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What is the best approach for absent or irregular periods and fertility concerns after hormonal treatment?
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Gynecology & Pregnancy Care
Question #30155
57 days ago
159

What is the best approach for absent or irregular periods and fertility concerns after hormonal treatment?

Client_d0c1c6

Hi Doctor, I would like a second opinion on my current management for absent/irregular periods and fertility concerns. My menstrual history includes absent/very irregular periods since a young age. I have mainly used hormonal birth control in the past to induce withdrawal bleeding. This current investigation started on 25 March, when I first consulted for this issue. At that visit, I was advised that we would proceed step by step rather than doing immediate blood tests. I was prescribed Steron-5 (20 tablets, twice daily), and Amycordial once daily, with a follow-up scheduled for 22 April. At that time, I experienced withdrawal bleeding while on Steron-5, similar to my response on birth control pills. At my 22 April follow-up, I was again prescribed Steron-5 for 1 week (14 tablets, twice daily), and Ironic once daily, starting 6 May, with a follow-up planned for 19 May. I was seen again on 19 May, where I was prescribed Primolut N (15 tablets, twice daily starting 8 June) and Ironic (30 tablets once daily starting from 19 May). The only side effect I have noticed throughout treatment has been acne, which I was advised is inevitable. I have consistently had withdrawal bleeding whenever I take the prescribed hormonal medication. My main concerns are: * Whether this step-by-step treatment approach is appropriate for diagnosing the cause of my absent/irregular natural cycles * Whether further investigations such as blood tests, hormone testing, or ultrasound should now be done * Whether my condition may affect my ability to conceive in the future * And whether this current management is standard, or if a second opinion or alternative approach is recommended I would appreciate a clear second opinion on my case. Thank you.

How long have you been experiencing absent or irregular periods?:

- More than 5 years

What specific hormonal treatments have you tried in the past?:

- Birth control pills and other hormones

Have you experienced any other symptoms besides irregular periods and acne?:

- Acne only

How regular have your withdrawal bleeds been while on hormonal treatment?:

- Very regular

Have you had any previous fertility evaluations or tests?:

- No, none at all

What is your age and overall health status?:

- 25-35, healthy

How has your menstrual cycle affected your daily life or emotional well-being?:

- Significantly affects me

Are you currently trying to conceive or planning to in the near future?:

- Yes, planning to start soon
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Doctors' responses

Hello dear See at your age this can be attributed to hormonal alterations or physiological variation Also there can be chances of PCOS. Already medication are going on Iam suggesting some tests for confirmation of exact diagnosis. Please share the result with gynaecologist in person for better clarity and for safety please donot take any medication without consulting the concerned physician Serum ferritin Serum tsh Serum prolactin Serum progesterone Rft Lft CBC Urine analysis Pelvic USG Serum estrogen Serum progesterone Hopefully you recover soon Regards

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The step-by-step treatment you’ve described seems aimed at achieving regular bleeding through withdrawal rather than addressing an underlying cause, which can be reasonable initially. However, given your ongoing concerns about fertility and irregular cycles, a more in-depth assessment could provide valuable insights. Blood tests are essential to evaluate hormone levels, such as FSH, LH, estrogen, progesterone, and thyroid function, which can identify hormone imbalances or conditions like polycystic ovary syndrome (PCOS) or premature ovarian insufficiency. Ultrasound imaging could help assess ovarian and uterine structures for abnormalities that might explain irregular periods.

Regarding fertility, irregular or absent periods often indicate ovulatory dysfunction, a common cause of fertility issues. Understanding the root cause will inform your treatment options and future planning. Hormonal treatments currently help manage symptoms, but they don’t address conditions like PCOS directly affecting ovulation and long-term fertility. Consulting with a fertility specialist could provide additional insights and management options focused particularly on conception.

Your treatment seems symptomatic rather than diagnostic at this point, which prompts consideration for a comprehensive evaluation. Seeking a second opinion from a gynecologist or endocrinologist specializing in reproductive health can be beneficial. They can guide you on whether your regimen should incorporate fertility-focused treatments or changes pending precise diagnosis. It’s crucial these decisions fit your lifestyle and health priorities, including maintaining informed communication with your current healthcare provider about your preferences and objectives.

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