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Absent MENSTRUAL CYCLE with FSH, LH, T3, T4 levels report.

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In March 2014 , I visited my OB/GYN concerning my absent menstrual cycle of which I had not seen in three years. After the initial consultation, he ended up ordering bloodwork to check my FSH level, LH level, T3 and T4 levels, and white blood cell count among other tests...in all I believe he checked nine different things...the only thing that came back abnormal was my androgen level and that was in the 209 range. He also prescribed me some synthetic progesterone (medroxyprogesterone acetate 5mg for 5 days) and I ended up having a menstrual cycle eight days after the withdrawal of the medication. When I consulted with him about the results of my bloodwork he advised me that it was likely the weight that I had put on that has caused my absent menstrual cycle and diagnosed me as having an annovulatory cycle.

Although this is quite possible, I don't believe it is the entire reason that I'm experiencing an absent menstrual cycle. I began menstruating at 11 years old patientold (I'm now 29 years old patientold) and have always had irregular periods that would not come for months at a time (9- 10 months sometimes more) after I experienced my first one. Further, up until four years old patientago, I weighed 130 pounds and still had this difficulty with my menstrual cycle where I would not see it for months or even years old patientat a time... I now weigh 220 pounds. I guess my question is, based solely on the information I have provided, do you think it may be possible that there are other reasons for my absent menstrual cycle? Do you think scheduling an appointment with an endocrinologist would be helpful? If so, would the endocrinologist be able to run further bloodwork that could tell me more about the cause of my absent menstrual cycle? I look forward to your response.

Edit: My most recent pap test that was completed in March 2014 was normal.


Category: Endocrinologist

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Category: Diabetologist
Dr. J Muthukrishnan is online now

Expert:  Dr. J Muthukrishnan replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com

From the information you have provided, you do seem to have anovulatory cycle, hence the response to progesterone.

The excess testosterone could be just due to excess weight, but certain conditions need to be excluded in this setting.

You need endocrinology consultation to exclude Cushing's syndrome (excess cortisol), excess 17 OH Progesterone (late onset CAH) and of course PCOD. Ultrasound will be helpful in PCOD.
Hypothyroidism seems to have been ruled out.

Please let me know if you have further queries,
Regards.


Patient replied :

Would you be able to provide me symptoms of these condition and perhaps a brief summary of each?


Expert:  Dr. J Muthukrishnan replied 3 Days.

Hello,
The symptoms are as following :
Cushing's - Weight gain, round plethoric face, easy bruising, muscle weakness, pains, excess body hair, acne, purple striae over abdomen, buffalo hump near the neck.

Late onset CAH - similar history in a sibling, acne, excess body hair, irregular menses/no menses.

PCOS- simialr to Late onset CAH, excess weight gain, family history of type 2 diabetes, delayed periods.

These are the main presenting symptoms.
Sometimes all the sympoms classically won't be present.

Hence it's better you get yourself evaluated.

Regards.


Patient replied :

And how many symptoms are generally presented when ssomeone is suspected of having any of these conditions? I've heard about PCOS but not about Cushings or CAH. Further, when you say round plethoric face, muscle weakness, and buffalo hump what do you mean? Also, how much body hair defines excess body hair? I aso see that pain is one of the symptoms of one fo the conditions you outlined? What kind of pain and where...like generalized pain or pain in a specific area?


Expert:  Dr. J Muthukrishnan replied 2 Days.

Hello,
There can be any number of symptoms.
Plethoric face is flushed face ( where the face appears pink due to increased blood supply ), buffalo hump is fat collected on upper back under the nape of the neck.
Muscle weakness and pain usually affects the muscles of thighs, arms and hips.
Body hair is more than normal, on face, chest, back and abdomen. It's darker than usual and thicker. There will be excessive hair in the armpits/ limbs.
Let me know if i can help you further,

Regards.


Dr. J Muthukrishnan
Category: Diabetologist
Experience: 
Fellowships/Training: 
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
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