Brief Answer:
Could be ovarian failure syndrome : More information required

Detailed Answer:
Hi XXXXXXX

I have gone through your long history written in a very sincere way. I have understood your problem, however, I would like to know more of your personal details:
1. Can you give me your marital history : Married how long, how many children, how old, etc.
2. About your personal history : Your age, thoughts set up, etc.
3. Your menstrual history since menarche : regularity, flow, periodicity, pain, cycle duration, etc.

Prima facae, when I went through your history, I have formed an opinion that you have landed in hormonal imbalance. It is unlikely due to the birth control pills as we prescribe these pills to correct the reproductory hormonal imbalance; i.e. imbalance between oestrogen and progesterone and/or hormones related to their production released by pituitary gland.

Your symptoms like hot flushes, burning sensation all over the body, dizziness, general body symptoms and frustration with stress points towards the menopausal symptoms. However, you have not mentioned your age. So I keep my fingers crossed till you give me your complete information.

I would like you to get your FSH & LH levels done on your blood. Please let me know the results.
Is there any family history of rheumatic arthritis? Your last sentence suggests that you have been diagnosed to have it.
XXXXXXX please get well composed. Your stress is making your condition worse as menstrual regularity also is governed by the emotional factors.
I would definitely like to guide you, help you. Please send me the information with the investigation reports I have requested for.

Moreover, please do not ignore the gastric/duodenal ulcers you are having. They also point towards the stress you are having in your life. Can you please send me the photographs of those ulcers if they have given you; otherwise please share me the detailed report of gastroscopy.
Before we come to any diagnosis and I suggest you its management, I would urge you to calm down. Take the professional help like counsellor or so.

Please send me the information. I am waiting for it and am keen to guide you.

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Brief Answer:
Multiple ailments due to multiple causes

Detailed Answer:
Thank you XXXXXXX for your response and providing the information.
Going through all your history and the reports I have formed a primary opinion that your different ailments are not due to one cause only. Let me discuss with you one by one:
1. The general weakness and fatigue you are experiencing seems to be related to your iron storage depletion. Agreed that your haemoglobin levels are within normal limits, however, your Serum Ferritin levels are low - not very low, but definitely low. When iron depots in the body start getting depleted, the Ferritin levels start dropping. Before it affects the haemoglobin levels showing anaemia, it depletes the cytochrome enzymes in the body which ultimately is reflected as fatigue, listlessness, apathy, tiredness, etc. I feel you should start consuming iron tablets daily to replenish your iron stores. Also consume jaggery, cilantro, green pepper, green leafy vegetables in the diet. Vitamins supplementation is needed.
2. The vertigo you are suffering from could be again due to iron deficiency however, please get an ENT surgeon's opinion whether you are having vestibulitis. This is known to cause vertigo, particularly on changing the position. Meclizine Hcl tablets once a day at bedtime should give you relief from this.
3. Now your symptoms regarding the menstruation. I have gone through all your reports. However, there is no mention in which phase of your menstrual cycle the tests were done. The levels of hormones vary according to the phase of menstruation. Can you tell me the date of your menstruation before the blood was given to the laboratory.
Even then the very fact you were continuously on the birth control pills for 12 years suggests that your body was set up to those higher levels of external hormones - oestrogen and progesterone. After discontinuing the pills, there was a relative low levels of these hormones - particularly oestrogen. Your reports show that you have high levels of free testosterone in your blood. Relatively lower oestrogen with higher levels of testosterone are causing the symptoms of hot flushes, burning sensation, depression, irritability, fatigue, etc.
Had you mentioned which pills you were taking previously and now you have shifted to which pills - particularly their contents, I could have figured out this more precisely. Now that you have entered into marital life and want to go for children, you have to get off the pills however, considering the withdrawal symptoms you are having, I would suggest you to do that gradually shifting to lesser oestrogen contents, but not high progesterone contents. Your Gynaecologist will prescribe you these pills. Then gradually you can stop the pills.
For a woman, Oestrogen is giving a sense of well being above the feminity.
In all these three causes, you must have noticed that your iron depletion also has a great role to play. Also since you are feeling the symptoms of oestrogen withdrawal, please start consuming Calcium with vitamin D3. As it is we always advice all the women to start calcium supplementation when they are 30 years of age.
4. And now a very delicate still sensitive issue of your stressful life. It is very difficult to opine whether the stress was the cause or is the result of all your ailments; you only can sort it out. Whatever is the situation, one thing is sure that the stress you are carrying has got a great impact on your all the ailments. Please try to have a professional help for your stress management along with the treatment I have suggested you.
I hope XXXXXXX I have given you a reasonably scientific explanation with solutions in the simple language to understand by a lay person. If you feel, you need to discuss more with me, please ask me freely. In your next communication, please mention about the date of your menstruation before the laboratory reports.
Please have patience. I am sure within few months you will be relieved of your symptoms and would be ready to travel of the path of maternity in your happy married life.

