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Tim Brown
Tim Brown, GP
Category: OB GYN
Satisfied Customers: 4078
Experience:  GP in Sussex
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Late period and cramps, no I'm not using contraceptives, my

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Late period and cramps
JA: The Obstetrician-Gynaecologist can help. To begin, apologies for the personal questions, but are you using any contraceptives? How long have you dealt with the cramps?
Customer: no I'm not using contraceptives, my cramps started few days now
JA: Thanks for that. OK, more personal questions coming up I'm afraid - when was your last smear test, and what were the results? Any swelling, discolouration, or unusual smells?
Customer: I didn't have a test, a discolouration was noticed around a month ago, accompanied by an unusual smell, but now that the discharge is normal, my period is still late and cramps started
JA: Thank you so much for your answers. Finally, is there anything else in your medical history the Obstetrician-Gynaecologist should know?
Customer: No

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?

Customer: replied 1 year ago.
Hi, my period is delayed with around 3 months now, my last period was in February, and no I haven't done a pregnancy test as I'm not sexually active

Ok, please standby as I answer your question.

Customer: replied 1 year ago.
okay

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.

Customer: replied 1 year ago.
I did a blood test in January

Do you have any problems with head hair loss, excessive hair growth, skin problems and weight issues?

Customer: replied 1 year ago.
all of those are normal, but some pimples come and go on my face, I'm having mood swings, and experience fatigue and sometimes dizziness

How old are you?

Customer: replied 1 year ago.
19
Customer: replied 1 year ago.
I spoke to a GP about a month ago who thought I might have PCOS, but back then I didn't have cramps which now I do, my breasts also kind of hurt now
Customer: replied 1 year ago.
that's why I got concerned

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).

Customer: replied 1 year ago.
you think I should go buy some birth control pills, isn't it risky if I take whatever pills I found in the grocery store or pharmacy
Customer: replied 1 year ago.
what should I do if the cramps and breast issues get worse

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.

Customer: replied 1 year ago.
will it help if I write to you the test results of my blood tests I did on January
Customer: replied 1 year ago.
I did do the tests but yeah they did not call to discuss the results with me

Yes. You can attach them here if you want.

Customer: replied 1 year ago.
okay one moment
Customer: replied 1 year ago.
Sorry how do I attach the picture

Use the paper click icon, upload your file, and write something in the text box, then click send.

Customer: replied 1 year ago.
File attached (PLM3V2L)
Customer: replied 1 year ago.
also, I'm aware that PCOS doesn't cause cramps, but is it possible that my hormone levels have changed from January to the present? which is what's causing cramps, breast pain, headaches and tiredness ... ?

Ok, the LH:FSH ratio is suggestive of PCOS, though the rest are OK.

Customer: replied 1 year ago.
what about the cramps then :/
Customer: replied 1 year ago.
I know they only started lately but it's getting uncomfortable

I think you should have the ultrasound, as it's not possible to pinpoint the cause of cramps without an exam and imaging.

Customer: replied 1 year ago.
I'm not really sure if it's possible with the Covid situation...

The cramps could be coming from the tubes, ovaries, uterus, even the kidneys or the intestines.

Customer: replied 1 year ago.
it's either the ovaries or the uterus for me
Customer: replied 1 year ago.
the rest feels fine to me
Customer: replied 1 year ago.
it's almost like period cramps, only coming and going, and without a period
Customer: replied 1 year ago.
not as painful, yet, but they're there

Let me return your question to the Expert pool, and we can see if someone else can help you. Don't do any rating.

Customer: replied 1 year ago.
alright

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?

Customer: replied 1 year ago.
my last period was in february
Customer: replied 1 year ago.
I did them because before that my period was irregular

I see, thanks, ***** ***** has your period been irregular?

Customer: replied 1 year ago.
it used to come sometimes in the beginning of the month, sometimes skips one sometimes a week late or two
Customer: replied 1 year ago.
about 2 years now I guess

Okay thanks, ***** ***** is your BMI?

Customer: replied 1 year ago.
Around 19.3
Customer: replied 1 year ago.
my body weight has been moving +- 1.5kg
Customer: replied 1 year ago.
sometimes I lose about 1 kg and sometimes gain it
Customer: replied 1 year ago.
it has to do with my appetite as well

Okay thanks. Has anyone ever discussed your weight could be contributing to your irregular and absence of periods?

