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Suggest treatment for premature ovarian failure

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Posted on Tue, 28 Jun 2016
Question: At age 32 I stopped having a period. After months and months of testing and 3 different doctors no one could tell me why. At the time I was still producing hormones. I got frustrated and stopped going for almost 2 years. I recently started getting bad cramping, swelling and hardening in my lower abdomen and down my left leg so I went back. They redid blood work and pap (negative) the blood work showed I was no longer producing hormones so I was put on a troche (estra 1.5, test 1.5,progest 100mg). With in 5 days I started bleeding as heavy as a regular period. And had very mucousy clotting. I went back in for an endometrial biopsy yesterday. The doc said because of my age that even though all my symptoms pointed toward endometrial cancer he is fairly positive that is not the case. But has no idea why, and that there was no way I should have had that reaction to the hormones that quickly. I'm basically looking for an opinion of why all this has happened and what is going on. Thank you.
doctor
Answered by Dr. Dr.Sameer Kumar (40 minutes later)
Brief Answer:
premature ovarian failure.

Detailed Answer:
Hello,
Thanks for the query to hcm,
From your history it is evident that as you have stopped producing hormones and if your FSH &LH levels are high and you have been amenorrhoeic since last 2 years then you have experienced a premature ovarian failure or POF. However there was a possibility that you may have been eating oestrogen foods like alpha sprouts, tofu, flax seeds in your diet which caused the endometrium to grow and once you were placed on progesterone 100mg /estra 1.5, likely that you may have mistimed your pills and that initiated a withdrawal bleed which was hence heavy and had clots. Ideally a ULTRASOUND pelvis( transvaginal) is a mandatory investigation in your case and hormone supplementation should be stopped and a dilatation and curettage should be done ( or an endometrial curettage for histopathology ) to rule out any atypia with endometrial hyperplasia which may be indicative of any cancerous changes. However the age is not conducive for the diagnosis but there is a probability as this bleed shall be anyhow taken as a post menopausal bleed and endometrial cancer may be a differential diagnosis.
I am not sure of you have a family history of POF or endometrial cancer in your maternal family which may explain the incidence if detected, but the line of management shall be as above to investigate the cause.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dr.Sameer Kumar (24 minutes later)
To my knowledge the only thing that has been common in my family history is endometriosis in both my grandmother and great-grandmother. However, my sister was diagnosed with stage 3b breast cancer at age 28 and underwent a full mastectomy. She is HER2 positive, after genetic testing they have found I am both HER2 and BRCA negative. I had no periods at all for 4 years, as well as no slowing of periods - they simply stopped abruptly and have not returned - would that be POF? When I was younger my cycle was always fairly irregular and I had issues with ovarian cysts, but when my period stopped it simply stopped. When I started the HRT the period started within 5 days, could it be simply from the HRT and nothing else?
doctor
Answered by Dr. Dr.Sameer Kumar (3 minutes later)
Brief Answer:
answered

Detailed Answer:
The present bleeding is due to the HRT withdrawal, yes. But the clots indicate a thick endometrial lining which cannot form in just 5 days so i requested you for an ultrasound pelvis before an endometrial curettage. Will that be possible for you to upload your hormonal profile report and an ultrasound pelvis if done , for perusal?
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr.Sameer Kumar (4 minutes later)
I had an endometrial biopsy done yesterday and have an ultrasound scheduled for Monday, awaiting those results within the next week - so that may be possible
doctor
Answered by Dr. Dr.Sameer Kumar (3 minutes later)
Brief Answer:
we can then wait for the reports.

Detailed Answer:
Fine, not a hassle. As you have already undergone the biopsy then we should wait for the report and then we can make a decision. I am not sure why you should be on HRT when you have been asymptomatic.
Anyhow, please revert back with reports.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr.Sameer Kumar

OB and GYN Specialist

Practicing since :2002

Answered : 1785 Questions

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Suggest treatment for premature ovarian failure

Brief Answer: premature ovarian failure. Detailed Answer: Hello, Thanks for the query to hcm, From your history it is evident that as you have stopped producing hormones and if your FSH &LH levels are high and you have been amenorrhoeic since last 2 years then you have experienced a premature ovarian failure or POF. However there was a possibility that you may have been eating oestrogen foods like alpha sprouts, tofu, flax seeds in your diet which caused the endometrium to grow and once you were placed on progesterone 100mg /estra 1.5, likely that you may have mistimed your pills and that initiated a withdrawal bleed which was hence heavy and had clots. Ideally a ULTRASOUND pelvis( transvaginal) is a mandatory investigation in your case and hormone supplementation should be stopped and a dilatation and curettage should be done ( or an endometrial curettage for histopathology ) to rule out any atypia with endometrial hyperplasia which may be indicative of any cancerous changes. However the age is not conducive for the diagnosis but there is a probability as this bleed shall be anyhow taken as a post menopausal bleed and endometrial cancer may be a differential diagnosis. I am not sure of you have a family history of POF or endometrial cancer in your maternal family which may explain the incidence if detected, but the line of management shall be as above to investigate the cause. Regards