Having Symptoms Of Hormonal Imbalance. Developed Menopause Symptoms. Prescribed Tricyclen. Suffer Side Effects. What To Do?

Brief Answer:
Impaired Ovarian Reserve is to be ruled out.

Detailed Answer:
Hello,

Thanks for writing to us. I am trying to solve your problem.

According to your clinical presentation, we need to rule out IMPAIRED OVARIAN RESERVE at the earliest as you are persisting with autoimmune thyroid disorders & heart disease. It may lead to PREMATURE OVARIAN FAILURE in future if it is not properly treated.

Before starting treatment, I would recommend some investigations to confirm the diagnosis. These include:

1) Day-3 FSH and estradiol (E2) level estimation.
2) Dynamic Assessment Following GnRH-a Administration (GAST)
3) Antral Follicle Count (AFC) through Trans Vaginal Ultrasound scan.
4) Blood test for AMH (Anti Mullerian Hormone) and Inhibin B. Ovarian volume measurement.
5) Complete thyroid profile, Anti-TPO & TSH Receptor antibody, Serum electrolyte, blood sugar (PPBS) etc.

You can consult with your gynecologist for overall clinical examination and proper guidance of the above mentioned tests.

TREATMENT: Impaired or poor ovarian reserve is mostly associated with high FSH level and low AMH & Inhibin-B.

HRT) is the best treatment protocol to eliminate above symptoms and restore reproductive function. Combined ethinyl estradiol or other synthetic estrogens and luteal phase progesterone are the ideal choice. It helps to lower FSH level and make sensitive to their receptor.

Alternatively, you can take phytoestrogen like isoflavone (plant based estrogen) instead of steroidal estrogen to avoid side effects. It will be effective with progesterone supplement. In addition, you can take soy, beans, peas, lentils, whole grains, rye, millet etc which contain plant estrogen. It has supportive role.

Gonadotropin-releasing hormone agonist/antagonist conversion with estrogen priming (AACEP) protocol and Glucocorticoid therapy (with dexamethasone) are quite effective as adjunct treatment to above one.

You must take supportive treatment for thyroid disorder & electrolyte imbalance. Drink more water with salt & sugar and take adequate rest to avoid muscle cramp. Take vitamin-E, C and other anti-oxidants to eliminate free radicals and body toxin.

Mental stress or depression must be reduced by regular meditation, yoga or breathing exercise (30 min daily). Take balanced diet with iron supplements, control body weight and need sound sleep.

Hopefully, I have guided you with my experience. Let me know, if you need any clarification.

Wish your good health and take care yourself.

Regards,
Dr Soumen

---