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ItalianPrincess1217's avatar

What type of doctor should I see first?

Asked by ItalianPrincess1217 (10000 points ) October 10th, 2013

I have been having some health issues and I’m wondering what type of doctor would be able to best address my concerns. I stopped birth control pills about 6 or 7 months ago and I have had no period still. My gyno told me she felt a cyst on my ovary. Not sure if this is related to the absent period. Also, ever since stopping the pill, my skin has been breaking out terribly. To me, these both sound like a hormonal imbalance issue. So if that’s the case, what type of doctor should I start with? Is there a one stop shop for my issues or should I see a dermatologist in addition to a gynecologist? Or maybe start with a general doctor? I have tried my general doc in the past for issues and she only treats the surface issue, not the root cause. For skin, she will give me a cream or antibiotic. For irregular periods she will put me on the pill. I want to find out why I am having breakouts and an absent period. I don’t want a quick fix again.

I recently switched insurance and I am waiting for my new insurance to kick in. So while I’m anxiously anticipating that, I am going to call and set up a doctor appointment(s) because I assume it can take a month or two to be seen.

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42 Answers

Cupcake's avatar

I’d start with the gyno. Do you like her? Trust her?

Discuss your concerns (no period, ovarian cyst? acne, etc). If you do not feel satisfied with her responses, ask her if there is a specialist she can recommend.

Rarebear's avatar

Family physician.

ItalianPrincess1217's avatar

@Cupcake I trust her but I never feel satisfied with her answers to my questions. It’s like pulling teeth and I leave the office more confused then when I got there.
@Rarebear What makes you suggest a family physician? I had a bad experience with my past one but I am open to trying a different one if you think that’s my best option.

Rarebear's avatar

Well, a good family physician can deal with both your derm and gynecological issues.

JLeslie's avatar

Reproductive Endocrinologist. I don’t remember, did you have an ultrasound? Did they find cysts on your ovaries on ultrasound?

@Rarebear What is a family doctor going to do? I don’t mean that in any sort of condescending way, I just have never heard of a GP really dealing with this like an RE. Do you test for the glucose and insulin issues thought to be associated with PCOS, or other possible underlying causes, or just treat symptoms with topical skin stuff like metrogel or prescribe doxicycline or the BC pill? I would guess her GYN maybe already ran some basic hormone tests. Like estrogen, testosterone, prolactin, etc. I’m just curious why a GP or internist would have a better ability to address these issues than a GYN. I realize some family practitioners might be better versed than others. We also don’t know for sure she has PCOS, but RE’s are the specialists for that condition and other hormonal conditions thay affect fertility.

ItalianPrincess1217's avatar

@JLeslie I have the script for the ultrasound but haven’t gone yet. Just waiting for my insurance to kick in.

Rarebear's avatar

Yes on everything you asked. And FYI you said, “I don’t mean that in any sort of condescending way” but you were pretty condescending.

I didn’t say they’d be able to diagnose it better. The OP asked what kind of doctor. I answered. The gynecologist would mostly likely refer to a dermatologist about the derm issue.

But whatever.

JLeslie's avatar

@Rarebear Ok, if it is yes, then I am wrong. You mean yes to everything regarding the tests? That is what I care about. Not the treatments I named. Everyone knows those treatments, I agree with you there.

I once had a discussion about PCOS with Dr.Dredd and she argued with me about how just treating the symptoms is fine, going on the pill is a good treatment. We went back and forth and then she admitted she didn’t even know about RE’s until she was an intern or resident (I don’t remember which) and now she actually has an appointment set up with one for her PCOS. Honestly, when she admitted towards the end of the conversation that she was a PCOS patient herself I could not believe it. Let’s just say that conversation reinforced for me that doctors are still just throwing BC pills at girls. When I was a teen (a long time ago, and I realize the understanding of PCOS and cycle problems have advanced a lot) my friends mostly were just handed the pill. I don’t think Dr. dredd was testing for insulin resistance with her patients.

It’s like I tell thyroid patients who are not doing well under a GP’s care, I tell them to go to an endocrinologist. Endocrinologist usually have a tighter nornal range for TSH than GP’s and the lab. A lot of GP’s don’t try adding T3 or switching to armour thyroid. My own experience was my GP was fine with me having a TSH of 6 something, thank goodness I knew better. In a few more weeks I would have been at 15 if I had just accepted her advice to not change my meds. I just have bad experience with GP’s and endocrine issues and so have many other people. But, certainly some patients do fine.

