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Diagnosed with PCOD, have occasional irregularity in periods and taking orgamed. Does it indicate any abnormality?
Question: I am 31 and had been diagnosed with PCOD nearly 10 years back. I have been exercising regularly since then and have brought my weight under control. But there have been occassional instances of irregularity in my cycles. I generally have an average of 34 day cycles. The last time I had an irregularity was in August 2013 and I had orgamed (medroxyprogesterone 10mg) for 10 days and I had my period after a 60 day gap from the previous cycle. I have been taking orgamed for three consecutive cycles now. This time- the for the third cycle-, I had only for 6 days, 1 tablet each day. The last dose was taken on 22nd Oct and it is 4th Nov today, i.e. 13 days since the last dose. My period has not started and I notice some brown discharge, which appeared only twice, in the last two days. This is the first time the period is delayed so much after taking the medicine. Pregnancy is ruled out completely. So I am worried if I should visit a physician for some abnormality or should I take another dose of orgamed.
Brief Answer: HAVE AN ULTRASOUND TO CHECK THE ENDOMETRIUM. Detailed Answer: Hello XXXX Thanks for writing to us with your health concern. In women with PCOD, delayed and irregular cycles are the norm. So the delay of 60 days could well be acceptable. Also, you have not mentioned your body weight, generally Orgamed is given twice a day for 5 - 7 days for inducing a withdrawal bleed. If you are slightly overweight, once a day might not have worked for you. Another consideration is that after taking the tablets for 6 days, you have spotted twice ( brownish discharge which I am considering as spotting ). Sometimes, in response to Orgamed, there would not be a proper bleed as in a period, but just spotting. I hope pregnancy has been conclusively ruled out, because women with PCOD have unpredictable cycles, and erratic ovulation, so pregnancy is an eventuality that can happen anytime ! Also, stress, anxiety, weight gain, travelling, change in diet or sleep , hypothyroidism - all these can anytime result in a missed or delayed period. Regarding whether another dose of Orgamed is in order - that depends on the endometrial thickness. If you have spotted in response to Orgamed, and the endometrial lining is thin, that means it has shed off, and you would not respond to further doses of Orgamed. If the response has not been adequate, and another dose would help, then the endometrial lining would be thick, and would be shed off after taking the hormonal withdrawal, which is how Orgamed acts. ( Builds up the progesterone levels, and then when you stop the medication, bleeding occurs as a result of the abrupt withdrawal of the hormonal levels ) So what you can do, is wait for a week, and if no proper bleeding ensues, then consult a Gynecologist, and have a pelvic scan to check the endometrium, and accordingly, you can opt for another dose of Orgamed. Meanwhile, pregnancy, thyroid hormone fluctuations, prolactin levels - get these three also ruled out during that consultation. All the best Please feel free to discuss further anytime. Take care.
Dear Dr. XXXXXXX Thank you for your detailed and well-explained response. My weight is 62kgs (height is 5.4ft). I have gained nearly 6kgs weight just before my periods got irregular. I have been exercising and have reduced 3 kgs and intend to shed 3kgs more since 59 kgs had been a healthy weight for me (that is when my periods were normal wihout any medication). Pregnancy is ruled out since it is not a possibility at all (I am single). On all earlier instances I was having 10 tablets of Orgamed, 1 per day for 10 days (15th to 25th day of the cycle) and the period would start within a maximum of 10 days. This time I personally started feeling that this much of hormones being taken externally may not be good so stopped on the 6th day of the dose( a very bad idea, I see by now). Another thing I wanted to mention, I generally have heaviness and soreness of breasts just 3 to 7 days before the onset of the period (It was one of the signals indicating that the period was about to start, in my case). This time I have been having heaviness for nearly 9 days so I was expecting the period to have started by this time. I am not sure if it is still indicative of oncoming period or just to do with the medicine? One another point, which I am not sure is relevant or not, is that my last cycle was just 26 days long - my period had started on 2nd day after the 10 day dose was stopped. Does this have any relevance to the delay this time? Finally, I have one enquiry to make: if the period does not start within a week, is it really unavoidable to meet to a gynaec? I had been consulting a gynaec in Chennai and now I am out-of-station so would it be okay to wait until the 50th day (today is the 35th day) of the cycle and then take another dose of Orgamed (10 days) and wait before meeting the gynaec? By the 50th day, I was thinking that it would anyway be the time for the next cycle, so would it be okay to take another dose and meet the gynaec only after seeing the reponse to the next dose? Or do you think this is a very bad option? Thanks.
