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Dr. K.
Dr. K., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 4206
Experience:  OB/GYN with 20 years of experience.
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hi there- I am 22 and amennorhea for 17months since coming

Resolved Question:

hi there- I am 22 and amennorhea for 17months since coming off the pill. I have low oestrogen levels which only range between 37-100 over the past few months. I have had a scan which presented with cysts on the ovaries- i was the diagnosed with Pcos by my g.p. I then went to see a gynae who did another scan and bloods who said i didn't have pcos as this scan showed no cysts and my fsh and lh levels were normal:firstly how can two scans show two different things ? secondly why does my oestrogen imbalance not matter and all that he is looking at is fsh and LH. I was told he doesn't know what it is so and endocrinologist seen me who said there is nothing wrong its just a result of the pill. I seem to have all the symptoms of pcos yet still no diagnosis of why I have no periods. I had a random outbreak of bad acne at age 20 after always having clear skin- i completed a course of roaccutance for 7 months and still have acne at age 22. I also follow a very very strict diet and exercise 5 days a week and cannot loose weight instead i have been putting on weight body fat of 21.9% and BMI of 27.5. Why is it so hard for a doctor to give me an answer there is something wrong and no-one seems to help? any ideas please I just feel so lost and confused
Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. K. replied 2 years ago.
Dr. K. :

Hello, this is Dr K.. Answers are not medical advice and do not constitute a doctor/patient relationship. I look forward to helping you today.

Dr. K. :

Pco is a very broad diagnosis and made by the Rotterdam criteria which is two of the three:

Dr. K. :

Oligo or anovulation

Dr. K. :

excess androgen activity

Dr. K. :

polycystic ovaries on ultrasound

Dr. K. :

If you had a scan at one time showing polycystic ovaries and anovulation as demonstrated by no period for 17 months, then you have pco

Dr. K. :

the ultrasound can change from time to time and pco may not be picked up if the scan quality is poor

Dr. K. :

Having been on the pill has nothing at all to do with lack of a cycle.

Dr. K. :

The fsh and lh and estrogen have little to do with diagnosis. I am hoping you have had your thyroid checked and other hormones checked such as adrenal hormones. Ruling out other causes must be done first before pco diagnosis can be made

Dr. K. :

Treatment is with the birth control pill, you should not go this long without a cycle. And consideration of Metformin, which is very helpful in terms of weight loss and reversing the metabolic syndrome of pco.

Dr. K. :

I hope this gives you a good start.

Customer:

Hi Thanks for your help i have had my thyroid and adrenal glands, prolactin all other test done by gynae and endocrinologist- they have both said everything is normal apart from oestrogen being two low? They are full sure its nothing to do with poly cystic ovaries as they seem to only diagnose based on FSH and LH - any ideas what I should do next or who do I go to ? endocrinologist told me I dont have a metabolic syndrome and the gynae wants me to go on clomid even though he is saying he has no idea what is wrong. I know its pcos and I just know they are missing the diagnosis should I go to someone else? what would explain my low oestrogen levels

Customer:

I would like to go on metformin but the gynae won't prescribe this as he is so sure its not pcos so I just dont no what to do, i dont want to go back on the pill as this I feel will just mask the problem I just need an answer from somebody as 17months is far to long at this stage and very stressful at age 22

Dr. K. :

Ok great. Be sure you have had a 17 hydroxyprogesterone done. On rare occasion mild forms of congenital adrenal hyperplasia turn up like this.

Dr. K. :

You are correct in that it IS pco.

Dr. K. :

The treatment is only Clomid is you want to conceive.

Dr. K. :

The pill does mask the issue but is necessary to prevent endometrial hyperplasia right now. Metformin is also helpful

Dr. K. :

There should be some gyn Drs that will do this. Give a try looking for one possibly younger or consider asking for a referral to a university clinic

Dr. K. :

Your are on the right track in your thinking

Customer:

Thanks so much for your help I really appreciate it I will see about them tests. So do you think I should fight my corner until I get a diagnosis of pcos. Its so hard when this gynae is not flexible in diagnosing seen as though he basis his diagnosis on FSH and LH hormones. what should i say to him ? is my oestrogen levels nothing to do with my lack of periods then ? as for the weight gain and inability to loose weight do you think this is down to having no periods? I will leave feedback on your reply, once again thanks for all your help .

Dr. K. :

Yes I do, I think you are on the right track. Your lack of periods is from the pco. Remember that the estrogen is just a snapshot in time. It could be a lot different on another day The weight gain is all tied in to the syndrome of pco

Dr. K. :

Its due to insulin resistance

Dr. K. :

That is why metformin works.

Dr. K. :

Best of luck

Dr. K., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 4206
Experience: OB/GYN with 20 years of experience.
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