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Re: No periods, even on birth control pill
From: Laurie (anonymous@obgyn.net)
Wed, 28 May 1997 05:42:17 -0500 (CDT)
At Wed, 28 May 1997, Lois wrote:
>
>My 21 year old daughter has had trouble with no periods since she was
>sixtreen. She has had only three or four natural periods. Last year
>the doctor tried Provera and she didn't respond. She then had an MRI of
>the pitutary and that was negative. The doctor was worried about her
>shedding the lining of the uterus and put her on Ortho Novum 777. She
>spotted and had light periods the first couple months. For the last
>three months she has had symptoms of getting a period, but no bleeding.
>Any suggestions would be appreciated. All tests for pro lactin and
>early onset menopause have come back negative.
>From this brief description, it sounds like your daughter has had a very
good workup. With no bleeding in response to Provera, that indicates
that her body is not producing an adequate amount of estrogen on its own
to create a uterine lining that can be shed, resulting in menstrual
bleeding. So in her case, it sounds like her medical risk of
osteoporosis and heart disease (consequences of long-term estrogen
deficiency) is worse than her risk of overgrowing the uterine lining
(which we worry about when estrogen stimulates the lining but it's not
shed regularly). With normal thyroid and prolactin studies, normal
gonadotropins (tests for early menopause), and low estrogen, she is
known to have hypothalamic amenorrhea (in other words, the ovary and
uterus work normally when stimulated, but the signals from the brain to
the ovary are somehow not being transmitted properly). This can be
caused by extreme exercise (is she on the track team or participate in
other sports?), recent significant weight change, anorexia nervosa,
stress, among others. If she has no obvious explanation based on those
things, an MRI or CT of the head should be done to rule out tumor (and
was normal in her case). So that just leaves treatment, which in her
case consists of birth control pills to replace the estrogen that her
ovaries aren't making on their own. There is certainly an adequate
amount in birth control pills, and there is a progestin component to
prevent overgrowth of the endometrial lining. In birth control pills,
the progestin component is stronger than the estrogen component, so the
lining can actually become very thin over time, and lead to light
bleeding or no bleeding at all. So this is a long answer just to
reassure you that there is no problem with the medicine, your daughter
is getting the medicine she needs, and in her situation, it is not at
all dangerous not to have periods.
--
Laurie Lovely, MD
RE fellow, UNC-Chapel Hill
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