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PCOS, on birth control pills. Family history of breast cancer. Has prolonged menstruation, weightgain, depression. Suggestions?

My daughter, age 25 years, has PCOS . She has not been to a GYN in two years (she is married), due to insurance issues that have just recently been resolved. At the time of her last visit to the doctor, he prescribed Metformin and birth control pills. She had severe gastrointestinal pain and loose bowels from the Metformin and stopped taking it, and she only took the birth control for 3 months, as I have hormone receptor positive breast cancer . (the doctor felt the risks outweighed the benefits). I am concerned because my daughter now has prolonged menstruation (lasting 2 weeks or more..with spotting and often heavy bleeding). She has gained quite a lot of weight, and seems to be very depressed. We are unsure where to proceed. Where should she start?
Asked On : Sat, 19 Jan 2013
Answers:  1 Views:  37
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General & Family Physician 's  Response
Hi,thanks for using healthcare magic

Depression is a severe illness that can have a profound negative impact on a person's life. There are certain criteria that are used to diagnose depression and at least 5 of them must be present for at least 2 weeks. The criteria are depressed mood most of the time, loss of interest in activities, weight or appetite change, sleep disturbance, fatigue or loss of energy, feeling worthless, suicidal ideas, decreased concentration or ability to think.
Once diagnosed then treatment is best, it involves counselling and the use of medication for a short time.

The increased in weight may or may not be linked to the depression.If she is depressed , she would not have the drive or energy to do anything about her weight right now, so the depression needs to be treated first.
Persons with PCOS tend to have increased weight, the metformin would be useful here because it would decrease the insulin resistance associated with PCOS and may help with the weight.In persons who experience GI problems with metformin, it is advised to start at a low dose - about 250 mg and increase slowly as tolerance to it improves.
Weight loss helps with PCOS- it reduces the insulin resistance and improves fertility.

In terms of the prolonged bleeding , this can be due to a number of factors such as hormonal imbalances, abnormal levels of the thyroid hormone, structural problems with the uterus (identified on Ultrasound)

I hope this helps
Answered: Wed, 23 Jan 2013
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