Re: No periods, even on birth control pill
From: Kelly (anonymous@obgyn.net)
Wed, 28 May 1997 22:23:51 -0500 (CDT)
At Wed, 28 May 1997, Laurie wrote:
>
>>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
Dr Lovely has, once again, given a thorough and very educational answer.
The bottom line, as I tell my patients, is "it's okay to not have
periods on the pill; it's not okay to not have periods on your own."
>
--
Kelly Shanahan, MD, FACOG
S. Lake Tahoe, CA
note: Opinions here are for educational purposes only. This information is not intended to supplant the need for you to consult with your own physician. It cannot take the place of a face to face consultation and examination.
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