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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for hormonal imbalance

Answered by
Dr.
Dr. Ajish TP

Endocrinologist

Practicing since :2002

Answered : 819 Questions

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Posted on Mon, 19 Jan 2015 in Thyroid Problem and Hormonal Problems
Question: Hello Doctor, This is my 7th doctor which iam consulting for my uterus problem.
I got my first periods at the age of 16, and it was only for 3 days. from next month i dint get. i consulted doctor and took treatment. when i take tablets for 30 days i will get periods if i stop it i wont get it. i got scanning done. Consulted Endocrinologist also. Starting i took tab Ovaral G. Then Recently 2 years back i was taking Premarine . Iam really worried, doctors says its hormonal defect and i wont get periods at all . its more than 10 years that i got periods normally. Please suggest i feel very bad. Even for my elder sister has same problem like me. my mother is normal. Now she is in Menopause. PLease Doctor Kindly Help me on this.
doctor
Answered by Dr. Ajish TP 1 hour later
Brief Answer:
Please share the results of hormonal tests.

Detailed Answer:
Hi XXXXXXX

Welcome to HCM. I had gone through your question and understand your concerns.

Irregular cycles can be due to various reasons. The treatment depends on the cause.

The usual first blood tests that we do in these cases are:
On the first week of menstrual cycle -

Serum LH, FSH
Serum prolactin
Thyroid function tests
Serum testosterone
Serum 17 hydroxy progesterone
Ultrasound of uterus and ovaries

In selected cases we will do additional tests like cortisol, diabetic tests, lipid profile, DHEAS etc based on the clinical picture.

Hope your endocrinologist have done most of these tests. Please upload the reports so that I can help you with a reasonable answer.

Please share the clinical details like weight, height, presence of hair in face, other medical problems etc.

If you have any further questions I will be happy to help.

Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Ajish TP 24 minutes later
Hello Doctor, Thank You for the reply. I will upload all my reports very shortly. or can i know or get an appointment to consult you. Sorry i dont no weather you stay in XXXXXXX Or no issue i can upload my reports till now.

Doctor, My Height is 5'.6". Weight : 67 KG.
Have normal hairs on face, it was more before and reduced now.
iam also having fissure problem due to hard stool, it bleeds and pains a lot.
doctor
Answered by Dr. Ajish TP 23 hours later
Brief Answer:
Repeat LH and FSH, if elevated primary ovary failure

Detailed Answer:
Hi XXXXXXX

Welcome back.

I have gone through your reports.

Your investigations are showing rudimentary ( small sized) uterus and ovaries. Your pituitary hormones , LH and FSH, are grossly elevated.

LH and FSH usually stimulate the ovaries to produce sex hormones- estrogen and progesterone. Sex hormones are needed for normal menstruation. In your case there is high LH and FSH, but they are not able to stimulate the ovary to produce sex hormones and menstruation. This condition is called ovarian failure.

In a similar case what I will do is to repeat LH and FSH to make sure they are truly elevated, and do a karyotyping- blood tests to see chromosomal analysis. Hope your endocrinologist has done the same thing.

The treatment of ovarian failure is to have estrogen progesterone replacement. That is exactly what your endocrinologist has suggested. You have to be continuously on these medications.

I hope everything has been explained to you by your endocrinologist. If you take the medications regularly you will have normal sexual development and menstrual cycles.

How is your breast development and sexual hair development?

The treatment in your case needs counselling and detailed explanation of the medical problems. Please share with me if you have any medical doubts regarding your condition or management. If you have any further queries I will be happy to help you.

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajish TP 23 minutes later
Hi Doctor,
Thanks for your reply . You mean to say i have ovarian failure then how come i got first period??
My Endocrinologist said i cant conceive, it may or may not. He said he cant assure you on this. For my satisfaction i can take this medicine for regular periods.
But he also says i should take this life time.

Can you suggest how long i have to take this medicine.

