Question:
I'm a 27 year old woman. I'm not pregnant. I went off the pill 7 months ago, and have not had a period since, though I had light spotting in response to a progesterone challenge. I'm about to be evaluated for PCOS, but I have a hard time believing this is what I have.
I have always been thin, and in the past I was told this was why I did not menstruate when I tried to go off the pill. I have made the effort to gain a little weight and my BMI is about 19 now. I work out regularly, though not more than 50 minutes a day. I have no family history of PCOS, diabetes or insulin resistance.
In the past 7 months I have developed benign PVC's of my heart, and have had a mild increase in facial hair and hair around my navel (this is why they think I might have PCOS).
My question is, are there any other conditions that might cause my symptoms that I should be aware of when I go to have the blood tests? Should I be tested for premature ovarian failure and hyperprolactinemia as well?
Thank you so much!
Answer:
Thank you for your question.
Your history does not quite fit PCOS. The most likely diagnosis is hypoganodotropic hypogonadism. It is a long name for saying that your brain is probably not stimulating the ovary. It is likely due to a lack of adequate body fat. Not premature ovarian failure. Since you had a little response to the Provera challenge, that shows that you are making a little estrogen, but the increase in hair growth is consistent with an elevation of the male hormone testosterone. If the ovary is not stimulated to ovulate, it does not produce estrogen and the available hormone precursors go to make testosterone.
Body fat is important because it is the chemical basis for the production of all hormones. If the body fat is too low, because of excessive exercise or anorexia or bulimia, the brain shuts down the production of FSH and LH. This leads to a lack of stimulation of the ovary, hence the above result.
This diagnosis can be made with blood testing. You should be tested for FSH, LH, Prolactin, TSH, Estradiol and Testosterone. This would test all the possible sources of your lack of menstruation. They will probably find that your FSH and LH are very low. Your thyroid may also be out of sync because of the same problem. TSH is the preliminary test for thyroid function.
It would be best if you could get your BMI up above 20, and increase your body fat content.
I hope this helps.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.
I have exactly the same situation. What is the best way to gain weight?
ReplyDeleteIn this case, you want to increase body fat, so you have to increase your fat intake and decrease output (i.e. decrease metabolism or exercise). A normal diet should do it. We take in plenty of fats in our diet, unless you are a vegetarian. There is no "best" way to increase weight that I can recommend. A dietician might be able to help better.
ReplyDeleteHello i am an 19 year old girl but my body does not seem to be able to produce the necessary hormones on its own for my menstrual cycle to take place. I have been on microgynon 30 for 6 months and i haven been having regular periods. I don't think i hace turner syndrome and the doctor i am seeing does not explain to me why i am on contraceptive pills so that my periods can come. Thank you!
ReplyDeleteHello.
ReplyDeleteYou are on the birth control pill simply to give you regular cycles. I am not sure that I understand what you mean by "my body does not seem to be able to produce the necessary hormones . . . " Hormone production is done at three levels of your body. At the hypothalamus level, the pituitary level and the ovarian level. The lack of menstrual cycles can occur from defects in any of these levels. The treatment depends on the level that is malfunctioning. On the other hand, birth control pills just take over the function at the uterus, and provide you with estrogen and progesterone hormone, to give you regular cycles.
You need to ask your doctor what the diagnosis is for your problem. If he/she can't answer that question, it is probably because either they don't know or they haven't checked. In that case, you may need to see either an endocrinologist or a reproductive endocrinologist.
At this point in your life, the birth control pill is a fine treatment. However, once you reach the point of wanting to get pregnant, then the specific problem must be identified so that the proper treatment can be applied.
Good Luck.
Hi
ReplyDeleteI too have difficulty having my period. I have been trying to increase my BMI and have been back on the pill for 3 months to increase oestrogen. After that do you think I will get back my periods? Also, I have decreased my exercise dramatically, however I still run and swim 3 times a week - should I stop altogether?
Hello,
ReplyDeleteThe pill is doing nothing to reverse the problem. It is giving you the estrogen that you lack, but it is essentially an artificial cycle. Once you stop the pill, you will be back to where you were before starting it.
The problem is not so much weight gain but the lack of adequate body fat to convert into steroid. Continued exercise will continue to burn off that body fat even if you gain some weight. If you ar serious about getting pregnant, then I would recommended that you either slow way down on the exercise and eat a lot to increase your body fat, or stop exercising altogether until you achieve pregnancy. You can resume some exercise during pregnancy.
