How can one manage irregular periods in PCOS?

Question

Hi doctor,

Two years ago, I consulted a gynecologist regarding family planning. They advised me to take Dronis 30 for two years. However, I stopped the medication after one year. Subsequently, I became obese and gained weight, reaching 145.505 pounds with a height of 149 centimeters. Last year, I was diagnosed with Polycystic Ovary Syndrome/polyendocrine metabolic ovarian syndrome (PCOS/PMOS) because I was not getting my periods without medication. After that, I adopted a healthy diet, exercise regimen, and a good lifestyle modification and managed to reduce my weight to 60 kilograms.

For three months, I only experienced light spotting. After three months, I had a two-day flow followed by 10 days of spotting. Last month, I got my period on the eighth, which lasted for four days, but then the flow decreased, and spotting started. The spotting has not stopped, and I notice slight spotting when I use the washroom. I am unsure how to stop this. Last month, I underwent an ultrasound scan, and the results showed that the cysts had fully resolved. My ovaries, uterus, and endometrium were normal. Additionally, my TSH levels and HbA1c were within the normal range.

However, some suggest this issue may be due to low progesterone levels. I do not want to take birth control pills again. Please guide me on how to regulate my menstrual cycle naturally.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Could you please confirm if you are married?
Two years ago, were you officially diagnosed with Polycystic Ovary Disease/polyendocrine metabolic ovarian syndrome (PCOD/PMOS)?
Did your ultrasound scan (USG) at that time reveal ovarian cystic follicles?
Were you prescribed Dronis 30 solely for family planning purposes, or was it also to regulate irregular periods?

To accurately diagnose PCOD/PMOS, it is important to have more detailed hormonal evaluations beyond just TSH (thyroid-stimulating hormone) and HbA1c. You will need to undergo blood tests for the following:

Follicle-stimulating hormone (FSH).
Luteinizing Hormone (LH).
Estradiol.
Anti-Müllerian Hormone (AMH).
Serum Prolactin.
Serum Testosterone.

If you can get these tests done and share the results with me, I will be able to provide a definitive diagnosis and recommend the most suitable course of action.

If PCOD or hormonal imbalance is confirmed, you must continue with your efforts to lose more weight and maintain a healthy diet. While there is no permanent cure for PCOD/PMOS, its symptoms can be managed effectively through lifestyle changes and, if necessary, medication.

In the case of irregular periods, the only ways to resume regular cycles are:

Taking oral contraceptives or progesterone to induce withdrawal bleeding.
If you are planning for pregnancy, consult a fertility specialist for ovulation-inducing medications.

I recommend discussing these aspects further during an in-person visit with a gynecologist for a more tailored approach to your care.

I hope I have answered your query.

Let me know if I can assist you further.

Thank you.