Excercise Induced Amenorrhea Leads To Poor Health & Infertility

QUESTION: I have been over exercising for about 10 years now. I get my period fine on birth control pills but when off birth control, I do not get it. I have been off it now for 6 months because the pills are expensive. Is this harmless not to get my period because of over exercising? I got a scan back in June and my gyno ruled out polycystic ovarian disorder. Since I know it's from the exercising and don't want to cut back, could this cause a problem with my fertility? What if I wanted to get pregnant right now? Would that even be possible? Thank you. N. from the U.S.

ANSWER:

Hello N. from the U.S.,

If in fact the reason why you are not getting a period is because you have "exercise induced amenorrhea", that is the result of a dysfunction of the hypothalamus. It is detrimental to your health because, you are not forming the hormones that your body needs. The purpose of the birth control pill was not mainly to have a period, it is not needed in a person who is not making a uterine lining, but the birth control pill gives you the essential hormone estrogen. In addition, the hypothalamus is important for production of other hormones as well including thyroid hormone.

In terms of your fertility, your ovaries will be shut down so that you will have difficulty getting pregnant unless you decrease your exercising so that you have normal ovarian function (have natural periods) or you use fertility medications to replace the hormones the hypothalamus is not producing, to stimulate the ovaries to ovulate.

So, I know that you are an exercise junkie, but keep in mind that instead of making you more healthy, it may actually be more detrimental to your health in many ways, including achieving pregnancy.

Follow-up Question:

You mentioned the hypothalamus being important for the production of hormones including the thyroid, well I have an underactive thyroid and have been taking Levoxyl for at least 5 years now. Is this giving me the hormones I need? Also, I explained not getting my period to my OBGYN and after a scan of my area, he told me nothing was wrong. Why do you think he would say that when he knows of my period problems?

Follow-Up Answer:

Hi Again,

Adequate levels of thyroid hormone is measured by a blood test. We usually use TSH. If your thyroid replacement is adequate, the TSH levels should be in the normal range.

A vaginal ultrasound is only for anatomical abnormalities. It can see the ovaries and uterus, but cannot diagnose ovulation or hormonal problems. That is done by other testing as mentioned previously. If your doc only checks you out by doing an ultrasound, he is inadequately evaluating you for menstrual problems. Most menstrual problems are caused by hormonal problems, as mentioned previously. At least by the ultrasound you know that your ovaries, tubes and uterus are normal, but you don't know anything more than that. So from that point of view, anatomically nothing is wrong, but that is only anatomically. I would suggest you find a better doctor!

Good Luck,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

http://www.montereybayivf.com/

Monterey, California

Off Depo Provera But Still No Period, What's Wrong?

Question:

Hello, I am 30 years old and was on the Depo-Provera shot for 3 years during which time I did not have a single period. I had my last shot in January 2008 and still have not had a period. My husband and I would like to start a family in the next 2-3 years and I am getting increasingly worried that this will not be possible. I am also suffering from very bad vaginal dryness (could this be related?)

I am currently doing some voluntary work in Argentina now and it is difficult to see an English speaking doctor. Is there something I can do to help my self in the short-term or should I consider returning home to seek medical advice?

Answer:

Hello T. from Argentina,

I am surprised that you can't find an English speaking doctor in Argentina. Maybe you should look for a Reproductive specialist specifically as most of them do speak English. If you still can't find one, then you should return to the U.S. for consultation.

Certainly, something is not working correctly which is preventing the ovary from ovulating, hence no periods. This is not due to the Depo Provera, since it does not last this long. It can delay periods for 1-3 months but not usually longer. There is something else going on and you need to undergo evaluation. The vaginal dryness is because you are probably not producing estrogen, which occurs with ovulation, and the vaginal gland is estrogen dependent. You don't want this to go on much longer because the vagina will actually begin to shrink and intercourse will be difficult and painful.

In order to get pregnant, depending on the cause of the problem, you need a treatment that will get you ovulating again. There are various options, but it depends on the cause. In the meantime, you might want to consider going on the birth control pill in order to get you cycling again (it overrides the ovaries so is not correcting the problem), which will give you estrogen. Many parts of your body require estrogen. You should be able to get this from a non-English speaking doctor while you plan to return to the U.S. for consultation.

Thank you for writing and good luck!

Sincerely,

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

Primary Amenorrhea In 32 Year Old

Question:

I am 32 years old and never had a period. My mom took me to the doctor when I was 20 yrs old and they did an ultrasound of my abdomen which showed no cysts in the ovaries and a hormone test which showed that my FSH and LH levels were low. The TSH was normal.

A genetics test confirmed that I am xx. I used the contraceptive pill and had a bleeding. I have always had excess hair growth since puberty and acne issues. Do you think something is seriously wrong with me or I should just let things stay the way they are?

Answer:

There is absolutely something wrong, and it should have been taken care of a long time ago. Without specific laboratory information I cannot tell you what the problem is, but you have some type of ovarian dysfunction. In other words, your ovaries are not working. The bad part of this is that you are probably estrogen deficient. Estrogen is the female hormone and is important for many different parts of your body. As a consequence, you have an elevation in the male hormone, testosterone, because your ovary is not making estrogen. If you keep up like this you could suffer the following consequences: increased facial and body hair, loss of head hair (male pattern baldness), increased acne, deepening of the voice, obesity, diabetes, osteoporosis, increased heart disease.

The reason for the birth control pill was to give you the female hormones that you need and block the male hormone production. If you are not planning on getting pregnant, then you need to go back on the birth control pill. I would recommend that you go on Yasmin or Yaz, which blocks the male hormone better. Bottom line is that you need to see an Endocrinologist or Reproductive endocrinologist.

Good luck and be sure to follow through with my advice!

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