Talk to General Practitioner on Hormones Issue
Asking for Self, Female, 20 years old, Jamshoro
Fatigue, excessive hairfall, facial hair, weight gain, pelvic pain, painful intercourse and pressure in the lower abdomen during that, cramps 10-15 days before periods, bloating, My abdomen swells after eating a little food., constant constipation from last 1 year, excessive headache, back pain, prolactin got high 2 to 3 times even after treatment, pelvic ultrasound clear and gynaecologist said everything is ok. Suffered iron deficiency, vitamin D3 deficiency and pre diabetes but all these are ok now. Thyroid profile is clear. But still the same fatigue body pain, cramps, weight gain, hairfall more than before, painful intercourse and sometimes lack of discharge, stress, difficulty in sleeping sometimes, mood changes, tired and headache even after 9 10 hours sleep. Please suggest what to do?
Dr. Maha Mehmood - General Practitioner
MBBS | Lahore
looks like.micornutrient deficiency. can see ur lab tests for iron and vitamin D? fresh reports?
do u have all hormonal reports n usg ??
Patient
Post Owner
Doctor, I have not had any hormonal tests done yet. Could you please guide me on which major hormonal tests are important to diagnose the underlying issues? I understand that hormones are numerous, so I would appreciate if you could suggest the most relevant ones that should be tested in my case."
4 months ago
serum FSH LH PROLACTINE LEVEL
4 months ago
symptoms of PCOS n also anxiety
Dr. Maryam Sami - General Practitioner
MBBS | Islamabad
Looks like the signs of pcos but for proper diagnosis we need to know more about your lifestyle like workout, diet and stress levels, menstrual history and also your reports
symptoms of PCOS and iron deficiency anemia aswell.need a detailed consultation to know the complete history.
Dr. Qurrat Ul Ain Usmani - General Practitioner
MBBS, Mcps family medicine, M.d internal medicine trained, M.d critical care trined | Karachi
2 Positive Reviews
It would look like PCOS what is yous fsh/ lh ratio ?
and prolactin levels .
for how long u have been married ?
u will also need cortisole levels at early morning 9 am
have u been taking another meds ?
I am thinking about some endocrinological issue . for that I'll need your further details ..
Patient
Post Owner
Aslam o alaikum Doctor,
I want to share the complete history of mine with you,
so you have a clear picture:
* I got married in September 2024. On 1st September 2025 it will be exactly 1 year. I do not have a baby yet.
* Initial Problems (before treatment):
Since August 2023 she has been facing chronic health issues including weight gain (especially on belly & thighs), irregular and painful periods, fatigue, constipation, leukorrhea, headaches, back pain, hair fall, and excessive facial hair.
* Investigations done before treatment:
Pelvic Ultrasound → Normal
Hemoglobin → around 7.8–8.0 g/dl (Iron deficiency anemia)
Ferritin → Very low
Vitamin D3 → Low
ESR → High
Prolactin Tests:
3 September 2024 → 44.7 ng/ml
23 November 2024 → 16.60 ng/ml
10 May 2025 → 40.95 ng/ml
* Treatment history:
Different gynecologists prescribed me:
Brotin (for prolactin)
Iron supplements (Ironone, Feroxyma drips, Neuromet, Folic Acid)
Vitamin D3 (SgIndrop D)
But unfortunately, every gynecologist i visited just gave medicines and sent me back. No one ever suggested detailed hormonal tests (like FSH/LH ratio, AMH, cortisol, thyroid profile, etc.) or listened to the symptoms properly.
* Current Situation:
Despite treatment, prolactin remains high, i still have hormonal imbalance symptoms and severe fatigue.
Doctor, we really need proper guidance. Please let us know:
1. Which complete hormonal panel you recommend (FSH, LH, AMH, TSH, Cortisol, etc.).
2. Should we arrange the morning 9 am cortisol test now?
I am looking for someone who can guide step by step, because until now no doctor has properly investigated beyond basic medicines.
Thank you for your attention
4 months ago
MBBS, Mcps family medicine, M.d internal medicine trained, M.d critical care trined | Karachi | Book Appointment
1 Positive Reviews
Yes get the detailed hormonal workup .
Like am cortisole , lh/fsh ratio, thyroid profile. Since you have ultrasound done before don't repeat ultrasound For now .
Have gynac done any cervical smear ?
