A 29-year-old lady comes to the hospital for complaints of oligomenorrhea for past 3 years. She attained menarche at 14 years and has had regular cycles since then. Over the last three years, she has gained 8–9 kilos of weight gradually. She has no complaints suggestive of galactorrhea, hot flashes or symptoms suggestive of thyroid dysfunction. She has been married for 3 years and wants to plan a pregnancy soon. Her last menstrual period was 15 days ago. She suffers from dyspepsia for which she uses pantoprazole and domperidone tablets 4–5 times a week. Her family has a history of thyroid dysfunction. On examination, she has a body mass index of 28.5 kg/m2. On general examination, she has grade 2 goiter, acanthosis, modified Ferriman–Gallwey score of 12/36 and expressive galactorrhea unnoticed before. Clinical examina- tion is not suggestive of any other illness like hypothyroidism or thyrotoxicosis, Cushing’s syndrome or acromegaly. Confrontation test is normal. Skin and ankle jerk normal.
Galactorrhea may be overlooked unless actively elicited.
Laboratory Examination Reveals Thyroid-stimulating hormone (TSH) 2.5 micro IU/L. Total T4 10 mg/dL, prolactin 160 ngmL, urine pregnancy test negative. Ultrasound pelvis shows ovarian volume 12 cm3 with numerous cysts in both ovaries peripherally. A diagnosis of hyperprolactinemia, probably drug induced is made.
How long should our patient wait before planning a pregnancy?
Medicine
Fertility might be restored even before regular cycles are restored. Hence, it is important to recommend barrier contraception along with the initiation of dopamine agonist therapy. It is recommended that menstrual periods be allowed to occur naturally for a period of time (3–4 months), long enough to predict that a missed period might be a result of pregnancy.
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