Irregular Periods and Heavy Bleeding in PCOS Patients

Polycystic Ovary Syndrome (PCOS)

I have no sexual experience and have polycystic ovary syndrome (PCOS).
My menstrual cycle has been irregular for a long time, often taking over six months to a year to come, and the flow is light.
Over two years ago, I had an ovarian tumor removed, and since then, I have had fewer than five menstrual cycles.
I went for an examination on April 19, and the doctor prescribed a five-day course of Provera (medroxyprogesterone).
I did not take it as directed, and during the first two to three days, I think I took two pills.
My period started on April 29, with a heavy flow, and as of May 5, it has been over a week without stopping.
I have started to feel dizzy and am very concerned about the prolonged bleeding.
I would like to ask the doctor why my menstrual cycle has not stopped.

Niming, 20~29 year old female. Ask Date: 2016/05/05

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the reasons for heavy menstrual bleeding in women may include hormonal imbalances, emotional factors, diet, age, and more.
However, it is crucial to rule out conditions such as uterine tumors, endometrial hyperplasia, cervical lesions, and vaginal lesions.
If the bleeding persists, it is advisable to consult a physician for further evaluation.
Thank you! Wishing you peace and health.
Dr.
Zhang.

Reply Date: 2016/05/05

More Info

Irregular periods and heavy bleeding are common concerns for individuals with Polycystic Ovary Syndrome (PCOS), especially for those who have undergone surgeries such as ovarian cyst removal. Your situation, characterized by prolonged menstrual cycles, heavy bleeding, and a history of ovarian surgery, raises several important considerations.

First, it's essential to understand that PCOS is a hormonal disorder that can lead to irregular menstrual cycles due to imbalances in estrogen and progesterone levels. Women with PCOS often experience anovulation, which means that ovulation does not occur regularly. This can result in the thickening of the uterine lining (endometrium) without the regular shedding that occurs during a typical menstrual cycle. When menstruation finally occurs, it can be heavy and prolonged, as the body attempts to shed this thickened lining.

In your case, you mentioned that you have not had a regular menstrual cycle for over a year, with only a few periods occurring in the past two years. The heavy bleeding you are experiencing now could be attributed to several factors:
1. Hormonal Imbalance: After your ovarian surgery, your hormonal balance may have been disrupted. The use of medications like Provera (medroxyprogesterone) is intended to help regulate your cycle and induce menstruation, but if your body is not responding as expected, it may indicate that your hormonal levels are still not balanced.

2. Endometrial Hyperplasia: Given your history of irregular periods and prolonged cycles, there is a possibility of endometrial hyperplasia, a condition where the uterine lining becomes too thick. This can lead to heavy and prolonged bleeding. It is crucial to monitor this condition, as it can increase the risk of endometrial cancer.

3. Medication Compliance: You mentioned not taking the Provera as prescribed. Consistency in taking hormonal medications is vital for them to be effective. If you miss doses or do not take them as directed, it can lead to unpredictable bleeding patterns.

4. Underlying Conditions: Other underlying conditions, such as thyroid disorders or bleeding disorders, could also contribute to heavy bleeding. It may be beneficial to have a comprehensive evaluation to rule out these possibilities.

Given that you have been experiencing heavy bleeding for over a week and are starting to feel dizzy, it is crucial to seek medical attention promptly. Heavy menstrual bleeding can lead to anemia, especially if it persists, and dizziness can be a sign of low blood pressure or low hemoglobin levels due to blood loss.

Recommendations:
1. Consult Your Doctor: Return to your healthcare provider as soon as possible. Explain your symptoms, including the duration and heaviness of your bleeding, and any other symptoms like dizziness. Your doctor may want to perform additional tests, such as blood tests to check your hemoglobin levels, and possibly an ultrasound to evaluate the thickness of your endometrial lining.

2. Medication Management: Discuss your medication regimen with your doctor. If Provera is not effective, your doctor may consider alternative treatments, such as hormonal birth control pills, which can help regulate your cycle and reduce heavy bleeding.

3. Lifestyle Modifications: Maintaining a healthy weight through diet and exercise can help manage PCOS symptoms. Weight loss can improve insulin sensitivity and may help regulate menstrual cycles.

4. Monitor Symptoms: Keep a detailed record of your menstrual cycles, including the duration, flow, and any associated symptoms. This information can be valuable for your healthcare provider in determining the best course of action.

In summary, irregular periods and heavy bleeding in PCOS patients can be complex and multifactorial. It is essential to work closely with your healthcare provider to identify the underlying causes and develop an appropriate treatment plan tailored to your needs. Your health and well-being are paramount, and timely medical intervention can help manage your symptoms effectively.

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