PCOS treatment

[Anonymous]

18yo has had very infrequent periods since 13 (about 3/year). Ultrasound normal, labs normal but testosterone slightly elevated. Acne is mild to moderate but not severe. Weight normal. What’s next? I guess decide between progesterone only or progesterone and estrogen?

[Anonymous]

What exactly is the issue?

[Anonymous]

I guess she needs meds, right? Would you start with progesterone only? Or straight to the pill?

[Anonymous]

So testosterone is high, ultrasound normal but has she officially been diagnosed with PCOS?

[Anonymous]

What is making the doctor say it’s PCOS with normal weight and no ultrasound findings? High testosterone is possible without it being PCOS and that can impact having a period. Although I see that she doesn’t even have high testosterone.

[Anonymous]

I was diagnosed with PCOS at 33yo while trying to get pregnant with our first child. I had very high testosterone/androgen levels, the classic "string of pearls" ovaries on ultrasound, and I was anovulatory. I am not insulin resistant and was quite petite at the time. I've never had acne or the weight issues that are typical with PCOS. I likely should have been diagnosed in my late teens, since I always had highly irregular cycles, but my doctor at the time told me it wasn't anything to worry about, put me on birth control, and I never thought much of it...until trying to get pregnant.

Are there symptoms that are bothering her, OP? Birth control is certainly an option for controlling symptoms like acne and irregular cycles, but there's no medication that will be a cure-all for this. There's also options if she's dealing with hair loss or concerns regarding weight.

From my own personal experience, it may be worthwhile to ask her doctor to run a full thyroid panel. I also had hypothyroidism and was eventually diagnosed with Hashimotos, which was missed for years because my TSH level was considered "normal" even though it absolutely was not. The endocrinologist I see for that said he sees lots of women with both thyroid issues and PCOS.

[Anonymous]

Anonymous wrote:So testosterone is high, ultrasound normal but has she officially been diagnosed with PCOS?

My thin DD with acne had testosterone over 100 but no ultrasound findings. A bit later, she had an MRI for an unrelated condition and it showed an incidental finding of 30 or so cysts on each ovary. Sprionalactone cleared up the acne after three Accutane failures.

[Anonymous]

Anonymous wrote:

Anonymous wrote:So testosterone is high, ultrasound normal but has she officially been diagnosed with PCOS?

My thin DD with acne had testosterone over 100 but no ultrasound findings. A bit later, she had an MRI for an unrelated condition and it showed an incidental finding of 30 or so cysts on each ovary. Sprionalactone cleared up the acne after three Accutane failures.

If acne is the issue, then yes, there are things to take but we are asking OP, what is the issue for her daughter? Is it acne? Is it that she wants regular cycles? She wants to gain weight?

[Anonymous]

Metformin is a standard treatment.

[Anonymous]

Op here. Gyn was worried about dd’s bone health with no periods and recommended at least progesterone every 3 months if no period. Dd has some mild/moderate acne and has been taking prescription topicals for years, so I wonder if the pill will fix her skin and period problems - but also worried about side effects of taking hormones

[Anonymous]

Spironolactone

[Anonymous]

Op again - normal A1c and glucose

[Anonymous]

Anonymous wrote:Op again - normal A1c and glucose

But again was she diagnosed with PCOS? Obviously she’s having some issues but it doesn’t sound like PCOS and doesn’t sound like labs and tests indicate it either.

[Anonymous]

Check vitamin D levels. Low levels are associated with PCOS. Supplement up to the upper end of the normal range.

[Anonymous]

Op All dr would say is that she is “at risk” for pcos. Was more concerned about bone development health