Which Specialist Should I See for My Symptoms: OB-GYN, Endocrinology, or Immunology?

Q: Which Specialist Should I See for My Symptoms: OB-GYN, Endocrinology, or Immunology?

Hello Ms. <br>Chen： Your condition can be evaluated by either an endocrinologist or a gynecologist. <br>If the endocrinologist determines that you do not have any immune-related issues, please note that menstrual flow can sometimes be easily influenced by your diet or medications

Which department should I see? (1) Obstetrics and Gynecology (2) Endocrinology (3) Immunology

Hello Doctor: I would like to ask which specialist I should see for my symptoms: (1) Obstetrics and Gynecology, (2) Endocrinology, or (3) Immunology, or could it be related to the long-term immunology medication I am taking? I feel that my condition is getting worse.

Symptoms:
1.
Menstrual flow: The amount of menstrual flow on the first day of my period now is equivalent to what used to be the amount in the first two hours, which I feel is too little, and this has been ongoing for 7 months.

2.
Acne: I used to only get acne during my period, but now I have many every day, with pus and scarring, appearing all over my body, including my face, neck, inner and outer arms, chest, back, and abdomen, and this has also persisted for over 7 months.

3.
Pelvic pain: I have severe pain on both sides of my lower back above the pelvis, and I need to take anti-inflammatory pain medication to sleep.
This has been ongoing for almost 2 years.
I have seen an immunologist, had blood tests, X-rays, and MRIs, and they found a gene for ankylosing spondylitis, but all tests were normal with no inflammation, confirming that my immune system is not the issue, yet I am still prescribed anti-inflammatory pain medication.

4.
Sleep: I feel like I am sleeping but not really rested.
Previously, I couldn't sleep due to pelvic pain, but now with the anti-inflammatory pain medication, I can sleep, although I still have vivid dreams and do not sleep well, experiencing at least three different dreams a day for over 2 years.

5.
Constipation: I have severe constipation, and I am mindful of my diet and water intake, and I have been exercising regularly.
This constipation issue has also lasted for about 7 months.

Please help me with your insights.
Thank you.

Chen Yingjun, 20~29 year old female. Ask Date: 2016/11/07

Dr. Huang Yiwen reply Obstetrics and Gynecology

Hello Ms.
Chen: Your condition can be evaluated by either an endocrinologist or a gynecologist.
If the endocrinologist determines that you do not have any immune-related issues, please note that menstrual flow can sometimes be easily influenced by your diet or medications.
For example, certain pain relievers can also lead to a decrease in menstrual volume.

Reply Date: 2016/11/07

More Info

Based on the symptoms you've described, it would be advisable to consult with an OB-GYN (obstetrician-gynecologist) and potentially an endocrinologist. Your symptoms suggest a complex interplay of hormonal and possibly gynecological issues that need to be addressed.

1. Menstrual Changes: The significant decrease in menstrual flow over the past seven months is concerning. This could be indicative of hormonal imbalances, which can be assessed by an endocrinologist. Conditions such as polycystic ovary syndrome (PCOS) or thyroid dysfunction can lead to changes in menstrual patterns. An OB-GYN can also evaluate for any structural issues within the reproductive system, such as fibroids or polyps, that might be contributing to these changes.

2. Acne: The increase in acne, particularly if it has become more widespread and severe, could also be linked to hormonal changes. Hormonal acne is often exacerbated by fluctuations in estrogen and testosterone levels. An endocrinologist can help assess your hormone levels and determine if there are underlying issues that need to be addressed.

3. Pelvic Pain: The chronic pelvic pain you've been experiencing, especially if it is severe enough to require anti-inflammatory medications for relief, warrants further investigation. While you have seen an immunologist and have ruled out inflammatory conditions, it may be beneficial to revisit this with an OB-GYN. Conditions such as endometriosis or pelvic inflammatory disease (PID) could be contributing to your pain and may require specific treatments.

4. Sleep Disturbances: Your sleep issues, including frequent dreaming and feeling unrested, could be secondary to chronic pain or hormonal imbalances. Sleep disturbances can also be a symptom of stress or anxiety, which may be exacerbated by your physical symptoms. A comprehensive approach that includes both medical and possibly psychological support may be beneficial.

5. Constipation: Chronic constipation can sometimes be linked to hormonal changes, particularly in women. It can also be a side effect of certain medications, including those used for pain management. Discussing this symptom with your healthcare provider is important, as they may recommend dietary changes, medications, or other interventions.

Given your complex symptoms, it may be beneficial to have a coordinated approach where both an OB-GYN and an endocrinologist are involved in your care. They can work together to evaluate your hormonal status, menstrual health, and any potential gynecological issues.
Additionally, it is important to consider the medications you are currently taking. Some medications can have side effects that impact menstrual cycles, skin health, and gastrointestinal function. A thorough review of your medication history with your healthcare providers can help identify any potential contributors to your symptoms.

In summary, I recommend scheduling appointments with both an OB-GYN and an endocrinologist. They can provide a comprehensive evaluation and develop a tailored treatment plan to address your symptoms effectively. It is crucial to communicate all your symptoms clearly during these visits, as this will help guide the diagnostic process and treatment options.

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