Am I doing this right?
Dear Dr Mitchell,
In December of last year I realised that my period was coming every other month and I started growing a few hairs under my chin so I decided to visit my gynaecologist. In March of this year I was diagnosed with PCOS and I have been given a number of pills to take.
I was given Clomiphene Citrate, Medroxyprogesterone Acetate, Metformin HCL and Diane 35 but I was told by the doctor to hold off on Diane 35 but he never told me when I should start taking it.
I haven’t started taking Diane 35 but I repeat the others every other month. My problem is, I don’t know if I am repeating the process correctly within the correct time. Could you please help in this regard?
Also, I am 27, but when I was 22 I got pregnant but I lost the baby. Since then I have been very careful as I wasn’t ready for a baby. My significant other lives overseas and we want to try next year to have a baby.
Do you think I am on the right path to making this dream a reality?
The symptoms that you are experiencing seem to fit the profile of polycystic ovarian disease. The excessive facial hair and irregular cycle are often associated with excessive weight gain. It is reassuring that your weight is 120lbs at 5 feet 2 inches.
It is important to control your weight and try to maintain your ideal weight for height. This helps to restore ovulatory cycles and helps especially if you are trying to conceive. It is also important in reducing your risk of developing diabetes mellitus which is sometimes seen as a feature in women with polycystic ovarian disease.
Clomiphene Citrate is used to induce ovulation and is usually taken on the third or the fifth day of the menstrual cycle for five days, counting day one as the first day that bleeding starts. The best time for conception is day 15 to 21. If conception does not occur, then the dose is gradually increased each month. A blood progesterone test should be done to determine if ovulation has occurred. Once the desired level of progesterone is reached then the Chlomiphene Citrate(Clomid) is continued for six months or until conception occurs. If you fail to get pregnant within six months of regular Clomid therapy then the treatment should be revised. Medroxy Progesterone Acetate is used to bring on the menstrual period if there is no flow before using Clomid.
It also helps to reverse the thickened lining of the uterus which tends to occur with polycystic ovaries because of failure to ovulate regularly and the relatively low level of progesterone and higher than usual levels of oestrogen which stimulates the lining of the uterus. The added Medroxy Progesterone Acetate helps to reduce the risk of cancer of the uterus several years later on in life. It is given for 10 days in a cycle.
Metformin is a drug that is used in the treatment of women with polycystic ovarian disease. It helps in establishing ovulation and controls the underlying metabolic abnormality which increases the risk of developing diabetes mellitus. Usually it is given once to twice daily. There is an extended release preparation which can be given once daily with good effect.
Diane 35 is a combined oral contraceptive pill which contains Cyproterone Acetate. It is used to control the irregular menstrual cycle seen in women with polycystic ovaries. Cyproterone Acetate is an anti-androgen which helps to reverse the changes caused by the high levels of testosterone seen in women with polycystic ovaries. Testosterone causes increased hair growth in a male pattern type, deepening of the voice, enlargement of the clitoris, male pattern type baldness (hair loss at the temples and receding hair line) and breast atrophy (small size of the breast). The Diane 35 is used once daily for 21 days to control these features and suppress the formation of cysts in the ovaries. It is a good form of treatment especially in women who do not desire conception in the short-term. Since you do not desire to become pregnant now, you should take the Diane 35 daily for 21 days of the menstrual cycle. The metformin should be taken once to twice daily if you are overweight and tend to have a high blood sugar or high insulin levels. If you have achieved your ideal weight for height, then all you really need to take is Diane 35 daily until you decide to try for a pregnancy. There is no need to take Medroxy Progesterone Acetate if you are on the Diane 35.
Once conception is planned, then discontinue the Diane 35, take the clomid and metformin as outlined. There is absolutely no need to take Clomid if you are not trying to become pregnant. Folic acid should be taken as a daily supplement prior to conception and continued in high dosages to reduce the risk of birth defects in the brain and spinal cord in the foetus once conception occursBoth you and your spouse should do routine blood tests to screen for sexually transmitted diseases. A pap smear should also be done and the cervical cancer vaccine should be given to reduce your risk of cervical cancer. It is given in three doses: the first dose is followed by the second one in a month, and the third dose given six months after the first dose. Consult your doctor who will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax 968-2025. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
