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Started irregular periods. Test showed TSH 5.63, retroverted uterus and normal cervix. Any advice?

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Practicing since : 2008
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Hi Doc.
For the first time in my life, I did not have my periods for more than a month. (I have been having asthma attacks for quite sometime now. I am 40 yrs old, unmarried and sexually inactive). The periods came later and meanwhile I consulted with a doctor. After an Ultra Sound scan, he said I had some Uterus infection and prescribed me Duphaston first. Bleeding ensued for almost a month. He asked me to stop Duphaston and asked me to take Trapic MF and Orgamed. Since my thyroid report came (5.63) he asked me to take 50mcg Thyronorm. After several days, the bleeding did not stop though it reduced drastically. Had to come back to work so consulted with another Gynaec in the city who prescribed only 25mcg Thyronorm and Trapic (wihtout MF for my asthma). The bleeding stopped. The scan showed everything normal. First report said anteverted Uterus, endometrial hyperplasia (endometrium thickess of 18 mm) and a possibility of Cervicitis. The last scan says retroverted Uterus and normal cervix, with endometrial thickness as 7-8mm. On August 25th was my last periods, almost entire September there was bleeding and no periods in October and November.

My urine is slightly yellow, I have pain in my left leg frequently and feel tired with no appetite at times.There is no discharge, smell or pains, except minimal left lower abdomen pain at times. Sometimes pain in my breasts, which comes and goes in seconds. I have frequent asthma attacks now but I use Levolin inhaler and respules for nebulization.

Please advice.
Posted Sun, 9 Dec 2012 in Women's Health
Answered by Dr. Asra Ishtiaq Ahmed 4 hours later
Hello there.

Thanks for writing.

The menstrual problem you have is well explained by your thyroid report.

TSH of 5.63 suggests hypothyroidism which is well known to cause menstrual irregularities.

Because you have delayed periods, the uterine lining gets thicker and thicker. So when you have periods you get a very heavy bleeding due to thickened endometrium.

Your menstrual regularities are likely to improve with thyronorm use regularly. You need to get a repeat TSH level after 6 weeks to check for improvement.

Besides use of Trapic tablet would help control your excess bleeding.
You should not use mefenamic acid (MF) combination drugs as they are likely to cause bronchoconstriction and precipitate asthma attacks.

Finding of cervicitis on ultrasound is NOT relevant unless your XXXXXXX examination reveals infection and erosion of cervix. Also PAP smear test is used for diagnosing cervicitis and not an ultrasound. Since you are sexually inactive likelihood of cervicitis is less in your case.

You can discuss with your doctor the option of using progesterone tablets like orgamed (medroxyprogesterone) or meprate on a monthly basis in later half of the cycle. This will help the periods to occur on time and also reduce the amount of bleeding. It will also tackle any endometrial hyperplasia responsible for heavy bleeding by shrinking the uterine lining.

If your bleeding remains excessive and irregular despite normal TSH and progesterone medications, you should go for an endometrial biospy.
This is essential in all cases of persistent abnormal uterine bleeding especially after 40 years of age to rule out any cancerous changes in the uterine lining.
Also the risk factor of endometrial hyperplasia in your case is you are unmarried with no issues. Pregnancy has a protective factor for avoiding hyper estrogenic state induced hyperplasia.
Further treatment depends on the biospy report.

I hope I have answered your queries.

take care.

Above answer was peer-reviewed by
Follow-up: Started irregular periods. Test showed TSH 5.63, retroverted uterus and normal cervix. Any advice? 6 hours later
Thank you Doc for your answer.

You have addressed my concerns mostly. Though, I seek four clarifications:
1) Is the dosage of Thyronorm (25mcg) enough? And how long should I take it?
2) I am overweight and not able to excercise due to asthma and almost everyday I have attacks. What would you suggest? I am strictly controlling my diet though.
3) Can I take Orgamed without consulting my doc, so that I get my periods fast? I have been hesitating for a physical examination so far.
4) Kindly advice me on the pain in my left leg
Answered by Dr. Asra Ishtiaq Ahmed 2 hours later
Hello there.

Thanks for writing.

You are most welcome for queries.

Your clarifications:

1. Starting dose of thyronorm is usually 25 ug when TSH levels are not too high like in your case. The adequacy of the dose is assessed by improvement in symptoms and TSH levels in the repeat tests. So if your next TSH, which should be done 4-6 weeks after starting thyronorm, does not show a decline then it suggests your thyronorm dose is not adequate and needs to be increased.
The titration of dose is done according to TSH levels.

2. Exercise is a must to ensure weight loss. Also it would help in correcting your menstrual irregularities which occur when you are overweight.
You can exercise at a level and environment which does not precipitate your asthma. Activities that involve short, intermittent periods of exertion are acceptable in asthma. These include swimming, outdoor and indoor biking, aerobics, walking or running on a treadmill. To avoid attacks always use your pre-exercise asthma inhalers (inhaled bronchodilators) before beginning exercise. Warm up exercises before and appropriate cool down period after exercise is a must.
If you have allergic asthma, avoid exercising outdoors when pollen or dust is there.

3. No, you should NOT take any medication on your own. Using progesterone medications like orgamed is beneficial if used in proper dose, method and at proper time. Your doctor will give you the prescription.

4. Pain in your leg could be due to the excess weight you have. If it is more in the knee joint, then it further supports it to be the same.
The only serious risk can be of XXXXXXX vein thrombosis which presents as pain in calf muscles, swelling, redness and tenderness in the leg. If you have any family history then you need to get evaluated for the same by a physician.

I hope I have answered your queries.

Kindly revert back if you have further doubts.

Take care.

Above answer was peer-reviewed by
Follow-up: Started irregular periods. Test showed TSH 5.63, retroverted uterus and normal cervix. Any advice? 7 hours later
Dear Doc

Thank you for your answers.

Please clarify whether the pain in my breasts is due to the above problems.

I am going to join a slow exercise program like Tai Chi. May be invest in a motorised treadmill too.

I have been given Duolin with Levolin whenever I take nebulization from hospitals. Can I mix both at home too? I get itching in the throat which becomes a cough and then vomiting ensues ending up in severe asthma attack, usually past midnight or early mornings. I am ensuring early food intake and sleep with raised pillows to prevent acid reflux, but it happens abruptly in the middle of sleep. Please advice on this too. I avoid certain foods that precipitate this, but is there any remedy that I can take in the night to preven this?

That would be all.


Answered by Dr. Asra Ishtiaq Ahmed 3 hours later
Hello there.

Thanks for writing back.

Breast pain may be related especially if you have it more before your periods. It is one of the premenstrual symptoms.
Also use of progesterone medication can cause breast tenderness and pain.

You should not mix any medications. Your physician would advice you better on how and which short term bronchodilator to use during asthma attacks.

Regarding your nocturnal acid reflux problem, I would say life style changes can help you in relieving it.
Weight reduction is most essential here again as it reduces pressure on stomach and thus reflux.
Apart from what you already have been doing, sleeping on your left side is another effective measure which alters the distribution of gastric acid in the stomach and can help to prevent reflux at night.

If lifestyle changes do not improve your acid reflux, you need to use certain antacids.

Take care.

Above answer was peer-reviewed by
Follow-up: Started irregular periods. Test showed TSH 5.63, retroverted uterus and normal cervix. Any advice? 12 hours later
Thank you very much indeed, Doc.
Answered by Dr. Asra Ishtiaq Ahmed 2 minutes later
You are most welcome.

Take care.
Above answer was peer-reviewed by
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