Brief Answer: detailed answer below. Detailed Answer: Hello and welcome, Please do not get tensed. Tension will only increase the polycystic ovaries. This disorder is extremely common now. It occurs due to hormonal imbalances. The imbalances lead to cysts in ovaries which further aggravate the imbalance and the cycle continues. Once the disease sets in it does not allow the ovum to be released every month during ovulation and hence traps it in the ovary and cysts form. It is unclear what comes first, the imbalance or the cysts. Stress is a common cause as it produces hormonal imbalance. Now about the treatment. It has different approaches depending upon where is the defect and what is the desire of the patient. There are 3 common approaches: 1. patient wants regular menses. Again there are 2 treatment options in this case.a) First is to try to restore ovulation and then menses will come by themselves. For this weight reduction, regular exercise, no sugar and fat diet, plenty of fruits, meditation and drugs like metformin [ to lower insulin and sugar] are used. It may not always be successful. b) Just regularise the periods without ovulation. This is done in women that do not want pregnancy. So oral contraceptive pills are used or progesterone is used. 2. patient wants pregnancy: drugs to release ovum are used. Sometimes laproscopic rupture of cysts may be needed. 3. there are excess body hairs and patient wants to decrease them. Certain oral contraceptive pills are used that decrease hair growth and acne. Since you are unmarried, what you need now is regular periods. At least 4 periods a year are sufficient. This will decrease any further risks due to absence of periods. For any treatment to be started it is important to get complete evaluation first. Other reasons for absent periods like thyroid dysfunction, prolactin dysfunction etc must be ruled out. Also if it is due to PCOD it helps to know which hormone is affected and then give drugs to help against that hormone. As of now, first get a blood TSH and prolactin test to rule out thyroid and prolactin abnormality. If these are normal then please take pills that contain estrogen and progesterone both like tablet ginette once a day for 21 days must be taken regularly. After stopping it the period will come in the next 7 days. On day 3 of the cycle get a PCOD profile evaluated. If a hormone dysfunction is detected then management will depend on it. Meanwhile try life style measures like weight loss, healthy diet, regular exercise and de stressing with yoga and meditation. They help a lot. Ayurvedic medicines like M2 tone are also used in India to help regularize periods. So please discuss all the treatment options with your doctor in details and choose the one that suits you. Please do not go for any invasive therapy like laparoscopy at this stage. It must be done only when children are desired. So please do not worry. This is very common and treatment is as per the requirement at the current time. Lifestyle modification help in a big way. Kindly do not get stressed. I am always here to help you. Feel free to ask any further queries that you may have. Thanks for using HCM. Have a good day. Dr Madhuri Bagde Consultant Ob Gyn

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Brief Answer: Suggested treatment Detailed Answer: Thanks XXXX and welcome back. You have already taken devery and it is more than 7 days. There are two likely possibilities. The dose of devery was less to induce periods or estrogen levels are extremely high or extremely low. So please take tablet Ginette or femilon one every day beginning from today for 21 days. After stopping the tablet periods will come after 7 days. sometimes they may come in the middle of treatment also as you have already taken devery. This will most likely need a prescription by your doctor. On day 3 of periods, do a PCOD profile test that will test levels of all hormones. It is important to get it done on day 2 or 3 as other times the results are not valid. Further management will then depend upon the results of the test. Meanwhile pleas start the lifestyle modification. Do not do very vigorous exercise as it will also delay periods. Not getting periods is bothersome. But if there are periods for at least 4 times in one year, it is more than enough. So do not worry so much about it. Please feel free to ask any further queries. Dr Madhuri

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Brief Answer: I understand it very well. Detailed Answer: Dear XXXX I completely understand that you did not get a period after devery and the thyroid was normal. There are other hormones than thyroid and prolactin that may cause this dysfunction. In PCOS, thyroid and prolactin are not the ones causing damage but others like FSH, LH, DHEAS, Testosterone, Insulin and a complete range is there. So these are tested in PCOD profile. I have already said that if you did not have a period after devery either the estrogen is too low or extremely high. Also I am assuming that your tests are recent and the ultrasound is also a recent one. If it is an old one, then other reason for absent period may be an ovarian cyst. So please check if the scan is done after the period was missed. Also I am assuming that there is no possibility of pregnancy as you have a recent scan and are unmarried. So I hope that these assumptions are correct. About devery: It is a hormone similar to the hormone progesterone in our body. During normal menstrual cycle, the initial days until the production of the female egg [Ovum], estrogen hormone is dominant and controls the growth of uterine lining. Once the ovum is released, progesterone takes over and becomes dominant with high levels for 14 days. After that if there is no pregnancy, both estrogen and progesterone decrease. So the uterine lining cannot grow any more and is shed as menses. In PCOD, usually estrogen is very high and progesterone never comes. Unless progesterone comes and then decreases again bleeding cannot occur. We give devery as a progesterone assuming that estrogen is already there. So now giving and stopping progesterone will mimic a normal body phenomenon and menses must occur. If they are not coming then there is either less progesterone given than what was required or the estrogen is too high for allowing devery to act. So we prescribe oral contraceptive pills containing both the hormones. They replace the body hormones and do not allow production of either estrogen or progesterone as both are given by tablet. So dysharmonius hormones in body are corrected. Hence I advised femilon tablet for 21 days. It will replace your deranged hormones, help build uterine lining in an orderly fashion and then after stopping it will cause menses. After that you may get a PCOD hormone profile tested on day 2-3 of period. Otherwise you will not even be able to do this test. So I hope that you understand the principal of treatment now. The only condition when these pills will not cause a period is pregnancy and ovarian cyst [ not PCOD but single big cyst, will be seen in Ultrasound]. Otherwise they will lead to a period. Also you must take them daily. If you miss pills in between you will have irregular bleeding. I hope that this has clarified the things. I know that you want an early period and are worried that they are not coming after devery too. So please remember that devery does not work in every case. Also your stress is negating the action of devery. So please relax and have patience. Things will take time but will ease off slowly. PCOD is a complex disease and has multiple treatment approaches. So please also discuss this with your doctor and after the results of the PCOD profile test other drugs like metformin may be added for future benefit. I am always here to help you for any more queries. Please feel free to ask. Regards, Dr Madhuri Bagde

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