Irregular Periods and Hormonal Imbalances in PCOS

Polycystic menstrual cycle

Hello, Doctor: My last menstrual period was at the end of March, and as of mid-May, it still hasn't arrived.
I visited both a large hospital and a small clinic.
At the hospital, they couldn't schedule an ultrasound, so I just described my situation of not having my period.
The doctor prescribed me menstrual induction medication (Utrogestan and Estrofem).
I took them for three days, and during that time, I accidentally had sexual intercourse.
The next day, I experienced some pain while urinating and noticed blood in my urine along with some blood-tinged discharge.
I then went to a clinic for an ultrasound and pelvic exam.
The ultrasound showed that my endometrial thickness was 1.2 cm, and I also had signs of polycystic ovaries.
The doctor mentioned that this thickness is already considered thick, but since my period still hasn't come, I became anxious.
The doctor advised me to continue taking Utrogestan (progesterone) and to hold off on Estrofem (estrogen).
I have a few questions for you, Doctor:
1.
Is the thickening of the endometrium related to estrogen? Given that my thickness is significant, does this indicate that I have high estrogen levels in my body? Would taking estrogen medication further exacerbate the situation?
2.
Following up on the above, should I pause the estrogen medication and only take progesterone to help balance things out and encourage my period to come?
3.
With the endometrial thickening, would taking both estrogen and progesterone together lead to abnormal bleeding?
4.
While taking the menstrual induction medication, since I had sexual intercourse, is there still a possibility of pregnancy despite having polycystic ovaries?

Jia You Mei Shao Nu, 20~29 year old female. Ask Date: 2019/05/12

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, thickening of the endometrium may indicate that menstruation is approaching.
It is advisable to check again after menstruation to see if there is any improvement.
To induce menstruation, progesterone can be taken.
Since there has been sexual intercourse, despite having polycystic ovary syndrome (PCOS), there is still a possibility of pregnancy.
It is always best to use contraception consistently, as the rhythm method is not reliable.
Wishing you good health.

Reply Date: 2019/05/12

More Info

Understanding irregular periods and hormonal imbalances, particularly in the context of Polycystic Ovary Syndrome (PCOS), can be quite complex. Your situation involves several key factors, including the thickness of the endometrial lining, hormonal treatments, and the implications of recent sexual activity. Let’s break down your questions one by one.

1. Endometrial Thickness and Estrogen Levels: The endometrial lining thickens in response to estrogen, which is produced primarily by the ovaries. A thickness of 1.2 cm (or 12 mm) is indeed considered thick and can indicate an excess of estrogen, especially if ovulation has not occurred. In PCOS, hormonal imbalances often lead to prolonged estrogen exposure without the balancing effect of progesterone (which is produced after ovulation). If you take estrogen medications while your endometrial lining is already thick, it could potentially exacerbate the situation, leading to further thickening or even abnormal bleeding. Therefore, it’s crucial to monitor your hormone levels and consult your healthcare provider about the best course of action.

2. Using Progesterone Alone: It seems your doctor has advised you to take only the progesterone (Utrogestan) and to hold off on the estrogen (Eides). This approach is typically aimed at inducing a withdrawal bleed, which can help shed the thickened endometrial lining. By using progesterone alone, you can help balance the hormonal environment and potentially trigger your period. However, it’s essential to follow your doctor’s guidance closely, as they will consider your specific hormonal profile and overall health.

3. Combined Use of Estrogen and Progesterone: When both estrogen and progesterone are used together, they can indeed lead to irregular bleeding, especially if there is an imbalance in how your body responds to these hormones. If your endometrial lining is already thick, adding more estrogen could lead to complications such as hyperplasia (an overgrowth of the endometrial lining), which can cause abnormal bleeding. It’s vital to have regular follow-ups with your healthcare provider to monitor your response to treatment and adjust as necessary.

4. Possibility of Pregnancy: Engaging in sexual activity while on hormonal treatments, especially if you have irregular cycles and are not ovulating, does carry some risk of pregnancy, albeit it may be lower due to the hormonal imbalance associated with PCOS. If you have not been ovulating, the chances of conception are reduced, but not eliminated. If you suspect you might be pregnant, it would be wise to take a pregnancy test or consult your healthcare provider for further evaluation.

In summary, your situation reflects the complexities of managing PCOS and hormonal treatments. It’s essential to maintain open communication with your healthcare provider, who can guide you through the nuances of your treatment plan and help you understand the implications of your symptoms and test results. Regular monitoring of your hormonal levels, along with appropriate imaging studies, will be crucial in managing your condition effectively. If you experience any unusual symptoms, such as heavy bleeding or severe pain, seek medical attention promptly.

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