My periods have been slightly irregular. What may be the reason?

Hello,

Welcome to icliniq.com.

We will pay close attention to your worries and address all your questions with utmost care.

The ultrasound scan report (attachment removed to protect the patient's identity), which you have posted shows a single follicle dominant, may be in the right ovary. The endometrial thickness and uterus seem to be of normal size. This does not appear to be a polycystic ovarian syndrome with normal size ovaries. So, PCOS may not be a cause for the irregularity. I suggest you attach the complete written ultrasound report in the follow-up. Also, I suggest you do the following tests.

1. Thyroid profile.
2. Serum prolactin levels.
3. Serum progesterone levels on day 21 of your cycle.
4. Serum testosterone.

If you have already done, kindly share the reports for evaluation or else get them done. Also, please mention the details of your menstrual cycles in the last three months along with the dates to understand the pattern of bleeding.

Please revert if you have any further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

I have checked your ultrasound scan and the written reports (attachment removed to protect the patient's identity). Your TSH (thyroid stimulating hormone) levels are normal, and rest of the ultrasound is also normal. The dominant follicle is seen in the right ovary as marked in the scan report. So, there is a likelihood that the written report has mistakenly mentioned the wrong ovary. So, stay informed. The reports are fairly normal, and we should wait for the prolactin levels. Please provide me the details of your last three menses so as to understand your irregularity.

I am looking forward to helping you further.

Thank you.

Hello,

Welcome back to icliniq.com.

Glad to have you back.

The single episodic delay in a month is likely to have been due to stress induced during the cycle. Stress is the most likely and the commonest cause of delay among females in the reproductive age group, when no other obvious causes are present, be it hormonal or organic (like fibroid, polyps and adnexal masses). As your last menses arrived on 16th of last month, this month your menses should be between 16th and 19th. Hence, you should wait this month. Ideally speaking, if three of your menstrual cycles are irregular, then it is said to be irregular menses or oligomenorrhea cycle. I feel this irregularity in your case is more likely to be stress induced and hence maintain a menstrual calendar for the next three months. We should wait for the prolactin results. Keep me informed.

Thank you.

Hello,

Welcome back to icliniq.com.

It would be better to get the ultrasound pelvis repeated to check the endometrial thickness and to detect the presence of any ovarian cysts (if any). Also, please share your serum prolactin reports.

Thank you.

Hello,

Welcome back to icliniq.com.

I can understand your concern.

I have gone through the USG (ultrasound sonography) report and the prescription (attachments removed to protect the patient's identity). It confirms that you have polycystic ovaries with each ovarian volume more than 10 cc which is the cut-off. Also, multiple small follicles are seen in each ovary which are immature follicles and there are no dominant follicles which indicates anovulation or no ovulation during the cycle. This leads to delayed or no menses or scanty anovulatory cycles (which is endometrial shedding following non-advancement towards the secretory phase in the absence of progesterone-secreted after ovulation).

PCOD (polycystic ovarian disease) is purely a lifestyle-based disease and can flare up anytime during the reproductive period when guards are brought down with regards to eating and exercise habits. Weight gain increases insulin resistance and further contributes to PCOD. You can continue the tablet Primolut (Norethisterone) for five days and then wait for withdrawal bleed. However, tablet Formitol (D-chiro-Inositol, L-methylfolate, Mecobalamin) can be started from now itself daily for the next three months. Also, I suggest you start low dose oral contraceptive pill like tablet Ginette 35 (Cyproterone and Ethinyl estradiol) once daily from day three of your cycle till 21 days and then take the next pack from day two of your next menses after you stop the first pack. This again for three cycles in all. Along with this drink plenty of water, do brisk walking daily for 45 minutes, and avoid fatty, spicy and fried foods.

Three months post treatment, kindly connect with me for a follow-up.

I hope I have resolved your queries.

Thank you.

Hi,

Welcome back to icliniq.com.

The hemorrhagic cyst does not indicate ovulation, and neither does 0.47 inches of endometrial thickness. These indicate anovulation. Ovulation is indicated by the presence of fluid in the pouch of Douglas and a corpus luteum cyst, and not a hemorrhagic cyst. Endometrium grew in response to unopposed estradiol effect. Your weight is controlled. I guess you need to maintain a healthy diet and drink plenty of water. Stress-inducing factors should be avoided. Just follow the prescription, and you should be doing good.

