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Prolonged period. TVS normal. Prescribed Duphaston for PCOS. Want your opinion

Mar 2013
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Practicing since : 1998
Answered : 5957 Questions
Hi I've been having two week long periods for two years. I've seen a couple of doctors and done many trans-vaginal ultrasounds but they all came out ok. The last doctor I saw thinks I have polysistic ovarian syndrome and say my endometreum is too thick which means my body isn't producing enough progesterone (because of a ovulation) so he gave me duphaston. Another hormone specialist however said my estrogen and testosterone are low, my fsh is fine but amh shows low egg reserve. I just turned 30 btw. Anyway, would like to know your opinion on the matter! Thank you
Posted Fri, 12 Apr 2013 in Menstruation and Miscarriage
Answered by Dr. Aarti Abraham 47 minutes later
Thank you for your query.

If possible, could you upload your previous blood reports and ultrasounds so that I can comment better ?

Anyways, having two week long periods is not normal.
Both the versions given to you are diabolically differing, almost opposite.
Patients with polycystic ovarian syndrome have multiple follicles in the ovaries, but due to hormonal imbalance, there is difficulty in ovulation and regular cycles. These patients have a high ovarian reserve, that is, lots of potential eggs in the ovaries, but none can mature properly due to hormonal imbalance. Your testosterone and estrogen both would be high in polycystic ovarian syndrome.

If your AMH is low, it means you have low ovarian reserve ( highly uncommon at 30 ) and you cannot have polycystic ovaries then.

One of the doctors is obviously wrong.
I feel that with your two week long period, you are definitely having endometrial hyperplasia ( lining of the uterus is too thick ) due to hormonal imbalance.

I would appreciate it if you get the following done :

1. Day 2 baseline transvaginal ultrasound
2. Day 2 FSH and LH
3. TSH, adrenal hormones, AMH ( can be done on any day of the cycle ).
4. Also, a transvaginal ultrasound on day 14 of your period ( to look for thickening of the lining of the uterus )

I hope conception is not a concern right now. If it is , you need to get additional tests like your partner's semen analysis, and fallopian tube assessment.

Also, rarely, such a pattern of periods could be caused by cervical polyps, growths, endometrial polyps etc.

Stress, anxiety, thyroid disorder, etc also are frequent culprits of such abnormal bleeding.

Please consult a reputed gynecologist , and get the above done.
Would love to hear from you with follow up again.
Take care, feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: Prolonged period. TVS normal. Prescribed Duphaston for PCOS. Want your opinion 1 hour later
Thanks for your quick response. That's exactly why I'm so confused because I read that to have polysistic ovarian syndrome means I should have high estrogen and high testosterone (is it possible not to have high testosterone though?) The tests I took in London however showed the opposite (although I got tested I believe on day 6 of my cycle so I don't know if that changes things). The doctor who's been doing my ultrasounds though says I do have multiple follicles and that the lining of my uterus is high (he checked several times on day 14 of my cycle) so he put me on progesterone tablets duphaston (I'm on it now).

The only thing that seems to contradict his findings is the hormone tests I took a few months ago. I saw a hormone specialist in London for that. I have the hormone tests but not the ultrasound on me (I can try to obtain it later). How can I upload it? I don't see an option on the website.

Answered by Dr. Aarti Abraham 1 hour later
See, high testosterone is not a prerequisite for PCOS, but PCOS patients cannot have a low AMH or a low ovarian reserve
The tests should be done on day 2 of the cycle, except for AMH which is not dependent on the day of cycle.
If the lining of the uterus is thickened, or you have endometrial hyperplasia, then again PCOS is the likelihood.
There is an option - on the right side of the page, there is an option to upload the reports.
Above answer was peer-reviewed by
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