Delayed Menstruation and Hormonal Treatments in PCOS

Polycystic Ovary Syndrome (PCOS) Progesterone

Hello Doctor, I was diagnosed with polycystic ovary syndrome (PCOS) in June 2020 and have been intermittently taking birth control pills (Nina coated tablets) for nearly a year.
In September 2022, after changing jobs, I went for a gynecological check-up.
The examination showed that there were no follicles in either ovary, but the uterus appeared normal with no abnormalities.
The doctor speculated that the ovaries might be inactive due to the birth control pills and prescribed ovulation induction medication and progesterone.
I started my menstrual period on October 1, took the ovulation medication from October 3 to 7 (as per the doctor's instructions), and took progesterone from October 20 to 29 (also as per the doctor's instructions).
As of today (November 4), my period has not yet arrived, but I have been experiencing some premenstrual symptoms (such as lower back pain, bloating, and occasional headaches), without any bleeding or brown discharge.
Since I currently do not plan to conceive, I would like to ask the doctor: 1.
Is it normal for my period to be delayed for this long? Do I need to schedule another appointment? If not, when is the latest I can expect my period to arrive? 2.
If I do not plan to conceive at this time, can I resume taking birth control pills after this menstrual cycle until I decide to try for pregnancy? Thank you for your response, Doctor.

An An, 20~29 year old female. Ask Date: 2022/11/04

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is normal to have your period within a week after taking progesterone.
If it exceeds that time, it is advisable to visit a gynecologist.
If you are not trying to conceive, you can take birth control pills to regulate your menstrual cycle.
Wishing you good health.

Reply Date: 2022/11/04

More Info

Understanding delayed menstruation and hormonal treatments in Polycystic Ovary Syndrome (PCOS) can be quite complex, especially for individuals who have undergone various treatments and hormonal therapies. Your situation, where you have been diagnosed with PCOS and have been on hormonal treatments, raises several important points regarding menstrual irregularities, the effects of hormonal medications, and the management of PCOS.

1. Delayed Menstruation: It is not uncommon for women with PCOS to experience delayed menstruation, particularly after undergoing hormonal treatments such as birth control pills or ovulation induction medications. Birth control pills, like the one you mentioned (Nina), can suppress ovarian function, leading to a temporary cessation of ovulation. This can result in a lack of menstrual periods, which may take some time to normalize once the medication is discontinued. In your case, since you have been on ovulation induction medications and progesterone, the delay in your menstrual cycle could be attributed to several factors, including the hormonal adjustments your body is undergoing.

Given that you are experiencing premenstrual symptoms (PMS) such as lower back pain, bloating, and occasional headaches, it suggests that your body is responding to the hormonal changes. However, the absence of menstrual bleeding for an extended period (beyond the expected timeframe) may warrant further evaluation. It is advisable to consult your healthcare provider if your period does not arrive soon, especially if you have concerns about your hormonal balance or if you experience any unusual symptoms.

2. When to Seek Medical Advice: If your menstrual cycle does not resume within a reasonable timeframe (typically, if it exceeds 60 days without a period), it is prudent to schedule a follow-up appointment with your gynecologist. They may want to perform additional tests, such as a pregnancy test, hormone level assessments, or an ultrasound, to rule out any underlying issues that may be contributing to the delay.

3. Returning to Birth Control Pills: If you are not planning to conceive in the near future, resuming birth control pills after your current menstrual cycle could be a viable option. Birth control pills can help regulate your menstrual cycle and manage symptoms associated with PCOS, such as acne and excessive hair growth. However, it is essential to discuss this plan with your healthcare provider to ensure that it aligns with your overall treatment goals and health status.

4. Long-term Management of PCOS: Managing PCOS often requires a multifaceted approach, including lifestyle modifications, such as diet and exercise, alongside medical treatments. Weight management can significantly improve insulin sensitivity and hormonal balance, which may help regulate your menstrual cycles. Additionally, medications like Metformin may be prescribed to help with insulin resistance, which is common in PCOS patients.

In conclusion, while delayed menstruation can be a normal occurrence in women with PCOS, especially after hormonal treatments, it is essential to monitor your symptoms and maintain open communication with your healthcare provider. Regular follow-ups can help ensure that your treatment plan is effective and that any potential complications are addressed promptly. If you have any further questions or concerns, do not hesitate to reach out to your doctor for personalized advice tailored to your specific situation.

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Hello, the medication you are currently taking is exogenous hormones. It is recommended to consider taking ovulation pills; you can discuss this with your physician. Wishing you good health.