Thank you.

Hello,

Welcome back to icliniq.com.

Let me guide you on this.

If you are not keen on starting the hormones now and would like to give yourself a chance to regulate ovulation naturally, then I appreciate that. You may continue with tablet Formitol alone for three months post your tablet Primolut-N induced withdrawal bleed and get your basal hormonal levels checked by day three of your cycle. Polycystic ovarian disease (PCOD) is like diabetes; it needs to be controlled to avoid it from getting flared up. Anyone who is at its predisposition would have to be strict on weight control and lifestyle modifications. Diet and exercise play a major role in this for sure, but significant reliance should be on adequate water intake, which shall help improve your metabolism and also help reduce your insulin resistance (which Formitol shall help as well).

Stress is a significant contributor (about 85 %) for causing irregularity in menses across the world and the symptoms overlap with that of PCOD. It is often seen that women who overcome stress in the next few cycles, have their cycles regularized and the features of PCOD diminish. Hormones do not make your cycles habitual unless you are not following proper diet, exercise, and adequate intake of water completely. The regimen is for three months followed by a break for a month to allow natural menses, and if the next menses again arrive on time, then the lady is switched to a natural treatment regimen, without any medications. So, if you want to give yourself a try, which is good, I suggest you give yourself at least two months time. Do not over exercise, just 45 minutes of brisk walking twice daily shall suffice as you are already 138 lbs. Over exercising can rebound at times. Also, maintain a menstrual calendar for the next three months. Good luck.

Wish you healthy and happy times ahead.

Thank you.

Hello,

Welcome back to icliniq.com.

We feel happy to help you again.

Did you take Ginette 35 (Cyproterone and Ethinyl Estradiol) oral contraceptive pill as well or just took Formitol tablet? If you had taken tablet Ginette, then once the pack ends, you should be getting the menses in the next three to five days. If not started, then considering the withdrawal bleed, menses should naturally start in the next five days if you have been eating healthy foods, drinking plenty of water, and also following regular exercise.

Thank you.

Hello,

Welcome back to icliniq.com.

In that case, when you had a normal period post-withdrawal bleed, you should wait for your menses to arrive naturally for another five days. The menses are usually never on time for women; however, some women have been lucky. A delay of three to four days or even occurring in advance is not considered irregular. So, for now, wait for your menses, and if they do not arrive naturally in the next five days, then we would have to consider progesterone withdrawal again and then you would have to be on hormonal pills as well.

The arrival of acne indicates that your testosterone balance is getting disturbed in spite of your changes in lifestyle. Perhaps they are inadequate, and this would call for the incorporation of Ginette. PCOD cannot be treated without Cyproterone acetate pills.

Thank you.

Hello,

Welcome back to icliniq.com.

Good to hear that your menses has arrived and has been just three days late when compared to the date of your last menses. So, you can avoid Ginette during this cycle and continue taking Formitol tablet for another month. The flaring of acne can be conservatively tackled by using neem face wash thrice a day and also with an increased intake of water daily. Drink 10 to 12 glasses of water a day to improve BMR (basal metabolic rate) and local facial blood circulation. By following this, there are chances that your acne will decrease in a week or so. Antibiotic cream for acne is not recommended until natural methods for oily skin and acne control have been exploited (keeping in view your age).

Please get back if you have any further queries.

Thank you.

Hello,

Welcome back to icliniq.com.

You do have a flare-up of acne on your face and your skin appears oily. Considering your cycles to be regular now, we are not contemplating the use of a PCOD regimen. The acne (which is pustular) can be treated with local treatment or through a short course of antibiotics. I suggest you do the following:

1. Take tablet Augmentin 625 mg (Amoxicillin + Clavulanic acid) twice a day for five days.
2. Keep the oil level of your face low by using neem face wash thrice a day.

I do not advise dermatologist treatment as of now since they would advise Retinoic acid which shall flare up the redness and cause peeling. So, take this short course and see the difference. Continue with water intake.

I am extremely grateful for allowing us to help you maintain a healthy lifestyle.

Thank you.