HYPOMENORRHOEA WITH OLIGOMENORRHOEA

24 Yrs, Girl, Unmarried, Student Chief Complaints Hypo - & Oligomenorrhoea for last 2 Yr. History Menstrual : Dysmenorrhoea (-), Clot (-), Pubertal age - 13 Yrs HAIR AN : No personal or family history of DM, Alopecia, Acne, Hirsutism, Acanthosis nigricans Others : No history of weight loss or weight gain. Appetite good. Vitals Stable Physical Examination Pallor nil. Built normal. Acne, Hirsutism, Alopecia absent. P/A: No tenderness, no mass. P/V : Not done (unmarried) Investigations USG (done in 2018) : ? PCOD BLOOD (Recent) : All normal. FSH - 6.55, LH - 4.77, TSH - 4.6, PRL - 14.9 Total testosterone - 30.9 Fasting Insulin - 0.32, Fasting sugar - 96 Lipid profile - wnl Diagnosis What is your diagnosis? Management What is your advice regarding further approach and management?

(Edited)

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Though this pt is diagnosed to be Pcos by Usg her hormones r not suggestive of Pcos as for Pcos FSH/LH ratio should be more than 2. But her testosterone level is far more. Any how repeat usg on 10th day of MC. Her prolactin level is normal but still look for Galactorrhoea. Mean while put her on oc pills for 3 mths. Syrup M2 tone 2 tsf TDs for 3 mths. Correction of Anaemia if any. If galactorrhoea + then tt with cabergolin.

Thank you ma'am
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Diagnosis is PCOD - which needs to be confirmed by a repeat Ultrasonography OR Hormonal imbalance- as GnRH has not been done . Treatment- A combination of Cyproterone 2 mg + ethinyl estradiol 0.035 mg ( Tab Krimson 35 ) 20 days in each cycle starting on 5th day of menstrual period 3 such cycles are needed . If Hb is less than 10 - then iron supplement is also needed. Certain- non - allopathic preparations like liq,Menohelp 1 tsf B.D for 3- 6 months do help I am using in my clinical practice as an adjunct to Hormonal therapy in menstrual irregularities with minimal side effects

Very nice sir. Thank you.
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Most likely it is a case of prepubertal oligomenorrhoea. All parameters shown are normal and does not indicates pcos.usg of 2018 ?pcos so rpt now fresh usg which only confirms pcos. In this case this variation is physiological and it takes 3 to 4yrs to become normal . So no need of tt and only reassurance and ask to wait for more 1to2 yrs. Gynaecologist opinion matters and must be taken.

Exactly sir. Thank you for this nice explanation.
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For sure it is the case of PCOD Few more investigations are advised... S.AMH..../S.prgesterone on day 21 st. Start Tab Registerone from day 25 th yo day 29 th. Metformin 500 md SR .OD.x 3 months.

Sir please see the insulin and fasting sugar value. No insulin resistance in there. So why Metformin sir?
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Wow nicely taking history Tell me HB%? Habbe mudire haiz two tab two times a day With shp niswani 10 ml twice a day Majun Dabidulward 5mg two times a day Sharbate foulad 5ml two times a day continue for one month

Sir advised it. Pending.
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Case of PCOD Repeat usg again for confirmation again because is last 2 yaer back See for proper diet n excersie regularly N take opinion of gynecologist and put her on hormonal therapy for further management N treat accordingly

First check if Anemic or not...Do CBC ESR Do FreeT4,T3,TSH Rule out Tuberculosis Give Combined OCP for 3 to 4 months If BMI high lifestyle modification

Give Sapthasaram kashayam two times a day,Kalyanakam gritham two times

Thank you
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