4 months ago
Patient
Post Owner
Thankyou so much doctor
"Yes, I will definitely get these tests done and visit the gynecologist for a check-up. My gynecologist didn't do the cervical smear test; she said there was no major issue. She only prescribed me the tablet Yaz, but after taking it, I felt really unwell. I had a headache, back pain, leg pain, shoulder pain, and body aches all over. That's why I stopped taking it after just 3 tablets."
4 months ago
Good Afternoon, the symptoms clearly point out that your body is telling is that everything is not OKAY, Its not just stress. These are your question: “Given my symptoms, could I have non-cystic PCOS?" Answer: Yes you can have PCOS even though its not On ultrasound, there is still a probability. According to latest guidelines ultrasound evidence is an important criteria but not the only one criterion on list, and its absence does-not rule out PCOS , There is a probability of normal appearing PCOS. The Gold Standard to Correctly identify PCOS is a procedure called Laparoscopic Evaluation in which ovaries are directly visualised through a small camera inserted in your belly. Given your symptoms of Hair-fall, Facial hair and weight gain and symptoms of insulin resistance, There is a very likely probability of PCOS.
Q2 "My pelvic pain is severe. Could this be any uterine pathology even with a clear ultrasound?" The answer is Yes. Even though cramping might be symptom in PCOS but this level of pain and painful coatis and pressure sensation in pelvis is usually indicative of other underlying pathology. Many things can be missed on Standard Pelvic ultrasound and hence more detailed and specialised tests or even ultrasounds are needed to correctly find the cause of your symptoms.
· "Do I need anymore tests other than TSH, Blood Glucose Levels and Prolactin Level?" The Answer is yes In your case Full androgen Panel and Complete Pituitary Function Analysis is needed. Given your constellation of symptoms, Especially Headache, Tiredness, Difficulty sleeping , Lack of secretions down-there , Increased pain during intercourse due to dryness , And most importantly RAISED PROLACTIN points to need of more investigations.
· "Why does my prolactin keep rising?" This is a very important question, its not normal. There might be Some issues with its production or part of body that produces it. And there is a probability that it might be the root cause of your symptoms. Final Question : “CAN ANXIETY CAUSE ALL OF THIS AND DO I NEED TO GET ALL THESE TESTS DONE IF ITS JUST ANXIETY” Well the answer is Yes and Yes, So anxiety can be due to chronic biological issues you are facing and it can be a other way around which seems bit unlikely here given the lab evidence. Latest studies shows that anxiety is actually disturbance in neurogenesis/ Functioning of emotion controlling part of brain due to chronic inflammatory Chemicals in blood. So. Anxiety might be a result of your underlying biological problems, latest studies are increasing showing that. In anxious patients is very beneficial to carry out necessary evaluations to find out any. Root cause. Even in some cases when no cause is found. The patient might find comfort that all tests are done and there is nothing wrong and its just something to do with my thinking pattern, And he start to move in constructive direction. I would recommend you ask these questions from your gynaecologist of your next appointment. However this forum is for Public information, I cant recommend any specific Tests or investigations or medicines here on public forum. This is the information and analyses I can provide. Rest is for your treating physician to decide. Regards, I sincerely hope this message helps. Wish you best of health.
Patient
Post Owner
Good Afternoon Doctor,
Thank you so much for your detailed and very informative reply. It really helped us in understanding the situation better.
As you rightly pointed out, I have been suffering from multiple symptoms — weight gain (especially on thighs and belly), severe fatigue, headaches, hair fall, facial hair, irregular and painful periods, dryness and pain during intercourse, and consistently raised prolactin levels despite medication. I also have iron deficiency anemia (Hb around 7.8–8 g/dl, low ferritin, and Vitamin D3 deficiency), which is being treated with iron supplements and drips.
Your explanation regarding PCOS even without cysts on ultrasound, and the possibility of other uterine pathology despite a normal pelvic scan, makes a lot of sense given her symptoms and the severe pelvic pain i experience.
We also understand from your guidance that a full androgen panel and complete pituitary function analysis are necessary next steps, especially because of persistent high prolactin, headaches, and other hormonal symptoms.
I will definitely consult gynaecologist/endocrinologist about further investigations and possible advanced imaging or tests as you advised.
Thank you again for taking the time to explain everything so clearly. It has given me a proper direction to discuss with treating doctor.
