Expert: Norman Solberg - 2/12/2010

Question
hello sir, I have PCOS. i have had irregular periods since menarche. USG showed polycystic ovaries. i have a son aged 1 and a 1/2 years and am not keen on having more children. yet i would like to have my periods regularised since long periods without ovulation or menstruation predispose to endometrial carcinoma. I am obese with BMI 32. I could start off with OCP's but i have homocysteinemia (a homocystein level double that of normal range) which is already a risk factor for thromboembolic phenomena and i dont want to use OCP's which also predispose to the same. my mother has had an MCA infarct and is rt sided hemiplegic.(due to homocysteinemia which i inherited from her). so would metformin be a good alternative? i recently had my Thyroid hormones tested and T3 T4 levels were normal but TSH was raised suggesting an inclination towards hypothyroidism.(only symptom being easy fatiguability) do u think that it could be a pituitary dysfunction with so many endocrinal abnormalities? also what other tests would you suggest for me? i also have classical migraine(if that has any bearing) which had turned into continuous migraine around an year back. now with flunarazine and inderal the attacks have subsided considerably. i am a doctor myself having completed MBBS. i would be grateful to recieve your advice. thank you.

Answer
Regarding metformin, it may be helpful for you by reducing insulin resistance, but very likely won't make much difference for your periods.  If you could lose weight by diet and exercise, that often will reverse the changes of PCOS and result in more regular ovulation and periods.  I don't think PCOS is a pituitary abnormality, and the fact that your TSH is raised means that your pituitary is responding appropriately to a decreased amount of thyroid hormone.  I agree that OCP's would not be a good idea for you.  I would suggest the Mirena IUD, which contains progesterone, which would prevent any endometrial hyperplasia or carcinoma.  It may cause you to have no periods, or at least lighter periods.  I hope that's helpful.