I have always been curious to know if the pill actually ever fixes cycle problems, or how often it works. It seems to me, just logically, it would more likely just mask a cycle problem and once the woman stopped the pill she would still have the same problem, but I have never been able to find data on it.

@ItalianPrincess1217 Definitely get the ultrasound. No matter what doctor you go to next you can bring those results with you. A GP or Internist will certainly be cheaper than an RE.

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ItalianPrincess1217's avatar

@JLeslie I have also had a bad experience with my GP. This is just one doctor so I can’t judge all doctors of course. I just don’t want to waste time visiting a GP if they’re only going to send me off to a specialist anyway. It’s been months just dealing with my gyno already that I’m very anxious at this point to start getting some answers. Thanks for the link. It has some good information. And actually, to what you mentioned earlier about my gyno ordering tests, she hasn’t. She’s only done the bare minimum so far. She keeps hoping that my period will return naturally. She gave me something to induce it a couple months ago. It forced a fake period but I never got a “real” period again after that. So it didn’t work. I don’t like the wait and see approach. Everything I have seen online (though I try my best not to google) says I should see a dr if my period hasn’t returned after 3–6 months within getting off the pill. So I’ve done the waiting thing already. Now it’s time to start figuring out what my real issue is. I agree 100% with you about doctors throwing the bc pill at patients. It doesn’t fix the real problem though. It masks it. I got periods on the pill but when I got off, no period. I have taken ovulation test strips everyday for months and I’ve never ovulated. Something is up. I never had an issue with periods before getting on the pill. So I’m confused! I just want the the right doctor to do the right testing and help me fix this. I don’t want to feel like maybe my doctor is missing something important.

JLeslie's avatar

@Rarebear I apologize if I sounded condescending, I don’t know how to word questions to doctors so they don’t take offense, it is very difficult. It seems I was right about all the things I named though, you said you do all those things, I do obviously know a little bit about what I am talking about. The GYN should have done the blood tests for the OP, wouldn’t you agree?

JLeslie's avatar

@ItalianPrincess1217 Well, if you want to try a GP or another GYN you could ask before you make the appointment if they treat PCOS. The problem is we don’t know for sure that is what you have, and more than likely all the offices will say yes, even if their solution is BC pills. The link I gave was interesting to me too, because it basically says RE’s usually don’t manage the condition long term.

For sure an RE can diagnose “cycle” problems. My RE sees women for fertility and menopause, some just really focus on fertility. They are more expensive usually, and insurance sometimes does not cover all their tests, but RE’s are really good usually about finding out what your insurance covers and also they give you price sheets up front a lot of the time. One of the few doctors I have been to that have all the pricing readily available. I had a GYN and a Dermatologist who also had pricing available like that, but most doctors don’t. They will find out what your first appointment will cost for you or tell you what codes to use and you can call your insurance and check.

Also, if you call the RE office and say you are not currently trying to get pregnant but your cycle has stopped and ask if the doctors evaluate patients like you, they should know.

ItalianPrincess1217's avatar

@JLeslie I just looked further into PCOS…Most of the symptoms are spot on. I never even considered that my rapid weight gain could also be linked to this. Or the anxiety/depression problems I have had recently. Maybe I should stay away from the PCOS sites for now! I am genuinely concerned that this very well may be my issue. And the bad news is there is no cure. And it can cause a lifetime of problems. I pray this doesn’t end up being my diagnosis!

snowberry's avatar

@ItalianPrincess1217 Your frustration with your doctors mirrors my own experiences. Add that to my past experience watching my mother struggle with her own illnesses is why I turned to alternative medicine. Of course, you can get in trouble there as well as with a medical doctor (it’s always buyer beware regardless of what kind of doctor you go to or how many accolades they have). But alternative doctors do approach health issues from an entirely different point of view. Not pushing the idea with you, but it is something to keep in mind. I’m much happier with my alternative doctors than with the ones I had before, and I do believe I’m getting somewhere this time around.

I expect that @Rarebear will scold me roundly for this :D.

