Polycystic ovarian syndrome

18 year old female presented with complains of irregular mensus and hirsuitism. She had been diagnosed with pcos in 2019 and was on tab premarin 0.625mg from day 5 of mensus to day 25 and tab deviry 10mg from day 16-25th of cycle and tab aldactone 50mg bd. However her menstruation always occured mid-cycle. She was on same treatment but till march, but then she could not consult her endocrinologist due to his unavailability in lockdown so discontinued medicines. Her hirsuitism has increased since then and she was started on the same treatment again, but started having mid cycle bleeding again between day 18-20. Pictures and relevant investigations attached Respected doctors, kindly advise treatment in this case foe both pcos and hirsuitism.

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Commen causes of HIRSUTISM are 1. PCOS 2. ANDROGEN SECRETING OVARIAN TUMORS 3. ANDROGEN SECRETING ADRENAL TUMORS 4. LATE ONSET CAH 5. CUSHING SYNDROME 6. EXOGENOUS ANDROGENS 7.IDIOPATHIC OR FAMILIAL. we needs to investigations accordingly.

SUGGESTIVE. OF.. P. C. O. D ELEVATED ..... T S H .... L. H ...RANDOM. S. INSULIN. LEVEL..

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Tab glucophage 250mg. Bd with meal Tab Diane 35 Vaniqa cream /laser for facial hair removal

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NEED'S.. HORMONAL STUDY..WITH.. ENDOCRINOLOGIST OPINION FOR FURTHER MANAGEMENT..

ENDOCRINOLOGIST ??? this pt. had already seen by three ENDOCRINOLOGIST before.
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Looks like menses r not controlled despite low dose hormonal therapy .try putting her on low dose contraceptive pill like femilon for 3 mths .do get her dheas and testosterone nd insulin levels done ,which r probably raised. Start on aldactone for hirsutism and ovahope or ferq forte tabs to stabilise her cycles.

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I agree with Dr.Nazia, needs further investigations like total/free testosterone levels, also look for symptoms & signs & presence of virilisation ( such as clitoromegaly and deepening of voice) sometimes CT. NEEDS dheas ,17 OH progesterone ,ACTH testing for confirmation

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Dear dr , what is her testosterone levels?

Dr, its 0.324
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