Do you exercise much?

Customer: replied 1 year ago.
no it is very unlikely, I try to maintain a balanced diet and I exercise often, like 2/3/4 times a week
Customer: replied 1 year ago.
my guess was always hormones, because my mood has been affected as well, besides now cramps, breast pain, tiredness and headaches
Customer: replied 1 year ago.
I don't think it's cysts since my pain is not extreme yet, but I didn't want to jump on any medication without doing an ultrasound and get a prescription or something

I am just trying to open your results to see what they show

Customer: replied 1 year ago.
Okay
Customer: replied 1 year ago.
that is assuming that nothing much has changed between january and now

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?

Customer: replied 1 year ago.
alright thank you
Customer: replied 1 year ago.
but is it still likely that I have PCOS
Customer: replied 1 year ago.
No, to be honest my periods were normal, medium to heavy on the first, second, maybe also third, then medium, medium, light, light and ends

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

Customer: replied 1 year ago.
one thing I would like to add though, is that on April and May, my discharge colour changed during some weeks to be brown-ish with very thin bloods veins sometimes, and smelled mineral-ish
Customer: replied 1 year ago.
then it ended at the end of May and my discharge came back to normal, and few days after that cramps started

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.

Customer: replied 1 year ago.
now what should I do, get an ultrasound before everything (although it is difficult now due to the Covid-19 situation), or start with metformin for PCOS or go for COCP right away?
Customer: replied 1 year ago.
also, do you think COCP will help with my potential amenorrhea, like by lifting my weight up a bit without an unhealthy increase in my body fat ratio?
Customer: replied 1 year ago.
is it likely that I have a uterus inflammation that is causing the cramps regardless of PCOS??

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.

Customer: replied 1 year ago.
that is, if I get my period to begin with :/
Customer: replied 1 year ago.
another question

Of course. Go ahead...

Customer: replied 1 year ago.
is it possible to get COCP without a prescription, and is there any brand you would recommend here in the UK since it'll be my first time

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

Customer: replied 1 year ago.
it is possible over the phone! alright
Customer: replied 1 year ago.
one last thing

Yes, but get a blood pressure first, unless you have had one in the last year and your GP already knows about it

Sure,

Customer: replied 1 year ago.
I'm not able to swallow pills, I've tried many times and I just ended up switching to syrups or other alternatives; do you think that the COCP pill will have the same effect if I crush it a bit before I swallow it with a sip of water?
Customer: replied 1 year ago.
I know it sounds silly, but this the only way I could get have pills :/
Customer: replied 1 year ago.
could have*
Customer: replied 1 year ago.
for capsules I used to empty the content in a bit of water and drink it all

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

Customer: replied 1 year ago.
okay I would ask the pharmacist if it is possible to crush them and get the same effect
Customer: replied 1 year ago.
if I'm getting this straight
Customer: replied 1 year ago.
I should contact a GP for blood pressure reading, and ask to get an ultrasound as possible, then get COCP

So ask your GP for the Ultrasound, but ask about the COCP at the same time, why wait?

Customer: replied 1 year ago.
because about a month ago, I called a GP (I didn't have cramps, breast pain, and headaches... back then), and even I insisted on a visit to get an ultrasound, she kept answering that I can only have PCOS, that it's common and I should just wait
Customer: replied 1 year ago.
now with the cramps and the whole inconvenience and missing period I got worried, so I will call again and hope a GP will give me an ultrasound and a recommended pill

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

Customer: replied 1 year ago.
you think it will be possible for me to get a face to face checkup by this Monday or Tuesday...?

Telephone yes, face to face depends on your GP practice. They would tell you how to get your blood pressure checked

Customer: replied 1 year ago.
my GP practice operates by phone, that's why I was wondering, since I cannot get an ultrasound by phone

They can refer you though

Customer: replied 1 year ago.
seems fair, I hope they do

I hope they do as well...good luck with this

Customer: replied 1 year ago.
well thenThanks a lot for your time, I will try not to stress too much about this until I contact them

No problem at all...

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Tim Brown, GP
Category: OB GYN
Satisfied Customers: 4078
Experience: GP in Sussex
Tim Brown and other OB GYN Specialists are ready to help you
Customer: replied 1 year ago.
Of course, Take care Doctor, thank you again