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Brief Answer:
Continue with the advice, you are going to be OK

Detailed Answer:
Dear XXXXXXX
I must appreciate your thorough story. I am happy to note that you could develop some little bit of confidence in me. I hope I stand to your expectations.
What I infer is that your tests were done in second half of the menstrual cycle; in that case FSH, LH and other reproductory hormone levels are within normal range.
From this story, again I felt that my diagnosis seems to be correct. The problem creating pills you were taking had Ethinyl Estradiol as Oestrogen and Desogestrel as progesterone. You seem to have landed in to the trouble after these pills. Still I maintain that you had oestrogen withdrawal symptoms which are very much like menopausal symptoms.
Also I learnt from your last presentation that your symptoms of hot flushes and burning are localizing and minimizing. It may take time, but I am sure with the time and the medicines you are taking, you will be relieved of them subsequently. By the way, do you smoke - active or passive? Reclipsen is known to cause problems in smokers.
The last tablet you took to tide over the crisis has played the trick. It has acclimatised your body to some extent to the oestrogen withdrawal.
And again I am insisting on iron, vitamins, calcium with D3. They will be key medicines to relieve you from your symptom.
One more fact is that your SGPT is high suggesting the low function of your liver. Liver usually regenerates to its required function and has got a tremendous reserve. To help liver regeneration please have low fat, high protein and high carbohydrate diet. You may take some medicines from your physician for that. However, in herbal medicines, there is a nice remedy for this - have juice extracted from very tender castor leaves. One teaspoonful (5 ml) of this juice to be mixed with equal amount of or more of honey and to be taken. Also if you can, drink sugar cane juice.
Your decision of staying away from the medicines is understandable and appreciated however, in this transitional phase, please take the required medicines like iron, vitamins, Calcium and D3. Rest of the things you can consume through the diet. Please have high protein diet with lots of roughage. Your urinary proteins are low. Though it is not a finding of any concern at all, it along with SGPT levels tells you that your liver is needing more proteins.
I do appreciate your plea for stress. However, it is coming on your health badly. Please do take some professional help to manage it successfully.
I do not think now you need any different medicines. Continue with the advice given, you are going to be fine and OK in the coming time. Please have some patience.
One more advice - for your husband. Please convey him this - he has to be very cooperative and understanding to you in these days. It is crucially required, particularly in low oestrogen syndrome.
You are most welcome to be in touch with me in future also. You can ask me direct questions too.

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Brief Answer:
You are on right path

Detailed Answer:
Hi XXXXXXX Nice to get your message again - a message in much positive encouraging mood.
The very fact you mention that you have been doing much better speaks how right you are on the path of your healthy life.
Yes, I have come across such patients with oestrogen depletion syndrome in my practice. Here in XXXXXXX we always ask the patients not to be on the birth control pills indefinitely; even some doctors tell them to take break every 3 years.
However, the news about fatty liver was new to me, although I had guessed it by your SGPT reports. You will have to strictly keep away from alcohol if you are consuming it. I know there are not very effective drugs in allopathy for regeneration of liver. If you know any ayurvedic practitioner in US or Hollistic Medical practitioner, you can get some medicines for liver from them.
Your liver regeneration will give you more speedy recovery.
Regarding castor oil : you are from New XXXXXXX There are many Indians in that state. If you contact some elderly person from them and ask about 'Erand' you will get the information. I do not know where you can procure them. You have to pluck the fresh tender leaves from the tree. Honey collected from flowers is good.
Now, I do not only hope but am sure, you are going to be healthy not before it is too long. Be patient. Please keep in touch. I am always at your service XXXXXXX
By the way, have you conveyed my message to your husband?
All the best. I shall be keen to learn the progress of your health. Even later on also you can anytime ask me direct question.

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Brief Answer:
You will be symptom free soon

Detailed Answer:
Let us not blame anybody and try to be healthy.
Ferrous sulphate 200 mg tablet daily is sufficient. To be taken before meals. It will cause you gastric disturbances. You may take iron twice a week in that case. Iron is available in time release spansule formats. It does not cause any gastric problems. Antacids if taken to minimize gastritis hampers the iron absorption.
Daily Calcium requirement is 1500 to 2000 mgms. I would advise you consume maximum share through diet - Milk, Cheese, Eggs, figs are good sources. Please have at least 500 ml of half to half milk every day in divided portions. Now a days most of the calcium tablets come with vitamin D3. You can have with your doctors prescription. Exposure to early morning sun rays is advisable.
Folic acid 5 mg a day should be more than sufficient. You get it from cabbage, spinach, green leafy vegetables, lentils
Have plenty of citrus fruits and lemon so that you do not need medicinal vitamin C.
I believe more in dietary and natural sources than medicines.
And there is no upper limit for the husbands love and care.
Such patients get symptom free usually within 3-6 months after they are on proper management.
Do let me know.

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Brief Answer:
Get cardiogram done if pain is on left side only

Detailed Answer:
Is it only on left side? If so, please get cardiogram done and show it to the cardiologist.
Otherwise this is most likely calcium and oestrogen related pain.
Does pressure on your bony points like chest bone, shin give pain? If so it denotes calcium deficiency. For symptomatic relief, you may take some analgesic like Tylenol.
Not only for this problem, but for your overall symptoms, can you do deep breathing exercises - what we call as pranayama? It has to be abdominal breathing largely. You can learn from some person there.
Let me know after 24 hours how is your shoulder pain.

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