JLeslie's avatar

@ItalianPrincess1217 Yeah, don’t let the websites stir you up. We still don’t know your diagnosis. I seem to think that people kind of can be off and on PCOS. You didn’t get it, if you have it, until your twenties, so I don’t see why there is not every reason to believe you might be ok again. I don’t know a lot about PCOS, because I don’t have it, but sometimes I can tell just looking at a woman she has it. Or, it is a good guess anyway. I figure those are women who had it since puberty. I really don’t know though.

I think you still need to have other things ruled out and in. It’s like having a sore throat, it can be from a start of a cold, strep, or yelling too much at a concert last night. Don’t get ahead of yourself, but I agree it is time for you to get to the bottom of it. I think the ultrasound is important, @Rarebear can maybe tell us more about that. And, of course some blood tests.

ItalianPrincess1217's avatar

@snowberry I am actually very open to that idea. I have recently been going to a masseuse. He gives me the Thai massage and also does a fertility stomach massage. I just started a few weeks ago so I haven’t given it much time to see results. Ideally I would love to completely stay away from prescription drugs. I have never been a fan. If there’s a natural way, I try to do that first.

JLeslie's avatar

I am not contradicting @snowberry, but I do think you need to be diagnosed by someone very familiar with cycle problems. My next stop would not be alternative medicine, unless the doctor has a lot of experience with women with that problem, and of course make sure he is an MD or DO. Once you have a diagnosis, if you want to seek alternative treatment, then maybe that is the right time. Quite a few RE offices also use Chinese medicine, acupuncture and some other alternative methods.

JLeslie's avatar

@ItalianPrincess1217 I wanted to add that many people really like their GP’s. Having experience with one is not enough to make a conclusion. I liked my last one ok. Just not for my thyroid problems, but she didn’t treat me for that anyway. She ran the test because I asked her to when I was seeing her for something else. She was a nurse practioner actually. I once asked a fluther question about GP’s and internists and so many jellies had positive things to say about theirs. It’s so hit or miss. My dad had an internist he liked, but it wound up the guy missed a really serious thing. My dad had to switch to a new one and that guy found it, it was good he had to switch. So, one good one bad right there.

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DigitalBlue's avatar

I say go to any doctor that will help you. That may sound vague, but I think that it’s the truth. Even looking at the responses here, no one can agree because there isn’t a right answer.
I always have to search for doctors who will help me to find the cause of my symptoms and not just throw a prescription at my symptoms. They seem to be hard to find.

JLeslie's avatar

By the way the weight gain can contribute to irregular cycles. It might be hard to know if it was the chicken or the egg. Your body might be very sensitive and the weight gain during your pregnancy and all the hormones might have contributed to the prolems you are having now. I think it can still straighten out. My nonexpert opinion. I know women who have their thyroid get whacky after pregnancy. Some of them it just sorts out on its own, others wind up needing thyroid medication the rest of their life.

ItalianPrincess1217's avatar

My insurance is officially active so I already scheduled my ultrasound for Tuesday. I will update here when I know something!

JLeslie's avatar

Great. Maybe ask your doctor the next step when you get the results, you can see where her head is at. She might very well finally order the blood tests. Sometimes doctors don’t let us know what they are thinking and we become inpatient and they don’t pick up on it. A lot of women don’t worry about not having regular cycles. A lot of women don’t treat it in any way. She may not understand how important it is to you to try and get to the bottom of it. No matter what, I really think you should get a second opinion. If she runs the tests get a copy so you can bring them to the next doctor if you choose to see one.

ItalianPrincess1217's avatar

@JLeslie I will definitely come prepared next appointment with questions. If I don’t feel like enough is being done I’ll be switching doctors.

ItalianPrincess1217's avatar

Update: The ultrasound results came back today and the doctor said everything looks fine, no cysts. She is sending me for blood work next week. I am half relieved, and half confused. I just wish I had some kind of answer for my issues.

JLeslie's avatar

Thanks for the update. Hopefully the bloodwork reveals something. I hope it is nothing serious. By serious I don’t mean life threatening, I’m sure it isn’t anything like that. I just mean hopefully it is something easily diagnosed and cured.

When you said the doctor thought she felt a cyst, I didn’t even know they could even feel those types of cysts. Obviously, she felt something else.

