Menstrual Irregularities: PCOS and Pituitary Tumors

I would like to inquire about menstrual irregularities, polycystic ovary syndrome (PCOS), and pituitary tumors?

Hello, Doctor.
I am 23 years old, and I started my menstruation relatively late, around 15 or 16 years old in the third year of junior high school.
Since then, my periods have never been regular.
I didn't think much of it until I went to see a gynecologist in my first year of college (around 20 years old).
An ultrasound revealed one or two small cysts on my ovaries.
The doctor mentioned that I was still young and did not have any immediate concerns regarding pregnancy, as I did not experience weight gain or excessive hair growth.
I was advised to monitor my condition, and I was prescribed medication.
Initially, my periods came as expected, but gradually they became delayed, and eventually, even with medication, I missed my periods.
I became busy with work and did not pay much attention to it.
In the past year or two, I have gained weight (from 55 kg to 63 kg) and noticed increased body hair.
Earlier this year, I was referred to a traditional Chinese medicine practitioner by a relative.
After taking a few herbal prescriptions, my menstruation did return, but it was always heavy and painful, and I experienced sudden weight gain.
I became scared and stopped the medication.
After stopping, my periods continued to come regularly, but the flow gradually decreased.
About six months ago, I consulted a Western medicine doctor, who diagnosed me with polycystic ovary syndrome (PCOS).
The doctor advised me to first ensure that my menstruation occurs regularly, and then to focus on normalizing the flow.
If I did not have a period for more than three months, I should return for medication.
However, after taking the medication, I reverted to my previous condition where my periods did not come even with medication.
The doctor then prescribed a month’s worth of oral medication, and after finishing it, my period returned.
The doctor mentioned that I would need to take the medication continuously for six months.
I am concerned about relying on medication and whether long-term use could harm my body.
Recently, I came across cases of pituitary tumors while researching online, and I am somewhat worried that this might be the cause of my issues.
Do you recommend that I pursue testing for this, or should I continue with the medication and monitor my condition? Thank you for your response!

Xi Zi, 20~29 year old female. Ask Date: 2016/11/29

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, I’m sorry that I cannot diagnose based on the described symptoms.
I recommend visiting a hospital for a detailed examination by an obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2016/11/29

More Info

Understanding menstrual irregularities, particularly in the context of conditions like Polycystic Ovary Syndrome (PCOS) and potential pituitary tumors, is crucial for effective management and treatment. Based on your description, it seems you have been experiencing a range of menstrual issues, including late onset of menarche, irregular cycles, weight gain, and increased body hair, which are all common symptoms associated with PCOS.

PCOS is a hormonal disorder that affects many women of reproductive age. It is characterized by irregular menstrual cycles, excess androgen levels (which can lead to symptoms such as hirsutism or acne), and polycystic ovaries, which may be detected via ultrasound. The condition can lead to complications such as infertility, metabolic syndrome, and increased risk of type 2 diabetes and cardiovascular diseases. Your experience of weight gain and menstrual irregularities aligns with typical presentations of PCOS.

The management of PCOS often involves lifestyle modifications, such as weight management through diet and exercise, which can help regulate menstrual cycles and improve insulin sensitivity. Medications such as hormonal contraceptives (birth control pills) are commonly prescribed to help regulate periods and manage symptoms. However, you mentioned concerns about long-term medication use, which is valid. While hormonal contraceptives are generally safe for most women, they may have side effects, and it's essential to discuss these with your healthcare provider.

Regarding your concern about a pituitary tumor, it is important to note that pituitary tumors can affect menstrual cycles, particularly if they lead to elevated prolactin levels (hyperprolactinemia). This condition can cause irregular periods or even amenorrhea (absence of menstruation). Symptoms of a pituitary tumor may also include headaches, vision changes, or other hormonal imbalances. If you have persistent concerns about this possibility, it would be prudent to discuss further evaluation with your healthcare provider. This may include blood tests to check hormone levels (such as prolactin) and possibly imaging studies like an MRI to assess the pituitary gland.

In summary, it is essential to continue monitoring your symptoms and maintain open communication with your healthcare provider. If you feel that your current treatment plan is not addressing your concerns or if you have new symptoms, seeking a second opinion or further evaluation is a reasonable step. Additionally, consider discussing lifestyle changes that could positively impact your condition, such as dietary adjustments and regular physical activity, which can be beneficial for managing PCOS and overall health.

In conclusion, while PCOS is a likely diagnosis based on your symptoms, it is essential to rule out other potential causes of menstrual irregularities, including pituitary issues. Regular follow-ups with your healthcare provider, along with appropriate testing, will help ensure that you receive the best care tailored to your needs.

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