PCOS, Birth Control, and Vaginal Itching: Key Insights

Polycystic Ovary Syndrome (PCOS), Birth Control Pills, and Vaginal Itching Issues?

Hello Doctor, I have two questions to ask.
Q1.
About a year ago, I consulted with a metabolic specialist and a gynecologist who suspected polycystic ovary syndrome (PCOS).
In addition to having a regular menstrual cycle, I also experience excessive hair growth (androgen excess), obesity (currently with a BMI > 25 and body fat > 35%), and abnormal insulin secretion.
The gynecologist advised me to return when my menstrual cycle becomes irregular.
I completed my first pack of the emergency contraceptive pill on October 5, which I purchased over-the-counter from a pharmacy (brand: Yejih).
I had unprotected intercourse between September 25 and September 26, with ejaculation inside.
I initially expected my period around October 8, but starting from October 5, I began to notice brown discharge, and as of today, October 8, I cannot say my period has arrived.
I have been experiencing a small amount of brown discharge daily, along with my usual vaginal discharge.
This feels completely different from my experience five years ago when I first took Yejih; back then, my period gradually decreased, starting normally and then becoming less frequent each month, but I never experienced symptoms like this.
I would like to know if this brown discharge is a normal occurrence.
If I need to see a doctor, how long should I observe before making an appointment? Additional information: Between October 5 and October 7, I experienced significant work stress, but I did not stay up late or have insomnia.
I had premenstrual depressive symptoms, sleeping from 11:00 PM to 6:30 AM, and I experienced cramping in my lower abdomen, which I believe is premenstrual pain, without diarrhea.
Q2.
My second question is regarding a visit to the gynecologist on October 2.
The reason for the visit was that during intercourse on September 25 and September 26, I experienced pain upon deep penetration.
After an internal examination (using a speculum and transvaginal ultrasound), the doctor indicated that there were no abnormalities and briefly mentioned the issue of ovulation related to PCOS, stating that my menstrual cycle was normal and not to worry too much.
However, after the internal examination, I have been experiencing itching in the vaginal area from October 2 to today, October 8.
The itching is located at the vaginal entrance, and upon self-examination with a mirror, I did not notice any unusual discharge, though the area appears slightly red.
Should I seek immediate medical attention to determine the cause of the itching, or can I continue to observe for a few more days?

Lin, 20~29 year old female. Ask Date: 2020/10/08

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, let's wait for your menstrual period.
As for the itching issue, if it doesn't improve, you can consult a gynecologist to address both the menstrual and itching problems.
Wishing you good health.

Reply Date: 2020/10/08

More Info

Understanding Polycystic Ovary Syndrome (PCOS), Birth Control, and Vaginal Itching: Key Insights
Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, excess androgen levels (which can lead to symptoms like hirsutism or male-pattern hair loss), and polycystic ovaries visible on ultrasound. Given your symptoms of irregular periods, excess hair growth, obesity, and insulin resistance, it seems you may indeed be experiencing PCOS.

Q1: Menstrual Irregularities and Brown Discharge
Regarding your first question about the brown discharge and menstrual irregularities after starting the birth control pill, it is not uncommon for women to experience changes in their menstrual cycle when they begin taking hormonal contraceptives. The brown discharge you are observing could be old blood that is being expelled from the uterus, which can happen when the lining is shedding irregularly.
Since you mentioned that you had unprotected intercourse shortly before starting the pill, it is also important to consider the possibility of pregnancy. However, if you have started taking the pill consistently, the likelihood of pregnancy is reduced.
The stress you experienced around the time of starting the pill can also contribute to menstrual irregularities. Stress can affect hormonal balance, potentially leading to changes in your cycle.
If the brown discharge continues for more than a week or if you experience any other concerning symptoms (such as heavy bleeding, severe pain, or fever), it would be wise to consult your healthcare provider. Monitoring your symptoms for a few more days is reasonable, but do not hesitate to seek medical advice if you feel something is off.

Q2: Vaginal Itching Post-Examination
As for your second question regarding the vaginal itching following your gynecological examination, it is not unusual to experience some irritation after an internal exam, especially if instruments were used. However, persistent itching can indicate an underlying issue, such as a yeast infection, bacterial vaginosis, or even an allergic reaction to products used during the examination.

Since you have noted that the itching has persisted for several days and you observed some redness, it would be prudent to consult your healthcare provider. They can perform a thorough examination and possibly a swab to determine if there is an infection or another cause for your symptoms.

Additional Considerations
In managing PCOS, lifestyle changes such as maintaining a healthy weight, regular exercise, and a balanced diet can significantly improve symptoms. Medications like metformin can help with insulin resistance, and hormonal contraceptives can regulate menstrual cycles and reduce androgen levels.

If you are experiencing significant distress due to your symptoms or if they interfere with your daily life, it is essential to communicate this to your healthcare provider. They can offer tailored advice and treatment options based on your specific situation.

In summary, while some changes in your menstrual cycle and vaginal health can be normal, persistent or severe symptoms warrant further investigation. It is always better to err on the side of caution and seek medical advice when you have concerns about your health.

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