PCOS: Navigating Symptoms and Treatment Options

Q: PCOS: Navigating Symptoms and Treatment Options

Regarding your questions, here are the answers：<br>1. <br>Which specialty should I see? You should see an obstetrician-gynecologist (OB-GYN).<br>2. <br>Is it necessary to wait for hyperprolactinemia to cause galactorrhea or tumors before treatment? Hyperprolactinemia requires tre

Could you please provide more context or specify what you need assistance with?

Hello, Doctor.
I am currently 23 years old, unmarried, and have no sexual experience.
My menstrual cycle has been irregular for about 8 years, starting when I was in high school.
I thought it was due to academic pressure, as I suddenly gained 10 kilograms in the middle of one month (which I have not been able to lose despite eating very little).
I took some menstrual regulation medication for a while but felt that it wasn't good to take it regularly, so I stopped.
Four years ago, I visited a gynecologist because I suddenly developed excessive body hair, including on my hands, feet, and chin, although the latter was not very noticeable.
The doctor suspected polycystic ovary syndrome (PCOS) but did not conduct any imaging tests.
Due to certain reasons, I did not return for follow-up until recently when I went to a large hospital and was found to have elevated prolactin levels, with a value of 75.
An ultrasound was performed, and the doctor confirmed PCOS.
The doctor prescribed bromocriptine 2.5 mg to be taken for six months for significant effects.
Initially, I had no issues for the first month, but after that, I began experiencing dizziness, nausea, and other symptoms that worsened, so I stopped taking it.
The doctor advised me to see an ophthalmologist due to concerns that an enlarged pituitary gland might be pressing on my optic nerve.
I then saw an ophthalmologist, who referred me to a neurosurgeon for an MRI to check if the pituitary gland was enlarged.
I often experience headaches, but the neurosurgeon said that a prolactin level of 75 is not too high, as some people have levels over 100 or 200 and still experience no issues.
He suggested waiting until a tumor develops before considering surgery.
I have a few questions: 1.
Which specialist should I see, neurosurgery or gynecology? 2.
Is elevated prolactin only treated when there is lactation or a tumor? 3.
Can I take ovulation medication to potentially cure my condition? 4.
I have heard that taking contraceptives and ovulation drugs excessively can lead to cancer; is this true? 5.
Are the symptoms of dizziness and nausea I experienced after one month of taking the medication side effects? (These symptoms disappeared after I stopped taking it.) Why didn't I experience these symptoms when I first started taking it? 6.
I often feel breast swelling but have no lactation; could this be caused by elevated prolactin? 7.
Given my situation, are there any treatments that are more effective and have fewer side effects (like nausea and dizziness)? Thank you, Doctor.

liǎng gè rén gēn liǎng zhī yú, 20~29 year old female. Ask Date: 2003/10/17

Dr. Shi Chengyang reply Obstetrics and Gynecology

Regarding your questions, here are the answers:
1.
Which specialty should I see? You should see an obstetrician-gynecologist (OB-GYN).
2.
Is it necessary to wait for hyperprolactinemia to cause galactorrhea or tumors before treatment? Hyperprolactinemia requires treatment to prevent disruption of the menstrual cycle and ovulation.
3.
Can I take ovulation medication to cure this condition? Ovulation medication cannot cure this condition.
4.
I heard that taking birth control pills and ovulation drugs excessively can cause cancer.
Is this true? There is no such claim.
5.
After taking the medication for a month, I started experiencing dizziness, nausea, and other symptoms.
Are these side effects of the medication? (Because the symptoms disappeared after I stopped taking it.) Why didn't I have these symptoms when I first started taking it? This is due to drug accumulation; as the concentration of the medication in your body increases, side effects like dizziness and nausea may appear.
6.
I often experience breast swelling but no galactorrhea.
Is this caused by prolactin? No, breast swelling is related to estrogen, not prolactin.
7.
Given my situation, is there a treatment option that works faster and has fewer side effects (like nausea, dizziness, etc.)? Reducing the medication dosage and alleviating physical and environmental stress may help improve the situation.
Thank you for your questions.
If you have further concerns, please consult a physician in the outpatient clinic.

Reply Date: 2003/10/17

More Info

Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder that affects many women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, excessive hair growth (hirsutism), acne, weight gain, and insulin resistance. Understanding your symptoms and treatment options is crucial for managing PCOS effectively.

Symptoms of PCOS
1. Irregular Menstrual Cycles: Many women with PCOS experience infrequent or prolonged menstrual periods. This can lead to challenges with fertility.

2. Hirsutism: Increased hair growth on the face, chest, and back is common due to elevated androgen levels.

3. Acne and Oily Skin: Hormonal imbalances can lead to skin issues, including acne.

4. Weight Gain: Many women with PCOS struggle with weight gain or difficulty losing weight, often due to insulin resistance.

5. Pelvic Pain: Some women experience pain during menstruation or ovulation.

Diagnosis
Diagnosis typically involves a combination of medical history, physical examination, blood tests to check hormone levels, and imaging studies like ultrasounds to identify cysts on the ovaries. It's important to note that not all women with PCOS will have cysts, and the diagnosis can be made based on symptoms and hormone levels.

Treatment Options
1. Lifestyle Changes: Weight management through diet and exercise is often the first line of treatment. Even a modest weight loss can help regulate menstrual cycles and improve insulin sensitivity.

2. Medications:
- Hormonal Birth Control: Birth control pills can help regulate menstrual cycles, reduce hirsutism, and improve acne.

- Metformin: This medication is often prescribed to improve insulin sensitivity and can help with weight loss and menstrual regularity.

- Anti-androgens: Medications like spironolactone can help reduce hirsutism and acne.

- Fertility Treatments: If pregnancy is a goal, ovulation induction medications may be necessary.

3. Surgery: In some cases, ovarian drilling (a laparoscopic procedure) may be considered if other treatments are ineffective.

Addressing Your Concerns
1. Choosing the Right Specialist: Given your symptoms, it would be best to consult with a reproductive endocrinologist or a gynecologist specializing in PCOS. They can provide a comprehensive evaluation and tailored treatment plan.

2. High Prolactin Levels: Elevated prolactin levels can be a concern, but not all cases require immediate treatment unless symptoms like galactorrhea (milk production) or significant tumors are present. Monitoring and follow-up with your healthcare provider are essential.

3. Ovulation Induction: Medications to induce ovulation can be effective for women with PCOS who are trying to conceive. However, it is crucial to address any underlying hormonal imbalances first.

4. Concerns About Cancer: There is some debate regarding the long-term use of hormonal medications and cancer risk. However, the benefits of managing PCOS symptoms often outweigh the risks. Regular check-ups and screenings are essential.

5. Medication Side Effects: The side effects you experienced with bromocriptine, such as dizziness and nausea, are known. These symptoms can sometimes diminish over time, but if they persist, discussing alternative treatments with your doctor is advisable.

6. Breast Tenderness: This can be related to hormonal fluctuations, including elevated prolactin levels. It is essential to discuss this symptom with your healthcare provider.

7. Seeking Effective Treatment: If you are looking for treatments with fewer side effects, discuss options like lifestyle modifications, metformin, or other hormonal treatments with your doctor. Each individual's response to treatment can vary, and finding the right approach may take time.

Conclusion
PCOS is a manageable condition, but it requires a comprehensive approach tailored to your specific symptoms and health goals. Regular follow-ups with your healthcare provider, lifestyle modifications, and appropriate medications can significantly improve your quality of life and reproductive health. Don't hesitate to seek a second opinion or ask for referrals to specialists if you feel your concerns are not being adequately addressed.

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