Brief Answer: CAN WAIT FOR A FORTNIGHT AND REPEAT DOSAGE. Detailed Answer: Hi again Thank you for the appreciation. Your weight is perfectly alright for your height. As I told you, Orgamed is generally given twice a day for 5 days, or a tablet daily for 10 days. You should not have stopped out cold on the 6th day by yourself, going against the prescription. That said, it is not a big deal anyways. NO, previous cycle length has nothing to do with this delay, as the previous cycle too was not natural, but induced, with Orgamed withdrawal. As you are out on holiday, do not worry, it is not a must to consult a gynec. You can wait for a fortnight more, and repeat the dosage. That is also a feasible option, if you would be in town afterwards. If you do not menstruate after the next dosage, then seek medical opinion. However, the next time round, please take the prescribed dosage of a tablet a day for 10 days. All the best. Please feel free to contact me directly anytime on my profile - WWW.WWWW.WW
Dear Dr. XXXXXXX Thanks for you reply. I had been saving up my reply so that I could gather all that I wanted to ask before this discussion closed according to the T&C of the website. The wait was useful for me, also because near to normal menstruation did start by the 15th day after the last dose of orgamed. I already had orgamed for 3 cycles now and I am wondering if it is safe to have it for more than 3 consecutive cycles. (the gynaec had suggested for 3 cycles). Does taking the medicine too frequently have an adverse affect or does it alter the body's regular pattern. Next month is expected to be very stressful (on my personal front) and I would rather spare myself the worry of a delayed cycle so wanted to have the medicine for one more cycle. Do you think it would be okay or its better to let the body do the job itself? One another query I had, which is slightly unrelated to the present consultation, is that considering the present condition of my health, what would be the first thing to do before thinking of pregnancy? Do you suggest that it is important to have medical advice before trying for a baby? It would be really useful if you could provide some kind of a thumb-rule before preparing for pregnancy, in terms of say, menstrual pattern, or regularity and length of cycles, or medication. Thanks a ton for all the advice and patient hearing. It does mean a lot. The amount of reassurance and guidance that your reply has given me, I hope justifies the time you spare to answer many people like me. Best.
Brief Answer: DETAILED BELOW Detailed Answer: Hey XXXXXXX ! Glad to hear from you again, you need not save up your queries next time around, I have provided the direct link to my profile, so that you can specifically address your queries to me anytime you wish to do so ! Am so happy for your words of appreciation, its the discerning patients like you who make my work worthwhile with their gratitude and positivity . More cheers to you dear ! Am also very happy that the period started, and hence your anxiety would be allayed. Many women take Orgamed ( or a substitute progesterone preparation ) on a regular basis ( I mean cyclically every month for various indications, PCOD being just one of them ) - it is quite a safe drug, and you are taking it in moderate dosages. Do not worry and yes, you can absolutely take it the next month for cyclical control. You must realize, that PCOD has no " cure ". It is underlined by basic metabolic and hormonal imbalance, and medications can help you control the symptoms - such as menstrual irregularities etc. Metformin can be taken regularly to help with the symptoms. As ovulatory disturbances go hand in hand with menstrual irregularities in women with PCOD, conception naturally can be an issue, and hence, medications ( for eg. clomiphene citrate ) are often prescribed to help in proper ovulation . Maintaining an active lifestyle ( exercising in moderation and eating right ) can go a long way in keeping PCOD in control. Am happy in a way that you brought up the issue of conception, as , without impinging on your personal rights and domain, my advice frankly as a gynecologist is - with PCOD, you should think of marriage and conception rather soon. Having difficulties in conception is to be expected in your case due to PCOD, hence, the dictum - the sooner the better, because alongwith PCOD, you would have to battle age as an additional factor when you try to conceive later. On the other hand, do not worry too much, as when you opt for pregnancy, there are various modalities to help you along. It is ideal to have regular cycles ( and hence, regular ovulation ) while planning for a pregnancy, but since you have PCOD, that will always be an issue. Hence, cyclical hormone therapy ( such as what you are taking ) can be taken to regulate cycles. The first step would be to undergo follicular monitoring ( serial pelvic ultrasounds throughout your menstrual cycle ) to check if you are spontaneously ovulating or not. If ovulation is a problem, then medications can be given to induce ovulation for you. Whenever you try to conceive, take folic acid supplements for atleast 3 months prior to conception, continuing into the first trimester of pregnancy. Both of us will be ( hopefully ! ) around when you come to that bridge, so let us cross it then, however, as I said, if you can, speed up your journey to motherhood , keeping PCOD in mind ! 31 is a good enough time by now. ( Just medically speaking ) Once again, use the URL to contact me anytime you wish to, or if you have any further issues to discuss in this thread itself. Would be glad if you could spare the time to leave a review for this discussion. I am happy I could be of help to somebody as intelligent and perceptive as you - gives me the momentum to keep on doing some good work ! Good luck and good health always. Aarti.
