Case Study 8

Patient 8: PRIMARY SUBFERTILITY AND AMENORRHOEA SINCE PUBERTY.

Female, 
Age 27.  

This is a real patient history. Their identification details have been removed to maintain the patient’s privacy.

Initial Presentation

  • Did not have any natural menstruation since attaining puberty at the age of 13
  • GP had started combined contraceptive pills to induce menstruation when she was 20 years old
  • After getting married 2 years ago, she had been trying to conceive without success and presented herself to seek fertility help in mid – 2018
  • No other medical issues (no menus as she was not on pills)
  • Family History
    • Both parents are long term diabetics
  • Initial Assessment
    • Normal body build. No abnormal examination findings. No signs of loss of secondary sexual characteristics
  • Investigations
    • Fasting blood sugar was high
    • Iron level was low normal
    • Normal lipid profile
    • Oestrogen level was compatible with day 14 – 25 range of a menstrual cycle (Luteal Phase)
    • But progesterone was very low (it should be at its peak level during this time). Patient did not know where she was in her cycle as she did not have menstruation for the last two years
    • Ultrasound of her pelvis showed multiple follicles on both her ovaries
    • Thyroid profile was normal
    • It was needed to do 28 – day salivary hormone profile to find out her female hormones behaviour in relation to each other. But, it was first needed to induce a menstruation artificially.
  • Initial assessment with intake questionnaires
    • Moderate to severe dysbiosis
    • Progesterone deficiency symptoms in hormone assessment
    • Insignificant fatigue score
  • One month after treatment, diet and exercise program
    • Patient started feeling better, blood sugar was normalised
    • Started bioidentical progesterone for the latter half of cycle
    • Patient went overseas for two months, one month after this review. Before she left, she was prescribed natural fertility – enhancing supplements
  • Five months after initial consultation
    • Patient presented one month after returning from overseas
    • 28 – day female hormone testing requested. She has had a period about 35 days ago with pills
  • Six-month consult
    • 28 – day salivary hormones revealed spiky estrogen levels even in the latter part of her menstrual cycle which is abnormal. Her progesterone level was relatively low
    • Cyclical progesterone treatment was continued. It was understood that her cycles are happening anywhere between 35 – 42 days even though she does not bleed.
  • Three weeks after previous consult (just under 7 months after initial consult and discontinuation of treatment for 2 months whilst she was overseas)
    • Patient presented nauseated and sick. Urine pregnancy test was positive. Blood Testing and Scans confirmed pregnancy.
  • She recently delivered a healthy full-term baby (in early 2020)