Good Luck.
Thank you Dr. Ramirez for this informative post! I know this was written some time ago, but here is my question: I have a low BMI (just under 19) but I've been petite and had regular menstrual cycles all my life. I've been charting my BBT for the past 3 months and I ovulate pretty regularly as well. My husband and I have been TTC for 6 months now. Could my low BMI be contributing to our failure to conceive? Would you recommend me gaining 10 pounds or go in for some basic testing? I am almost 27 and have no other major health issues. Thank you.
ReplyDeleteHello Megan,
ReplyDeleteSorry for the delay in getting back to you. If you have regular menstrual cycles, which as you pointed out, is a sign of ovulation, then your weight is NOT an issue. You may be petit, but you are not underweight. You have enough body fat to form the hormones that you need. Therefore, this is not an issue for you.
By definition we do not classify a patient as having an infertility problem until they have been trying for at least 12 months. That is because the average woman under the age of 30 will take 8-12 months to become pregnant. Don't worry so much about the fact that you have not gotten pregnant right away and give yourself a little more time. If you don't get pregnant by 12 months, then it will be time for you to see an infertility specialist for an evaluation. Ovulation is not the problem for you so don't let them just put you on a fertility medication without an evaluation. Something else would be the problem in your case.
Good Luck.
I am 21 years old and have always had an abnormal cycle, and by abnormal I just mean varying amount of days when I am actually on my period (anywhere from 1-7). After starting college, I gained about 15 lbs which brought me up to 150 lbs and I knew that I needed to figure something out to loose weight. I lost my weight pretty fast, and now I am down to 113. For the past 2 months, I have had no period. I know that I am not pregnant. I also am the oral contraceptive Beyaz. I switched to Beyaz from Ortho Tri Cyclen lo back in February because I bled continuously, clotting blood, for 4 months. Can you help me?I want my period back, and normal.
ReplyDeleteHello,
ReplyDeleteI am not sure what they timing is on your lack of menses but were you on the Beyaz at the time you missed your periods? If you were, that would not necessarily be unusual. Now-a-days, the dosage of the birth control pills are so low that often there won't be enough endometrial development for anything to slough, hence no period. If you want to have a period, you need to change to a higher dosage pill.
Good Luck
I'm a 29 year old who has been suffering from anorexia for the past 15 years. I've e had spells of having periods and not and it doesn't seem to correspond with a higher bmi. I've recently started my periods again but at a low bmi of 14 and can't understand why or if its normal when at higher bmi's say of 17,18 OR 19 i haven't started again. Is this normal. Have i messed my body around so much being higher and lower weights bmi's that my body is confused?? Don't understand. Am currently in hospital in an eating disorders ward and my periods came back at that bmi 14. can you explain why when it's no where near a normal weight??
ReplyDeleteHello Sept 23rd anonymous,
ReplyDeleteBMI is not the complete answer in explaining the lack of menstruation based on weight. For instance, an intense athlete can have a normal BMI but most of the weight is muscled(which is heavier) and they still won't menstruate. The reason is because your body's hormones are derived from the cholesterol molecule, which comes from fat. If you don't have enough body fat, then you can't make hormones, hence no periods i.e. the ovulation pathway does not work.
Dr. Ramirez,
ReplyDeleteMy husband and I have been trying to conceive for the past 15 months. We've both had initial fertility testing done. His SA came back perfect, and my thyroid test was normal. My doctor hasnt tested any of my other hormone levels, but Im wondering if my weight is affecting my fertility. I'm 25 years old, 5'5" and 100 lbs. I've always been thin, and I've never had a history of menstrual problems. But now that I'm seriously trying, I've been taking my bbt the past 4 months and it looks like I only ovulated one of these months, and that time I had a short luteal phase. I'm not sure why I'm having fairly regular cycles (30-35 days) but no signs of ovulation. Does this sound like it could be an issue with my weight? I brought it up with my doctor but he sort of dismissed the idea.
