Brief Answer:
USG ASAP

Detailed Answer:
Dear XXXX,

Before I advise you any thing, I would like to know on which parameters you were diagnosed as a case of Polycystic Ovarian Syndrome (PCOS) - by ultrasonography or blood hormonal profile or both?

You have been prescribed Biogmet-500 which is a Metformin preparation and Crisanta which is an oral contraceptive preparation containing Ethinylestradiol and Drospirenone. I will discuss about these medicines after I explain you the basic facts of PCOS.

PCOS is a condition in which the eggs are trapped in ovaries even though they are getting matured. Thus the follicles of the egg become cystic making the ovaries with many cysts; hence Poly Cystic Ovaries. This leads to irregular heavy menstrual periods associated with infertility.

However, there are some other aspects of PCOS also. In this condition, the levels of insulin and male hormone also increase. The condition is characterised by obesity, pimples, hair on unwanted places of body like face, chest, abdomen, legs, etc. Do you have any of these symptoms?

Hence the management of PCOS should be aimed in releasing the eggs from the ovaries and reducing the levels of insulin and male hormone.

Crisanta will regularise your menses; however will not help you conceive as long as you are taking these pills as they are contraceptive pills. They will have to be down regulated for the egg formation (ovulation). To induce ovulation, initially, after discontinuing oral pills, Clomiphene citrate is given from day 2 onwards for 5 days. After that ultrasonography ovulation monitoring gives evidence of any ovulation. A combination of Metformin with this medicine helps ovulation by reducing insulin levels. You are taking Metformin; however, you will have to now down regulate the Crisanta pills and start Clomiphene citrate. Only Biogmet will never give you relief from PCOS. If Clomiphene fails to induce ovulation and/or make you pregnant within 6 cycles, you may have to switch over to hCG/HMG combination for induction of ovulation.

With the medicines given for induction of ovulation, many a times, too many eggs are released causing severe pain on one side. However, since you are not on any medicine for induction of ovulation, this possibility does not exist. It is likely that your ovaries have become to large with the cysts causing pain. I feel you should go ultrasonography ASAP.

Oral contraceptive pills do cause white vaginal discharge.

Unless you have missed your period, you should not suspect pregnancy.

I want to offer you some more advice; however, I need to know your height, weight, BMI and the detailed menstrual history with your age. After getting this information, I might ask for some more information. Also, please upload all the reports and images of your investigations for my review.

For any more information, please feel free to ask me anytime, XXXX.

Dr. Nishikant Shrotri

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