WOMENS-HEALTH Messages for September, 1997: Re: amenorreah

Re: amenorreah

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Tue, 2 Sep 1997 06:25:53 -0500 (CDT)

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In reply to: ellen: "amenorreah"

At Mon, 1 Sep 1997, ellen wrote: >
>Since going off of the pill in December '96, I have not had a period.

Secondary amenorrhea, where there is no menstrual period for 6 months or more in a woman who previously had periods, is usually a reasonably easy problem to evaluate. In most cases a good history, physical exam, and a battery of tests will rule out many conditions and help pinpoint the cause. Common tests include a pregnancy test (the number one cause of secondary amenorrhea), thyroid evaluation (to rule out hypothyroidism), prolactin level (the hormone that causes milk to leak from the nipples), an FSH level to rule out premature menopause, and, in unusual circumstances, an evaluation for an anatomic problem within the uterus preventing blood from exiting.

Stress itself can lead to irregularities of the menstrual cycle, perhaps from weight loss. Significant weight changes can alter the pituitary hormones, which in turn effect the ovaries. This is not dangerous per se, but leads to irregular cycles and usually an inability to conceive due to lack of regular egg release from the ovaries. If the cause turns out to be lack of regular egg release (anovulation) then there is an increased chance of a build-up, over time, of the lining of the uterine cavity, which can lead to pre-cancer or even cancer. If the cause turns out to be amenorrhea from, for example, increased stress or weight changes, then there may be inadequate estrogen, which can lead to osteoporosis, where lack of estrogen causes bone loss. Fortunately for us, the birth control pill treats both problems.

You stated that you may want children next year. If you decide on the pill, this should not hamper your ability to conceive. Contrary to popular belief, the pill does not produce difficulty with conception after taking it (other than perhaps 1 cycle). Furthermore, if it is due to anovulation sometimes a true "cure" is impossible, and patients need low-dose fertility pills (clomiphine citrate) to conceive. Others need to gain a little weight, which will restore normal menstrual function. In cases of premature menopause, which is unusual, conception is very, very difficult and often impossible. If the cause is hypotyhroidism, treatment with thyroid medication usually restores both fertility and normal menstruation.

Good luck with your evaluation and treatment, and with having a baby next year.

--
Ashley Hill
D. Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, FL
I apologize, but I am unable to answer personal e-mail
due to time constraints.

Next message: Roberta: "PCOS"
Previous message: Laura: "Thankyou Dr. Shanahan"
In reply to: ellen: "amenorreah"

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