Hello,
ReplyDeleteThe main impact of low weight on your fertility is if the hypothalamus does not have sufficient fat cells to process the hormones. We call that hypogonadotropic hypogonadism. This is what is seen in very lean athletes. The cardinal sign is that you don't have regular periods because you don't ovulate. If you have regular and predictable periods, that is a sign that you are ovulating. I am not sure why the ovulation kit is not showing ovulation, unless you are not testing at the correct time. If you have a 33-35 days cycle, say 34 days average, you should ovulate around CD#20 so you should start testing from CD#16. Your fertile period would be CD#18-22 so if you wnated to time intercoure by the calendar method, you would have intercourse each of these days, only once per day and only one ejaculation per episode. Your weight is NOT an issue in this case.
From what you describe, you have not had initial fertility testing done. You have only done two of the nine tests. The remainder of the tests are: Hormone panel (FSH, LH, Estradiol, Prolactin), Hysterosalpingogram (HSG), Hysteroscopy or Hysterosonogram, Laparoscopy, Mid luteal phase progesterone (should be CD#25 or 26 in your case), end cycle endometrial biopsy for dating (cD#33 or 34) and pelvic ultrasound.
Good Luck.
hello i am 24 years old i had my daughter 6 months ago after i stopped bleeding from that i have not had a period and i have lost alot of weight my bmi is 16.4 but i do eat and the only thing i eat really is junk like mc donalds and carbs i dont exercise and in the last week i have lost 5 lbs what can be causing me to loose weight so rapidly and is that why i have not been having my period i took a pregnancy test like 2 or 3 months after i stopped bleeding from delvering a baby and they kept coming back negitive any advice
ReplyDeleteHello April 25th,
ReplyDeleteIf there is no obvious reason for losing weight then an evaluation has to be done to find a cause. There are many causes of which a hormonal problem is the most common. It could lie in the hypothalamus, pituitary, thyroid or ovaries. Without testing there is no way to know which it is. I would strongly recommend that you see your doctor for this evaluation.
Good Luck
since the birth of my son 15 months ago i had Heavy bleeding for 12 weeks after birth then nothing since. my bmi is now 16 i think it was about 17-18 ish when i first conceived him. I've also had pndis my low bi now the reason my periods not come back? I've been this weight for about ten months now and have recently increased my carbs intake
ReplyDeleteHello May 9th,
ReplyDeleteI don't think that your BMI is the reason for not having a period. There is probably some other hormonal problem going on. I would recommend that you see a reproductive endocrinologist for an evaluation so that proper treatment can be given.
Hi Im a 30 year old I've got a two yr old son and am waiting to try concieve again. But since the birth of my son I've not had a single period. My bmi is 16.5 it was 17-18 ish before i had my son. So Im about 4-5 lbs lighter now. I don't exercise and have had some blood tests 6 months ago that showed low hormone levels. Im getting my blood tested again soon. What is the problem is it my weight? Can i do anything? Dr says keep trying as i could ovulate without periods!!?? Im worried i might never have another baby
ReplyDeleteCertainly your weight is on the low side, but I don't think you need to wait to have a child. You don't mention specifically what "hormones" are low, but medication is available to stimulate the ovaries to ovulate, so there is no need to wait for your doctor. Maybe you should see a doctor that has the proper expertise.
DeleteHi i think my bmi is about 17 Im 5'2 and just under 7 stone. I've not had my period in two years since the birth of my last child Im keen to try for another baby but struggle to gain weight i don't think I've ever had a bmi over 18/18.5 is there anything else i can do? Also i don't exercise other than running around after children!
ReplyDeleteHello,
DeleteI just answered the same question above and the recommendation is the same. I don't think you need to necessarily wait for your weight to increase, rather, there are fertility medications that can be use to induce ovulation. I think that is what you need to do. Make sure you see the proper doctor so that you get the proper medications.
Just as a side note, we don't use "stone" measurements here in the U.S. so it was a novelty for me to see this used. Unfortunately, I couldn't interpret it, but that doesn't change my answer.
Hello, I am 31yrs old and have 2 children already. My periods have always been regular yet I haven't had one since January. I am currently at 14.3 % bmi, up from 13.4 %. I eat normal and snack through out the day. Yet I still struggle to gain weight. My normal weight is between 115 and 120, but for some reason now I have trouble getting above 108. I'm always tired and my body hurts so bad. I'm not anorexic or bulimic on the contrary I love to cook and eat. What tests should I ask my Dr to run and why?
ReplyDelete