Dear Dr. XXXXXXX Thanks for the detailed response. Your reply answers almost all that I had to enquire about. And yeah, I agree that 31 is probably high-time for me to move onto the next phase. Aware of that, I am actually preparing to move onto that phase very soon (less than two months from now) - that was the reason I enquired about conception. One thing I am still not really clear about: From your reply, it appears to me that the real difficulty with PCOD is conception more than the possibility of miscarriages or other complications after conception. I am not sure if this really is the case? Can PCOD also be a cause of anxiety even after conception? The reason I am asking this is that, after marriage, is it better to abstain from intercourse and thereby, also conception, without adequate medical investigations and medications? If it is okay to conceive even without further treatment or medication then that means abstinence is not really essential. I did discuss this with my partner-to-be, so abstinence for a period of time is surely a possibility and implementable (more, because we both are going to be at two different cities for a few months even after marriage). And meanwhile, I intended to get myself prepared, medically, for conception. However, if it is okay to conceive anytime then that means I can really be care-free, though I intend to follow your advice and take the required tests and medication before actually trying for conception. Thank you also for acknowledging my appreciation for your work. Its really nice to know that even our little gestures do count between all your busy schedule. Best.
Brief Answer: DETAILED BELOW Detailed Answer: Hello again. Hearing from you is always a very pleasant surprise ! Yes, your gestures and words do count ( a lot ) , as nothing that boosts a person's morale can ever be little ! Regarding PCOD, it is far more notorious as a cause of subfertility rather than as a cause of miscarriages. Women with PCOD have hormonal imbalance, so once they conceive, they require progesterone supplementation to support the pregnancy, which is easily done. They are at more risk of anovulation and difficulty in conception. Once conception is achieved, there are numerous complications which are more common in women with PCOD - miscarriage, hypertension, diabetes, preterm labour, multiple pregnancy etc. However, the key thing to remember - ALL THESE COMPLICATIONS ARE WORSENED WITH INCREASING MATERNAL AGE ! PCOD is a leading cause of infertility, and if a lady like you with PCOD walked into my clinic with PCOD, I would be more worried about her getting pregnant, than about what would happen once she gets pregnant ( because some complications can be prevented, most can be treated ) Also, apart from keeping your weight in check, there is nothing you can do to reduce your risk of developing these complications , if you conceive, say after 3 years, rather than, within the next 6 months. In fact, their incidence and severity will only increase with increasing age at which you get pregnant. There is NO REASON to abstain from intercourse after marriage, it would be unwise. You have been investigated, and you should try to conceive at the earliest. All you can do is take proper folic acid supplements while you are trying to conceive. Also, get detailed evaluation of PCOD - FSH LH TSH Prolactin DHEAS Free testosterone Oral glucose tolerance test. If any parameter is out of range, it can be treated, otherwise there is no medication needed except that needed to help you conceive. If you do not conceive naturally within 6 months, seek medical aid for the same ( follicular study to check on your ovulation, and drugs if needed to help you ovulate ). Since you would not be in the same city, try and have intercourse in fact around your ovulatory days ( again difficult to track in PCOD ). And yes, you can be carefree and try for conception in a stress free way. The earlier, the better. Will look forward to hearing from you as you embark on the new journey ! Take care again.
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