Thursday, December 3, 2009

Amenorrhea and Bulimia


I have not had a period since July of 2008 and my gynecologist told me that is is not dangerous to NOT bleed, only dangerous to bleed too much. At first, I assumed the loss of the period was because I had started working out so much and lost a decent amount of weight. However, (ironically) after joining the military, I've been less active, but still have not had a cycle. Someone suggested to me that amenorrhea can be caused by athletic activity or eating disorders. At age 16 I was diagnosed with bulimia, but stopped seeing my psychologist shortly thereafter as he thought I was better.

Truth be told, I've never completely stopped the binge/purge cycle because I don't know how to break it. Now I'm afraid I may have affected my cycle after 7 years of abuse. I don't know what to do and this scares me. I can't talk to doctors on my military post because I don't want them to find out about my issues (as this can lead to separation from the service). Does this type of amenorrhea mean infertility? Is there any way to reverse the effects? Who should I talk to or what should I do? Any help is greatly appreciated. Thank you in advance.


Your gynecologist is incorrect in advising that not having a period is okay. It is not okay for lots of reasons, one of which is that you may have a hormone imbalance that can have negative long term effects on your body. At the very least, you should be cycled on birth control pills to correct the estrogen/progesterone imbalance.

It is certainly possible that if your weight is too low, that is you have a low body fat content, as occurs with professional athletes, the hormones cannot be created because there are no fat cells and cholesterol to produce the hormones. Also, the hypothalamus can shut down so that the hormones are not produced. This is NOT an acceptable situation. Not only can it be a source of infertility, but it can lead to all the problems that menopausal women have.

In terms of your bulimia, that is also abnormal and needs to be treated. You should not worry that the doctors you see will cause you to be released from the military. That is not true. I was a military doctor (US Army) for 9 years. The requirement that all medical information remain confidential (doctor-patient confidentiality) applies to military doctors as well. I would request to see a gynecologist or medical endocrinologist to begin an evaluation or your hormones and get a referral to a psychiatrist. You should get immediate care for both these problems!

Take care of yourself and don't delay. Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.


  1. Hi Doc,
    I had single frozen embryo transfer (day 3 with 8 cells).
    I had mild pain and cramp post transfer but start to had spotting (light brown) on post transfer day 7.
    I am oral progesterone as well as chronine.
    This is my 2nd IVF cycle with OHSS at the same time. The 1st cycle was cancelled due to no response on follicle.
    I am worried sick and please advice.

    1. I have a section on this blog specifically talking about bleeding after embryo transfer that you might want to read through. Light brown spotting is not a concern. I tell my patients not to worry unless the bleeding is bright red and an amount similar to a period. Also, Crinone has been associated with cervical bleeding which may be the cause in most cases.

  2. Dr. Ramirez, is there a body fat percentage minimum you would recommend for optimal fertility? Thank you for your blog.

    1. Hello,

      I'm sorry there is no "optimal" number.

      Good Luck

  3. Hi i wonder if you could im on day 13 after i had two embryo transfered and now im losing brown blood :( is this anything to be concerned about??

    1. No. I only worry if there is bright red bleeding that is an amount like a normal period combined with uterine cramping. Anything less than that is not significant and should not warrant worry.

  4. Hi, I am 30yrs old and had Day3, 3 embryo's transfer (1)8A (1)8B (1)10B. Today is 5 day now. I am not feeling any symptoms. Is this normal??

  5. How long does your menses last after egg retrieval is performed for IVF. Period is heavy and causes weakness in the body, is that normal? How long do you want to have the egg transfer done. Egg retrieval was a week ago and currently taking bc pills.



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