Ask a Gynaecologist and Get Answers to Your OB/GYN Questions ASAP
Hi, I will try and assist you.
Has your period started late or it's delayed? If it's late, then how many days late?
Have you done a pregnancy test?
Ok, please standby as I answer your question.
If you did not have your period in 3 months, then we can do some tests to check what exactly the hormonal problem is. Blood tests and an ultrasound are done. After common conditions like polycystic ovarian syndrome and thyroid disorders (hypothyroidism) are excluded, some of the blood tests that are done are : FSH, LH, estradiol, 17 hydroxyprogesterone, prolactin. This workup will be able to identify the cause for not having your periods. These are mostly blood tests, and can be initiated by your GP.
Do you have any problems with head hair loss, excessive hair growth, skin problems and weight issues?
How old are you?
Ok, one way to regulate your periods would be to start birth control pills then, and using a diabetes drug known as metformin, which will also help regulate your periods. Cramps and breast symptoms can be due to your hormonal imbalance/anovulatory cycles (breast tissue is very sensitive to hormonal changes).
No, birth control pills are very low risk medications, especially in younger women. Before you start them yourself, you should have the workup I suggested. Polycystic ovaries don't produce pain, but ovarian cysts can, and you would need an ultrasound to check for them. At this time, you can try taking ibuprofen 400 mg three times a day for 2 to 3 days for the cramps. If they become worse or don't get better, you will need to be checked urgently.
Chances are that the GP did not do the tests I suggested, or they would have started PCOS treatment.
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Ok, the LH:FSH ratio is suggestive of PCOS, though the rest are OK.
I think you should have the ultrasound, as it's not possible to pinpoint the cause of cramps without an exam and imaging.
The cramps could be coming from the tubes, ovaries, uterus, even the kidneys or the intestines.
Let me return your question to the Expert pool, and we can see if someone else can help you. Don't do any rating.
Good evening, I am Dr Elliot. The advice you have been so far is correct. However crampy abdominal pain is more likely uterus, however a pelvic ultrasound would tell you if anything is wrong.
The only thing that puzzles me so far is that you had the blood tests in early January, but say your last period was in March. Why did you have the blood tests done please?
I see, thanks, ***** ***** has your period been irregular?
Okay thanks, ***** ***** is your BMI?
Okay thanks. Has anyone ever discussed your weight could be contributing to your irregular and absence of periods?
Do you exercise much?
I am just trying to open your results to see what they show
Okay, so they are all indeed normal. So yes, weight is unlikely to be a factor. But do be aware, weight below a BMI of 20 is associated with amenorrhea. Cysts can cause pain, but not amenorrhea. Your blood tests are reassuring as they show no sign of ovarian failure.
The blood tests are reassuring, the only missing thing is your ultrasound. If that is normal and there is no outflow obstruction then you don't have to do anything about this. But if you want to regulate your periods, your options is a combined contraceptive (COCP).
The risks with COCP are low due to your age and low weight. Factors that increase your risk of embolus is a raised Blood Pressure, Migraines, smoking, BMI>25 and age over 35years.
The COCP may be beneficial for the pain. However your can use anti-inflammatory medication such as Mefenamic acid for the pain if you do not want to take a contraceptive
Did you use to get heavy periods?
Yes, PCOS seems most likely, if you haven't had heavy periods then endometriosis is unlikely
Certainly nothing serious though. Would you like me to provide a link to a professional guide to the causes and management of this?
I only ask as some people would rather not know everything
So brownish blood refers to old blood, that had started breaking down before you see it, the thready stuff is often from a clot that would have been present. This is likely to be evidence of that you have had a bleed, but hasn't presented like a proper period.
Cramps are referring to the inflammation of the uterus.
I would consider the COCP, it would regulate your periods, and will help with discomfort.
So a few of those things, yes, go easy with exercise, and if your weight was up slightly you may find regulation is better. A COCP will artificially address these.
Metformin has very weak evidence for this indication, so I wouldn't use this, plus it is off license for this. In PCOS and raised weight (i.e. overweight) Metformin is used for diabetes due to increased insulin resistance. And somtimes in fertility.
You can wait for the Ultrasound, but I think the outcome of this would not change the first option of a COCP.
And yes, you can still get period pains, PCOS doesn't stop this.
Regarding an ultrasound, elective scans are being done in most places from next week, so hopefully wouldn't take too long to arrange this.
Of course. Go ahead...
In the UK, no sorry. It needs a Blood Pressure checked annually. You can either get it from a GP, Nurse or sexual health clinic
If you can get a blood pressure reading, your GP would do this for you over the phone
Yes, but get a blood pressure first, unless you have had one in the last year and your GP already knows about it
Not at all, I couldnt do this for a while, but soon discovered it is quite easy and it was the build up to swallowing them that was the issue.
So a syrup COCP is considered a special item, which means it would not be available on the NHS. Some you would be able to crush, but only a pharmacist could check which ones, however the COCP pills are tiny, generally speaking some are around 3-4mm, which is actually smaller than food you swallow after chewing.
I wouldn't worry too much, but if you get them, ask the pharmacist.
I was referring to pills in general sorry.
I hope this helps
So ask your GP for the Ultrasound, but ask about the COCP at the same time, why wait?
Fair enough, but a month ago we were still anticipating a bit of a shocker in terms of COVID cases etc, but this didn't happen like we were told
Healthcare has been planning to return to normal for the last 2 weeks, and in the next 2 weeks, this starts to happen, perfectly reasonable to chase your GP about this again
Telephone yes, face to face depends on your GP practice. They would tell you how to get your blood pressure checked
They can refer you though
I hope they do as well...good luck with this
No problem at all...
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