No Menstruation

Question:

I am 26 and have two children. I am about 5'7.5" tall. My last spontaneous menses was April 6, 2005. After this, I became pregnant with my first child. After her birth, I dropped from 168 pounds (the same weight as prepregnancy, but since I stopped drinking alcohol and eating unhealthily and started walking daily, I maintained healthily) to 113 pounds in 10 months while breastfeeding and walking. I stopped breastfeeding and walking to try and gain weight to get pregnant with my second, but even after gaining 20 pounds, taking progestin and estrogen, there was no menses. After estrogen therapy plus clomid, I menstruated, took Clomid again, and got pregnant with #2. After her birth, my weight fell from 171 at her birth to 113 with breastfeeding and running. I never menstruated. She was born March 1, 2008.

Four months ago, I was prescribed the NuvaRing for amenorrhea after progestin again failed to produce a period. I have had four successful withdrawal bleeds. After this month, however, I have to stop; we cannot afford my taking it and pills make me sick.

I am currently training for a half marathon and run 50 miles per week. I am about 117 pounds now. I don't want to have more children but am concerned that after all of this time I won't be able to get my period back. I will cut back my running after my October 3 race, but what do I do to get my period back? CAN I get my period back? After gaining weight in late 2006/early 2007 there was no menses. There are no blockages or anything abnormal, though I may have mild subclinical hyperthyroidism as a byproduct of my running; my follicles are just dormant.

I want to be normal and healthy. I MISS my period, however odd that may sound to some. How can I get this back?

Answer:
Hello Bethany from the U.S.,

The problem that you have is more long-term than short term. The fact that you are not having periods is a sign that your ovaries are not functioning an therefore not ovulating. Because of that, you are NOT producing the essential female hormones, Estrogen and Progesterone. Without estrogen, you will be at long term risk for osteoporosis, heart disease, vaginal dryness and shrinkage. Once these occur, they are not reversible.

It is most likely that you have a disorder called "hypogonadotropic hypogonadism" which is a lack of hypothalamic stimulation to produce the hormones that the pituitary produces to stimulate the ovaries. The thyroid is one of those hormones that the pituitary stimulates as well. You need to see a Reproductive endocrinologist or Gynecologist to solve this problem. It is not so much that you need to have a period, that is just the monthly shedding of the uterine lining if you don't become pregnant, but the lack of hormone is worst. You need to be evaluated to make sure that you don't have some other underlying cause, other than your weight and decreased body mass.

In terms of replacing hormones, the birth control pill is the best because it has both estrogen and progesterone in it. If you can't tolerate the pill because of gastric side effects, then you can consider the patch. A progesterone only contraceptive of any type is NOT adequate. You need estrogen.

Sincerely,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com

Monterey, California, U.S.A.