Understandably frustrating for you. :(

ItalianPrincess1217's avatar

New update: My blood work results are back. The normal range for testosterone for a woman is between 2–45 and mine happens to be 73. The reason for all my symptoms (absent period, no ovulation, acne) is due to the elevated levels of testosterone. My doctor gave me a referral for an endocrinologist and I was able to get an appointment with one today.

JLeslie's avatar

@ItalianPrincess1217 So you have the high testosterone, which explains the acne, but you did not have the cysts seen sometimes during PCOS. Did your doctor test for glucose levels and insulin resistance also?

I’m glad you could get into the endocrinologist so fast.

Thanks for the update.

ItalianPrincess1217's avatar

@JLeslie I’m not sure if those things were tested for. I have a copy of my blood work. It shows 6 different things were tested for although I am unsure of what all the abbreviations stand for. It lists FSH, LH, TSH, DHEA Sulfate, Prolactin, and Testosterone. The only abnormal result was with the testosterone.

JLeslie's avatar

@ItalianPrincess1217 She didn’t test it then. None of those are sugar or insulin related. I’ll be interested to know what the endocrinologist tests for. Not because I know what she should test for exactly, I don’t know tons about what causes hormonal shifts, just the basics. Is it a reproductive endocrinologist? Or, just a regular endocrinologist? I think both are fine for this stage in the game. This is what I was talking about when I argued with @Rarebear, some doctors might test everything, obviously rarebear does, but many doctors don’t. Endocrinology will for sure.

ItalianPrincess1217's avatar

She’s a reproductive endocrinologist. I’m sure she will be ordering more blood work as my first doctor did just the bare minimum. So I’m hoping for more answers in the near future.

JLeslie's avatar

Oh good, RE even better. :).

DigitalBlue's avatar

Thanks for the update, glad to hear that you’re getting somewhere with this. I actually came on for the first time in a few days to check here for an update.

ItalianPrincess1217's avatar

It’s been awhile since the last update but I just finally got a diagnosis last week. After a lot more blood work, another ultrasound that revealed cysts this time, and in depth questions about symptoms and family history, my doctor has diagnosed me with PCOS (polycystic ovary syndrome). It explains all of the health issues I’ve been having. She put me on a medicine called Metformin. It’s actually primarily for diabetes but it’s also used to treat PCOS. I am hopeful that this will help straighten things out. I’m relieved to finally have some answers after months of worrying and wondering!

JLeslie's avatar

My girlfriend did start to ovulate on that drug, I hope it works for you. She actually only took it to get pregnant and then went back off. I don’t understand it really, it seems like if you need it to be regular and get the sugar insulin balance right that maybe it is good to take ongoing? I guess there is some controversy over it, or lack of concrete science on the topic.

Who finally diagnosed you? What type of doctor?

ItalianPrincess1217's avatar

@JLeslie I would think it’s best to stay on for as long as you’re having issues. But it might depend on the person. If someone only wanted help getting pregnant and the other symptoms didn’t bother them, I suppose there isn’t a need for the drug after they got pregnant. My symptoms are very bothersome and I plan to stay on for as long as needed. I’m hoping it regulates my cycles. My primary doctor was actually the one who diagnosed it. After seeing several different doctors and getting absolutely nowhere I went to my primary and expressed my concerns. It took 3 visits to figure it out.

JLeslie's avatar

Interesting. So, it did wind up being a primary doctor. I can’t for the life of me understand why it took three visits, but I also can’t understand why the GYN nor the RE didn’t find the answer either. How can fluther diagnose you and three doctors take 6 visits totalled up (if I counted correctly) to figure it out? Jellies obviously did not know for sure, but all along I thought they should test, or at least think, sugar, and our resident doctor here seemed to agree.

ItalianPrincess1217's avatar

@JLeslie I feel the exact same way. I should have initially gone to my primary to begin with. There are 2 in the practice and I never had luck with the first one but never thought to see the other. Right away she started doing tests, not just for hormones but for insulin etc. I’m just glad she got to the bottom of it when nobody else could.

JLeslie's avatar

It’s so hit or miss and frustrating! This is what I tried to explain to some of the doctor jellies, they might be great doctors, but they don’t realize how many doctors aren’t great.

DigitalBlue's avatar

Such a relief to finally know what is going on. Glad there was an update, happy to hear that you now have something to go on and can hopefully get yourself feeling back to normal.

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