Best regards,
4 months ago
Happy to Help, However Please note that in your current health it is strongly advised that you choose a GP who navigate you through entire process, It will save you lot of time and resources. For example You are motivated to get an ultrasound done, But which Ultrasound ? It is not advised that health checkups are guided by online suggestions. ( even by experts in field) and not by long term attached physician. GPs fees are very little and waiting times are very less, Please find a GP that can navigate your process of better health. Please note that many time patient symptoms take prime priority rather than labs. TREAT PATIENT NOT THE LABS. What if initial investigations might not be sufficient ? I know medical system in Pakistan and their is no concept of having a GP to navigate you through your Health issues and Regular health checkup. But. In your case I would highly recommend a GP, Trust him/her to navigate you through this. Or at least your gynaecologist, Get a referral from your Gynaecologist she will know the next best steps, there are subtle. Details and nuances that can be lifesaving and resource saving. Regards.
4 months ago
It can be PCOS , kindly consult a good physician and gynaecologist too
I can help and guide you
Dear !
you didn't mention here your marital status ,when you got married ?
n if you have children ?
Your Labs r good , you suffered in vitamin d3 and iron deficiency before ,but now all r good ,if you r an over thinker you can face all these problem for long time so try to get rid of this condition .
Homeopathic treatment is very helpful to resolve the problem , take an appointment for consultation.
JazakAllah khair
take care
Dr. Inamullah Jan - General Practitioner
| MBBS | | Swat
Assalam O Alaikum. It seems like PCOS but please book an appointment for detail history.So after that i can guide you properly. Thank You
Rizwan Ali Khan - Clinical Psychologist
| MSc (Psychology) | MS (Clinical Psychology) | Certified (Crucial Conversations) | | Lahore
36 Positive Reviews
Don't need to go anywhere I'm at your doorstep just press a button video consultation I will give you a list of solutions pick the best one Apply and Enjoy Good Health Forever InshaAllah
I will help u through homeo medicine need ur detail history....then I recommend u medicine in shah Allah u feel batter ...plzzz book appointment for further details
symptoms are consistent with PCOs..i e..polycystic ovarian syndrome..get an ultrasound from Radiologist..FSH LH and prolactin profile is also required to rule out hormonal imbalance..
Patient
Post Owner
Assalam o Alaikum Doctor,
Thank you very much for your kind response and guidance. I will Insha’Allah arrange the ultrasound from a radiologist as advised, and also get the FSH, LH, and Prolactin profile done to rule out any hormonal imbalance.
May Allah reward you for your time and efforts, and grant you health, barakah, and success in both worlds.
JazakAllah Khair.
4 months ago
If you need online consultation for this, you can consult me online
Rizwan Ali Khan - Clinical Psychologist
| MSc (Psychology) | MS (Clinical Psychology) | Certified (Crucial Conversations) | | Lahore
36 Positive Reviews
Don't worry I am at your doorstep just press a button video consultation I will give you a list of solutions pick the best one Apply and Enjoy Good Health Forever InshaAllah
Your symptoms suggest a hormonal imbalance, most likely PCOS (polycystic ovary syndrome), even if your ultrasound is normal. PCOS can cause weight gain, hair fall, facial hair, bloating, cramps, and fatigue. Since you also had high prolactin, it is very important to repeat hormone tests (Prolactin, FSH, LH, Testosterone, Insulin resistance) and sometimes an MRI of the pituitary is advised if prolactin stays high.
For now:
Maintain a healthy diet (low sugar, fewer processed foods, more fruits/vegetables).
Do regular exercise (30–40 minutes daily walk or activity).
Manage stress and sleep hygiene.
Please consult an endocrinologist or gynecologist for further tests and treatment. With proper medicines and lifestyle changes, your symptoms can improve significantly.
Patient
Post Owner
Assalamualaikum Doctor, thank you very much for your kind response and guidance. I do have these symptoms such as weight gain, hair fall, facial hair, bloating, cramps, and fatigue, and my prolactin levels have also been high in the past.
Can you please guide me which major hormones tests are most important to confirm PCOS diagnosis, so that I can get them done in detail? Also, you mentioned MRI if prolactin stays high could you kindly let me know exactly which type of MRI should be done (for example MRI of pituitary or brain)?
JazakAllah for your support and valuable advice.
4 months ago
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