my periods problem

Buttercup:

psychdoc

RE..Psychdoc

Buttercup:

Walaikum Salam,

I'm fine, thanks. And you are very welcome.

Actually, your labs don't show any major abnormalities. There are only a couple of things worth mentioning. Your estradiol levels are on the lowest limit of normal, and your LH is almost at the upper limit of normal, however the LH/FSH ratio is not high enough to point towards PCOS.

Your thyroid function ( TSH,T3 and T4) and prolactin levels are all normal, that's good. I certainly agree with checking the day 21 progesterone levels, as it would help in determining whether you are ovulating or not. I think it would be beneficial also for you to get your Fasting Blood Sugar levels checked as well as your serum Testosterone levels checked, as testosterone levels are often times increased in PCOS and they are worth checking. By the way, do you have any acne on face, upper back, and arms etc, or problems with excessive body hair ( facial hairs, hair on chest, arms, legs etc)?

Regarding your HSG test next month, it would help determine whether you have any obstruction in your reproductive tract, for example blocked Fallopian tubes etc.

Re

H/dr_Qasim:

Dr.Qasim, thank you very much.

Buttercup:

Yes, they can be done on day 21, in the morning. Blood sugar has to be fasting though.

The results of your progesterone levels, Fasting glucose and testosterone levels would help clarify further why you have irregular periods. Can you share the results of your ultrasound when the doctor suggested that you had PCOS?

Abscence of periods does not necessarily suggest that you did not ovulate ( some women do ovulate but not have bleeding, for example with certain hymen abnormalities etc).

Re

Buttercup:

Yes, I just wanted to see what your ultrasound showed, because your labs actually did not reveal much in terms of your PCOS. However, presence of enlarged ovaries with multiple cysts is consistent with PCOS ( even though not all women with PCOS have cysts on their ovaries).

As I mentioned before, I think you should get your fasting blood glucose levels and testosterone levels checked in addition to your progesterone levels.

And remember, weight loss, weight loss and weight loss.

RE..Psychdoc

Some Suggestions For You:

Walaikum Salam,

I'm doing very well, thanks, how about you?

Regarding your labs, even though most labs mention the normal insulin levels in the range of approximately 5-25, still anything over 10 is considered a red flag and points towards insulin resistance ( a hallmark of PCOS).

Your level is not that high, but you should still take steps to get it down, and the thing that would help the most is weight loss. Insulin resistance is responsible for a number of features of PCOS, including hormonal imbalance.

Now regarding your day 21 progesterone levels, yes your levels are low, and point towards the fact that you did not ovulate, but there is something else very important to consider here. Ideally, Progesterone levels should be checked 7 days after ovulation ( 7 DPO or 7 Days Post Ovulation)), and only then the results could be relied upon. However,since it is hard to know exeactly when a person ovulated ( without additional testing), most doctors assume that the ovulation occured on day 14, and 7 days post ovulation would be day 21, and that's why they order progesterone on day 21. The problem with this approach is that in most women with abnormal menses, or prolonged periods, the ovulation does not occur on day 14, and probably can occur much later, even after day 20, and in that case your progesterone level is bound to come back as abnormal. I hope you understand what I am trying to explain.

 Now, the question is how to get a more clear and reliable picture of whether you ovulated or not, and if you did, then precisely when? And the answer to this question is Follicular Tracking, which basically is a series of ultrasounds done starting around day 9 and closely monitoring the size and growth/maturity of follicles ( egg sacs), and then finally confirming that ovulation has occured as the follicle's appearance would change once it has ruptured and released the egg. In my opinion this is the best way to track and confirm whether ovulation has occured or not.

However, this process could be somewhat inconvenient as it involves several visits to the doctor at short intervals. So here is what I would suggest for you. Buy an ovulation predictor kit and follow the instructions, and it would tell you whether you are ovulating or not thus cutting on a number of doctors visits and giving you meaningful information which you can then share with your doctor, which would give you a head start in your proper treatment.

Please let me know if anything that I explained is not clear.

I know it can be a bit frustrating being in the situation that you are, but I want to reassure you once again that with proper diagnosis and treatment, women with PCOS can and do conceive, and you should be no exception.

thanks again

Buttercup:

You're very welcome.

Yes, metformin would be a reasonable choice. Your doctor may also consider an ovulation inducer like clomid. Good luck with the doctor's visit.

doctors visit..

periods problem

Buttercup:

Hina143:

RE..Psychdoc

Buttercup:

Walaikum Salam,

I am doing very well, thanks.

I am glad that your HSG did not reveal any major abnormalities, like ductal blockage etc.

Yes, ovulation inducers certainly sound like a reasonable choice.

Regarding your low progesterone levels, as you may recall from my earlier reply, we really did not know for sure whether your progesterone was low because you were not ovulating at all, not ovulating on day 14, or had an abnormal luteal phase. We would have known if follicular tracking ( serial ultrasounds ) had been done, or ovulation predictor kit had been used.

Anyway, ovulation inducers will hopefully help you to ovulate, which would be the first step in your attempts to become pregnant.

Best of luck!