Brief Answer:
Fibroids do not cause loss of menses

Detailed Answer:
Dear XXXX,

Please know that fibroids are not known to cause amenorrhoea (missing a period). Moreover, you are having subserosal fibroid. It usually does not interfere the menstrual cycle periodicity. When it grows to within the muscle of the uterus and or uterine cavity, it will cause menstruation to appear irregularly in between the menses; however, it will not cause amenorrhoea.

To clarify your doubts, I would liked to have some more information:

1. Your marital status with sexual activity
2. Child bearing history
3. Your menstrual pattern : days of bleeding, periodicity, amount of bleeding (you mention no. of days of bleeding and the pads you change every day), regularity, pain factor.
4. Any such pervious incidence?
5. Size of the fibroid with its location: I would appreciate if you upload the ultrasonography images with the reports. Also I would like to know the endometrial (lining of the uterus) thickness.
6. Any history of other illnesses like tuberculosis, Thyroid dysfunction, etc..

After knowing this much information, I may request for any another information if required.

The dictum of medical science instructs us that if any sexually active woman in a childbearing age group misses her period, the first in the differential diagnosis should be pregnancy unless and until proved otherwise. You are in childbearing age group (29 years); if you are sexually active, I would advise you to look for any possibility of pregnancy first. Since it is more than 12 days that you have missed your period, pregnancy test on urine will give you reliable results. Please use overnight first morning urine sample for this test. Alternatively, you may opt for Beta hCG test.

If these tests confirm that you are not pregnant, you may go for withdrawal bleeding. Your gynecologist will prescribe medications to induce withdrawal bleeding.

If the ultrasonography report does not have the information I have requested for, you may repeat ultrasonography with the specific request for the information.

So I am awaiting for the information which will enable me to help you in more scientific manner.

For any more information, I am always available for you, XXXX.

Dr. Nishikant Shrotri

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Brief Answer:
Go for withdrawal bleeding

Detailed Answer:
Dear XXXX,


You have mentioned the anxiety status you had during last month. Anxiety can delay the menses.

Considering your marital and sexual history, I feel you may safely go for the withdrawal bleeding by Tab. Deviry.

If you get the withdrawal bleeding within 7 days after the discontinuation of Deviry, you have two options:

1. You may ignore this as a solitary incidence of delayed menses; however will monitor your subsequent cycles.

2. Straight a way start investigations.

Will you please update me with the following information:

1. Your BMI. If you do not know how to calculate it, you may inform me your height and weight.
2. Do you have any coarse hair on unwanted places like lips, cheek, legs, below the umbilicus, etc.?
3. Please get your T3, T4, TSH - Thyroid function test performed and upload the reports.
4. Blood examination for FSH, LH, Prolactin.
5. Do you have any secretions from your nipples?

Based on these, I may ask for more investigations. Lets try to look for Thyroid dysfunction and Polycystic Ovarian Syndrome.

Please feel free to ask me any more information.

Dr. Nishikant Shrotri

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Brief Answer:
PCOS needs management

Detailed Answer:
Dear XXXX,

It seems from your brief information that you have provided that you are having Polycystic Ovarian Syndrome (PCOS). You mention that you are overweight. Madam, you might be overweight for quite some time; however, the PCOS starts showing when the hormonal imbalance occurs.

PCOS is known to cause irregular menses. You may attribute your delayed menses to PCOS. It is a condition which has Polycystic Ovaries, High insulin and High androgens in the body. This treatment needs to be managed at all three levels.

For regularising your menses, you may take birth control pills with the advice of your Gynaecologist. Since you are not married, the failure in releasing eggs need not be tackled at this stage.

You may require Metformin or Myo inositol for managing high insulin levels.

You will have to bring down your BMI under 23.9. High protein/moderate carbohydrates/ low fat diet is suggested with lots of fresh fruits and green leafy vegetables. Along with, you will have to do exercises also.

To give you the detailed advice, I need the reports of the investigations. Currently, I have advised based on whatever brief information you have provided me. I hope you will take it seriously and provide me the information.

Dr. Nishikant Shrotri

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Brief Answer:
Please do not neglect PCOS

Detailed Answer:
Dear XXXX,

As I have advised you, you may ignore this solitary incidence, however, keeping PCOS in mind, please keep watch on your menstrual pattern. Oligomenorrhoea ( delayed menses) followed by heavy bleeding is a classic pattern of PCOS. I would not advise neglecting PCOS.

Would you now mind posting a good review with 5 starts rating for me?

Dr. Nishikant Shrotri

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