What is LH and FSH .. why it is high in me.

Regards,
XXXX
doctor
Answered by Dr. Ajish TP 7 hours later
Brief Answer:
Please see the detailed answer

Detailed Answer:
Hi XXXXXXX

Welcome back.

I can understand your concerns. I will explain your condition so that you cn understand things better and follow the medications properly.

Your condition is called premature ovarian failure. Premature ovarian failure is a condition in which menopause ( ovarian failure) sets in early, any time after menarche. In this condition instead of having menopause at 50 yrs you will have menopause early. After that there won't be any menatruation or ovulation. The cause can be genetic or auto immune.

The initial bleeding in your case can be a withdrawal bleeding or a normal menstruation. That means there will be a small amount of hormones that was produced in your ovary which when ovaries stopped functioning has lead to a bleeding.

We diagnose premature ovarian failure when there is an elevated FSH in two blood samples.Additional test that we do is to look for chromosome pattern to see if you have genetic disorders commonly seen with this condition.

LH and FSH are hormones from brain ( pituitary) which will stimulate the ovary to produce hormones and cause ovulation. When there is ovarian failure, the brain will try to stimulate ovary and produce hormones. So LH and FSH will be high in ovarian failure.

This will explain your medical condition. I know it may be tough for you to understand, but go through it and if you have any doubts please feel free to ask.

What you should understand from your condition is :

1. Your ovaries stop producing estrogen and progesterone. These hormones are important for menstruation, sexual development, bone health and generalised well being.

Don't worry. You can take estrogen/progesterone treatment till the age of normal menopause ( 50yrs)

2. Your ovaries won't produce ovum. So you cannot conceive naturally.

Don't worry. You can conceive using an ovum donor. Just like sperm bank infertility centres can help you with ovum donation and fertility. I have patients who have children through this after ovarian failure.

So think positive. Think that what that would have naturally happened to your ovaries at 50 years happened very early in your case. The problem can be solved with regular hormone replacement treatment and artificial fertilisation.

If you have any further queries I will be happy to help you.

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Ajish TP 9 hours later
Hello Doctor, Thanku very much for your reply. Now iam worried why is that i got menopause early. Their is no treatment to improve my estrogen/progesterone??

If yes what medicine i have to start for it. If their is a solution please tell me know what i have to do.
Doctor iam positive for what iam and happening in my life till now. but its very hard to know i cant conceive.. Please kindly help me with some solution and medication for it.
doctor
Answered by Dr. Ajish TP 3 hours later
Brief Answer:
Premarin 1-25 days and Modus 15-25 days can be tried

Detailed Answer:
Hi XXXXXXX

Welcome back.
Detailed answer for your questions:

1. The cause for premature ovarian failure are:

a. Genetic - chromosomal disorders like turners syndrome and fragile X syndrome
b. Auto immune - ovarian antibodies that destroy your ovaries - what causes the increase in antibodies is unknown.

2. Treatment to improve the condition

Currently no treatment can improve the ovarian function once the FSH is consistently above 20 miu/l. ie if high LH and FSH cant stimulate ovary, no drug or natural treatment can do it.

3. Medications:

The medicines are estrogen - progesterone replacement in a cyclical manner. Premarin 1-25 days and Modus 15-25 days as suggested by your endocrinologist. These treatment has to be taken every month till the age of 50 years.

4. Fertility

Since ovaries are not functioning spontaneous fertility is very very rare in ovarian failure. No treatment options are available for ovulation. Fertility is possible only with help of ovum donor. Ovum and husband's sperm are fertilized outside and introduced to your uterus. With hormone treatment you can have full pregnancy and deliver a normal baby.

Hope I have answered your query. If you have any further questions I will be happy to help

With warm regards,
Dr Ajish TP (MD,DM)
Consultant Endocrinologist.

Above answer was peer-reviewed by : Dr. Shanthi.E
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