Irregular Menstrual Cycles and PCOS: Symptoms and Concerns

Long menstrual cycle, heavy menstrual flow, polycystic ovary syndrome (PCOS)?

Hello, I am 19 years old, with no sexual experience.
My height is 157 cm, weight is 55 kg, and body fat is approximately 24-25%.
Until the end of August 2018, I was an athlete in competitive sports.
I had an ultrasound at Taipei Wan Fang Hospital's obstetrics and gynecology department, which showed that my ovaries are larger and function less effectively, indicating a "constitution" of polycystic ovary syndrome (PCOS).

On March 10, the first day of my menstrual period, I noticed very light brown discharge around 8 PM, so I used a regular flow tampon to sleep.
Upon waking up, I found that the menstrual blood had soaked through my underwear to about the size of 1.5 palms, prompting me to change to a super absorbent tampon.
Today, March 11, on the second day, I have changed three super absorbent tampons and two regular ones, all with 23 cm sanitary pads underneath, which are soaked to varying degrees of 4-7 cm.

A week before my period, I felt discomfort in my lower abdomen (not painful), and the week prior, my nipples were particularly sensitive, with slight itching and breast tenderness.
During my period, in addition to the heavy flow, I frequently noticed blood clots ranging from the size of a one-dollar to a ten-dollar coin, appearing dark red.
My body feels achy in the lower back, with abdominal pain, and I cannot lie down or stand for long periods.
After eating, I feel nauseous and have no appetite.

My menstrual history in 2018 is as follows: (09/29-10/04 light bleeding, unsure if it was ovulation bleeding) 09/07-11, 07/26-08/02 (07/08-15 light bleeding, unsure if it was ovulation bleeding) 06/20-26, 05/07-12, 03/26-04/01, 02/22-28, 01/15-21.
This menstrual cycle is the first one since the end of September 2018, with a gap of 185 days (the app indicates a delay of 146 days).
Additionally, in 2017, I only had seven menstrual cycles, including long cycles of 158 days and 63 days.
Recently, I have noticed a few pubic hairs growing down to the thigh area (which were not there before).
1.
Is this a symptom of hirsutism?
2.
Can you explain why this is happening? (Is it due to polycystic ovary syndrome?)
3.
Could this be a sign of any disease? (Is there a possibility of endometrial cancer?)
4.
If I seek medical attention, what medications might be prescribed? (Such as progesterone, birth control pills, etc.)
Thank you.

Jill, 10~19 year old female. Ask Date: 2019/03/12

Dr. Huang Jianzhong reply Obstetrics and Gynecology

At 19 years old, with no sexual experience, I am 157 cm tall, weigh 55 kg, and have a body fat percentage of about 24-25%.
Until the end of August 2018, I was an athlete in competitive sports.
I previously had an ultrasound at Wan Fang Hospital in Taipei, which showed that my ovaries are larger and functioning poorly, indicating a "polycystic ovarian" condition.
On March 10, the first day of my menstrual period, I noticed very light, brownish discharge around 8 PM, so I used a regular absorbency tampon to sleep.
Upon waking up, I found that the menstrual blood had soaked through my pants to about the size of 1.5 handprints, prompting me to change to a super absorbency tampon.
Today, March 11, on the second day, I have changed three super absorbency tampons and two regular ones, all while using 23 cm sanitary pads that are soaked to varying degrees of 4-7 cm.

A week before my period, I felt a dull discomfort in my lower abdomen (not painful), and the week before that, I noticed that my nipples were particularly sensitive, slightly itchy, and I experienced breast tenderness.
During my period, in addition to the heavy flow, I often see blood clots ranging from the size of a one-dollar to a ten-dollar coin, appearing dark red.
My body feels sore in the lower back, with abdominal pain; I cannot lie down or stand for too long, and I feel nauseous and lack appetite after eating.

The menstrual conditions in 2018 were as follows: (09/29-10/04 light bleeding, unsure if it was ovulation bleeding) 09/07-11, 07/26-08/02 (07/08-15 light bleeding, unsure if it was ovulation bleeding) 06/20-26, 05/07-12, 03/26-04/01, 02/22-28, 01/15-21.
This period is the first one since the end of September 2018, with a gap of 185 days (the app indicates a delay of 146 days).
In 2017, I also had only seven menstrual cycles, including long cycles of 158 days and 63 days.
Recently, I noticed a few pubic hairs growing down to the thigh area, which were not there before.

1.
Could this be a symptom of hirsutism?
2.
I would like to know why this is happening (polycystic ovarian condition?)
Answer: Blood tests are needed for confirmation.

3.
Could this be a sign of any disease? (Is there a possibility of endometrial cancer?)
Answer: It should not be.

4.
If I seek medical attention, what medications might be prescribed? (Progesterone, contraceptives...)
Answer: A diagnosis requires blood tests to determine what medications may be prescribed.

Reply Date: 2019/03/12

More Info

Understanding irregular menstrual cycles and conditions like Polycystic Ovary Syndrome (PCOS) can be quite complex, especially for young women experiencing significant changes in their menstrual patterns. Based on the details you've provided, let's break down your concerns and symptoms.

1. Symptoms of Hirsutism: The presence of hair growth in areas typically associated with male-pattern hair growth, such as the thighs, can indeed be a symptom of hirsutism, which is often linked to hormonal imbalances, particularly in conditions like PCOS. Hirsutism is characterized by excessive hair growth in women and can be caused by elevated levels of androgens (male hormones) in the body.

2. Irregular Menstrual Cycles: Your history of irregular menstrual cycles, with periods occurring infrequently (as noted with intervals of 158 days and 63 days), is a hallmark of PCOS. This condition is often associated with anovulation (lack of ovulation), which can lead to irregular or absent periods. The heavy bleeding and presence of blood clots during your recent menstruation could also be indicative of hormonal imbalances, which are common in PCOS.

3. Potential Health Concerns: While your symptoms are suggestive of PCOS, it is essential to rule out other conditions. For instance, endometrial cancer is a concern in women with prolonged anovulation, as the lining of the uterus can become thickened due to unopposed estrogen exposure. However, this is less common in younger women. Other potential conditions to consider include uterine fibroids or polyps, which can also cause heavy bleeding and irregular cycles.

4. Diagnosis and Treatment Options: If you seek medical advice, a healthcare provider may recommend several diagnostic tests, including blood tests to check hormone levels (like testosterone, estrogen, and progesterone) and possibly an ultrasound to assess the ovaries and uterine lining. Treatment options for PCOS often include hormonal contraceptives (like birth control pills) to help regulate menstrual cycles and manage symptoms such as hirsutism and acne. Additionally, medications like metformin may be prescribed to improve insulin sensitivity, which can be beneficial for women with PCOS.

5. Lifestyle Modifications: Alongside medical treatment, lifestyle changes can play a crucial role in managing PCOS. Regular exercise, a balanced diet low in refined carbohydrates, and maintaining a healthy weight can help regulate menstrual cycles and improve overall health.

6. Follow-Up Care: Given the complexity of your symptoms and the potential for underlying conditions, it is advisable to follow up with a healthcare provider who specializes in reproductive health. They can provide personalized care and monitor your condition over time.

In summary, your symptoms align with characteristics of PCOS, but it is crucial to undergo a thorough evaluation to confirm the diagnosis and rule out other potential health issues. Early intervention can help manage symptoms effectively and improve your quality of life. If you have further questions or concerns, don't hesitate to reach out to a healthcare professional for guidance.

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