[23F] Experiencing irregular periods and difficulty conceiving

Patient Description

A 23-year-old female reports having had normal menstrual cycles until 2020, when she began experiencing prolonged bleeding episodes lasting up to two months. The bleeding was only controlled after being prescribed Primolut N, which she took three times daily for 10 days over three months. Despite treatment, her periods remain irregular, with instances of spotting for two weeks and at times having a 9-day period. She also observed a nearly black menstrual flow on one occasion. The patient has noticed a gradual weight increase from 110 to 180 pounds since 2020, coinciding with reduced physical activity. Additionally, she has been suffering from sudden severe headaches accompanied by eye pain. A dark spot on her stomach, present for years, has faded slightly with the application of petroleum jelly. There is no history of excessive hair growth, severe acne, or any significant past medical history, including chronic illnesses or allergies to medications. Family history is negative for menstrual or fertility issues. The patient has not been diagnosed with PCOS and does not use tobacco, alcohol, or recreational drugs.

Arora's Assessment

What might be happening

Based on the information you've provided, several conditions could be causing your symptoms:

Polycystic Ovary Syndrome (PCOS): Even though your ultrasound did not show cysts, PCOS can sometimes be present without visible cysts. This condition is characterized by hormonal imbalances that can cause irregular periods, weight gain, and difficulty getting pregnant. The headaches and eye pain you're experiencing could be related to these hormonal imbalances.
Thyroid Disorders: Conditions like hypothyroidism can cause weight gain and menstrual irregularities. Although you didn't mention any other common symptoms like fatigue, dry skin, or constipation, it might still be worth considering.
Hyperprolactinemia: This is a condition where the body produces too much of the hormone prolactin, which can cause irregular periods and difficulty getting pregnant.

The dark spot on your stomach could be a separate issue, such as a form of hyperpigmentation or a benign skin condition. However, it's also possible that it's related to your hormonal imbalances.

What you can do

You should definitely seek medical attention to get a proper diagnosis and treatment plan. Here are some steps you can take:

Make an appointment with your healthcare provider. They can order blood tests to check your hormone levels, which can help diagnose conditions like PCOS, thyroid disorders, or hyperprolactinemia.
Keep track of your symptoms. This can help your healthcare provider understand your condition better.
Try to maintain a healthy lifestyle. Regular exercise and a balanced diet can help manage symptoms of hormonal imbalances.