Difficulty Getting Diagnosed
Question
I am 34. I had endometriosis four years ago. I had a laprooscopic done because of fertility problems. That was how Dr. found endometriosis. He first said I has polycystic ovarian syndrome. I did conceive a year after the laprooscopic was done. I went on birth control for a year. I wanted another child so I came off the pill and conceived two months without taking clomid. I have always had to be given provera to help with my cycles for the past four years. In October, I was given prometrium and had an allergic reaction. I lost conscious, my tongue withdrew to left side, and I was numb on left side. My husband had to call the ambulance. The EMT’s thought I was having a stroke.
All tests revealed no stroke. That was my second time taking prometrium. I had a period for three months and last month I skipped. I had intercourse with my husband and bled for fifteen minutes after. Then I stopped. I called Dr. and was seen by another physician other than my primary one. He explained that I was trying to have a period and gave me a shot of progestin. I finally started five days later and had a cycle for three days. I have pelvic pain when I have a cycle. I had hemorrhoids during both pregnancies and had to have a hemorrhoid operation one week before delivery with my second child. I still have them. I have diarrhea during my cycles. Also, my legs hurt. I did have a lighting injury in 1994 which the neurologist said I had problems with my pituitary gland not responding for ovulation. I was referred to an endocrinologist. He sent me back to a gynecologist.
What would be the best test to ask for. I am tired. When I do not have a cycle, I get very upset. One minute I will cry and the next minute I hate everyone and could fight you I will get bloated and cramp for weeks but don’t have periods until I get some progesterone. I just want to know if endometriosis is back or if I do have polycystic syndrome. Also, I get big knots (pimples) on my back, arms, face, and neck.
They are very painful. This occurs before my cycle should start. I see my Dr. June 15th and I would like to know what tests I need to help with all my problems. Thanks!
Answer
Last Updated: June 14, 2013
First, the allergic reaction was probably related to the peanut oil used in the Prometrium. Sometimes progesterone injections are also used with a peanut oil base, so you will need to be aware of this if you use progesterone supplementation in the future.
Regarding your menstrual abnormality, you certainly could have polycystic ovarian syndrome (PCOS). Although there is a variety of ways to diagnose it, it is defined as anovulatory cycles with evidence of hyperandrogenism. Hyperandrogenism can be evident by the acne you described, an increase in facial hair, male-pattern baldness or elevated androgens on blood tests.
If you are not charting with a natural family planning method yet, I would highly recommend it. It will help both you and your doctor understand your cycles better, and will give evidence for anovulatory cycles. It also provides an excellent framework to monitor the progress of the treatment.
To evaluate for polycystic ovarian syndrome, as well as to look for other causes of your menstrual abnormality, I would recommend checking a TSH, prolactin, DHEAS, LH, FSH, testosterone, and a fasting glucose and insulin. However, there are several different approaches to the work up, and it is best decided by the physician who has taken a thorough history and examination.
Polycystic ovarian syndrome carries an increased risk of diabetes and atherosclerosis in the future, so it is important to diagnose it, both to correct your current menstrual abnormality as well as to optimize your future health. Although some doctors will treat PCOS with oral contraceptives, this only maintains your monthly bleeding cycle, but will not help protect you from the long term risks of diabetes and heart disease. Instead, it will actually increase those risks. A safer approach is to encourage exercise and dieting to ideal body weight, and, if necessary, using medications that will help your body use the insulin better, such as metformin.
You also mention symptoms of premenstrual tension disorder. This is frequently seen in PCOS patients. Progesterone supplementation can be very beneficial for these symptoms, but you will need to choose a form that does not contain peanut oil. Increasing your exercise during the premenstrual phase will also help.
Thank you for your questions, I wish you the best as you seek to improve your health.
Sincerely,
Dr. Keenan
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