Hello
Thanks for posting your query at DoctorSpring.com
I hope conventional factors responsible for menstrual delay are ruled out in your case - stress, anxiety, weight changes, exercise, travelling, smoking, drinking, late nights, erratic eating habits etc.
Were your periods always regular ?
If so, then you should seek a Specialist opinion
I would suspect PCOD as the first diagnosis - Polycystic Ovarian Disease.
In this condition, there are irregular cycles alongwith hormonal disturbance.
You should have an internal exam , pelvic ultrasound scan and hormonal levels - FSH, LH, TSH, Prolactin, OGTT, DHEAS, Free Testosterone, Lipid profile etc.
All the best
Please feel free to discuss further.
Regards.
Patient replied :
Hello,
**EDIT: I apologize, I meant to write LMP 11AUG2014, LMP before that was 4JUL2014**
All conventional factors are ruled out. I excercise regularly, eat regularly and nothing too unhealthy, etc. My periods were more or less always regular, occasionally varying by a few days, but never have I been so late. Unfortunately, I cannot get an internal exam, Army regs state that I must be 21 I believe to get internal exams unless in the case of an STD, so you could see how hard it would be to be able to get an exam. Not only that but there are no available appointments within the next 30 days it seems. I have no family hx of any reproductive issues, or any issues with the reproductive organs. My own personal hx consists of pain-free menstruation, with a medium flow lasting about 7 days. No mood swings, cramps, etc before or during menstruation ever. I understand I should probably get the tests done, I'm still waiting on an appointment to become available for me. Is there anything I should be watching out for as far as sx and such? Or anything I should be doing in the meantime, besides scheduling a doctor visit?
Hello,
Thank you for your feedback.
I am an Inhouse Physician and i understand that you were not satisfied with the reply that was given to you.
The doctor has clarified that PCOD was not the diagnosis, but a suspicion.
Infact a lot of women with PCOD are not diagnosed until they do an ultrasound for some other cause. And hence the symptoms that you mentioned in the feedback, not necessarily are present in everyone. A woman with normal periods, if she misses one period the first thing that needs to be ruled out is : stress, weight changes, hormonal imbalance, and anxiety. The doctor mentioned in her reply, ( considering the conventional factors have been ruled out ). So PCOD was not the first diagnosis.
Now once that has been ruled out, couple of other things can also lead to missed period. One is PCOD, and the other is thyroid disorder. A lot of women come with missed periods/delayed periods and then their thyroid levels show hypothyroidism. PCOS as i mentioned, can be an incidental finding, and sometimes the only symptom that is present is delayed or missed periods.
Hence she meant that you need to rule out these causes. The other tests were mentioned becuase these are the hormones that due to minor disturbances can also lead to a missed period.
She has also mentioned you can take Progesterone tablets in her follow up reply. That will take care of the hormonal disturbance if it is present, and the period can be expected once you finish the course after 5 days. If it still does not happen, then you need an ultrasound to rule out PCOS.
Her follow up reply is below. Kindly review and let me know if you have any follow ups.
'You can try taking medications for mild hormonal disturbance.
Generally progesterone tablets are given twice a day ( what is your height and weight - that would dictate the dosage ) for 5 days.
Once you stop them, you would have a withdrawal bleed, technically a ' period ' within a week at the most.
This is the treatment for mild hormonal imbalance causing such a delayed period.
It is best not to undertake this regimen without consulting a doctor, but , if the appointment is going to take very long, you can try this course.
Other than that, there is nothing much you can do.
Use protection during sex, for sure.
Take care.'
Let me know if you have any follow ups,
I will be happy to help you,
Regards,
InHouse Physician.
Patient replied :
I have had an ultrasound multiple times to check for other issues unrelated to this, but that were still in the same area. Nothing has ever been found to suggest PCOS. I would think you'd need a little bit of outside-the-box thinking if you really assumed that I literally meant that was her final say, her diagnosis. I'm sure you are familiar with using whatever term comes to mind at the time of writing something, so if anybody really thinks I was that challenged so as to have believed she was giving me a soid diagnosis, you might want to reevaluate yourself. OF COURSE it was a suspicion on her part.
I have had my thyroid tested several times because of my ongoing depression and weight gain that later turned out to be side effects of an antidepressant.
I did NOT need clarification as to why the doc reached the conclusions she did- I WORK in the medical field I am aware of how this works. I would never just start progesterone tablets (where would I get them from anyway, if I'm having so much trouble getting a doctor's appointment to begin with?)
That all said, again, you have done nothing to lead me in the right direction whatsoever. My proof is in that I just found out I'm pregnant. NOT that I would have really known before since I have never been pregnant before so any subtle sign or sx of pregnancy would have gone unnoticed by myself, or simply dismissed as PMS and the belief that my period was finally about to start.
I will kindly ask that the doctors on this site refrain from contacting me and taking up space in my inbox.