope this information helps you.

Please feel free to revert anytime. I would be happy to help.

Thankyou

Hello,

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.

Hello,

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 polycystic ovarian disease/Polyendocrine metabolic ovarian syndrome (PCOS/PMOS). 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/PMOS. Based on her test results, she has the following issues:

• She does not have insulin resistance (although borderline fasting insulin). I suggest rechecking after a year.
• Also, I approve the treatment suggested by your doctor, as your daughter is severely deficient in vitamin B12 levels; she needs injections to replenish the levels, as vitamin B12 is an essential constituent for nerve function regulation.
• If injections 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 (thyroid-stimulating hormone) levels point towards hyperthyroidism, which needs further evaluation. She needs to check her free T4 (thyroxine) and T3 (triiodothyronine), and anti-TPO (thyroid peroxidase) 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, so anti-TPO antibody 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 exercise.
• If possible, consult a good dietitian 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 less than 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. To know more, go through prescription medication for acne.

The probable causes are PCOS/PMOS and hyperthyroidism. So you need to get the investigations like free T4, free T3, and anti-TPO antibodies. Take a course of Dronis 20 for three months and then stop and watch for spontaneous periods.

Reduce weight, diet modifications, and regular exercise at least one hour daily, and maintain menstrual diary.

Follow-up with an endocrinologist for evaluation of hyperthyroidism. Check GTT (glucose tolerance test) and lipid profile at least yearly, and thyroid profile as advised by your endocrinologist.

I hope I have explained everything to you in detail.

Please feel free to revert anytime.

All the best for your daughter's future.

Regards.