Amenorrhea--revisited, revisited

Quick update (since I live my life on the Internet): the round of birth control pills did not do what they were supposed to do, which was to force me to have a period (and no, I'm not pregnant). I realize that most women do not look forward to their 'monthly visitor,' but it's been so long (and I took the pills against my better judgement), so I was disappointed to not have a period. By around Wednesday of last week (when it was becoming pretty obvious that nothing was happening), I was getting worried.

Worried, but yet still very, er, calm?

In the back of my head, crazy thoughts started to pop up, like maybe my ovaries are full of cancer and that's why I haven't had a period in over a year and a half. Then the more rational part of my brain kicked in, and I would think, absolutely nothing else is wrong with me. I'm pretty sure if I'd had cancer manifesting in my reproductive system for the last eighteen months, something else would have shown (more extensive weight loss, pain, weird lumps, etc.). I am fine. Regardless, I was kind of on the emotional side on Wednesday, having unexpected tears a couple of times during the day.

On Friday I emailed my health care provider at MIT Medical to let her know about my lack of flow. She got back to me later on in the day, and her response gave me a great deal of relief. Although it seems to have been something of a surprise that the birth control pills didn't trigger a period, she also didn't seem alarmed (i.e., she didn't tell me I needed to come in immediately). I'm to do a couple of extra tests, an ultrasound, and more blood work, but this is just to make sure everything is indeed all right.

So, that's where I stand, or sit, or whatever. I'm most likely normal, and I'm just to carry on from here. Personally, I will try to eat more on a consistent basis (rather than making up for the lost calories during the weekend), and I'll continue to take a multivitamin to help me get the iron I don't get from my pseudo-vegetarian diet. I'll also assume that for now, I'm mostly normal, until proven otherwise.

Ciao,

Andrea

Amenorrhea--revisted

Remember how I wrote back in the late winter/early spring that I was experiencing post-pill amenorrhea? Well, I still haven't had a period. I've seen two more health care professionals at MIT Medical (both nurse practitioners, one of whom specializes in obstetrics), and I've now been told that what I'm experiencing is hypothelamic amenorrhea.

It's what I kind of thought the problem was, but couldn't quite believe was the problem because I'm not a super trim, high performance athlete. Basically, I'm too lean to support the process of menstruation. My BMI is fine, partially because I have a higher than average amount of muscle for a woman. I only exercise 8-9 hours a week, and spend most of the rest of my time sitting, but I guess that's enough to do it. More probably, of those 8-9 hours of exercise, I spend 2 hours lifting weights in the gym, and 2-3 hours lifting myself practicing aerials (hence why I'm rather muscular).

So, what's my treatment? I could cut down on exercise, or I could eat more. I know from tracking my diet for the last several years that I consumed between 2,100-2,300 calories/day, and on average have a balanced calorie intake/output every week. The other option was a chemical reminder to my brain and ovaries about what their supposed to do once a month.

Presently, I'm back on birth control pills. This isn't necessary because I wanted the quick and easy fix, but I want/needed the definite (or should be definite) fix. It's just for three weeks, which is what I have to continually remind myself. Three weeks only, and I've decided if it doesn't work, I will NOT be continuing on them no matter what. I've gained around 6 pounds in 2 weeks thanks to the pill. As Andrew repeatedly reminds me (and as I know myself, I really do), it's the pill that's caused this weight gain, and it's because my body is retaining water.

That doesn't help me feel better.

As I've blogged before, I was overweight as a child and teen, so any hint of gaining weight makes me worry. I hate that the weight gain has happened so quickly (2 weeks!) and it will probably take me a couple of months to get back to where I was before January. Except, given that my weight and body compilation seem to be the source of my problems, maybe I just need to accept that I need to be 5 or 8 pounds heavier to be healthy. That, my dear readers, if definitely more easily said than done.

I'm not going to delve into the issues of popular culture and female body image. Others have done, and will continue to do so better than I am capable of, but there are times when being a young-ish health-conscious woman sucks.

Ciao,

Andrea

How is amenorrhea treated?

Last but not least in this series, how is amenorrhea treated? All of the sources I've consulted say more or less the same thing and that's: treat the underlying cause, and your period will come back.

That sounds pretty easy, right? Probably not. If I've learned anything, it's that the body and how it regulates itself if complex; however, I suppose in theory it sounds simply enough.

If your period stopped because you're over or under weight, achieve a healthy weight (whatever a healthy weight is).

Stopped because of olycystic ovary syndrome (PCOS) (sorry, I didn't talk about this)? Treat PCOS, which has a variety of solutions such as: hormone treatment (often oral contraceptives); improve the body's sensitivity to insulin through other medications (e.g. metformin); fertility medications; or surgery.

If your thyroid isn't working properly, again, you're likely going to be put on medication to regulate the thyroid, or possibly undergo radiotherapy.

You get the point, right? This seems to be a cause and effect situation, where once you've pinned down the problem, the solution should be possible to identify.

In my case, because my blood tests came back normal (I did 2 sets, several months apart), and I have no history of health problems, the cause is vague. The first doctor I saw said it could take as much as a year for my period to return, and even the second one said that period return times varied widely between women. Further, the second doctor had suggested after several visits the next step in my treatment process would be to go back on the pill--just for a month or two to get things re-started.

Unfortunately, I have no desire to go back on the pill, ever. So I'm going to wait.

Here's a link for the National Institute of Health (UK):http://www.nhs.uk/Conditions/periods-absent/Pages/Introduction.aspx

Here's a link for the National Institute of Health (US):http://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/Pages/treatments.aspx

Here's a link to a health clinic in the US, the Cleveland Clinic:http://my.clevelandclinic.org/disorders/amenorrhea/hic_amenorrhea.aspx

Here's another link to a health clinic in the US, the Brown University Health Clinic:http://brown.edu/Student_Services/Health_Services/Health_Education/womens_health/amenorrhea.php

Ciao,

What is amenorrhea?

Next up in the discussion, amenorrhea. What is it, and just exactly how do you say it?

Amenorrhea (said: a-men-o-REE-uh) is the absence of menstruation. According to Williams Gynecology 2nd Edition, there are a couple of different situations for which amenorrhea can be diagnosed. The first two are in the case of young girls who haven't started to menstruate by a) 14 years of age and are showing no other sides of puberty; or b) 16 years of age with other signs of puberty visible. Obviously this isn't my case. The third definition is for females who had previously been menstruating, but missed menses for 3 cycles in a row, or 6 months.

The most common cause of amenorrhea is pregnancy, but again, this isn't my case.

If you look through the links you'll find a variety of reason for why amenorrhea occurs. Included among them are use of oral contraceptives, discontinuation of oral contraceptives, sudden weight loss, low body fat percent, and extreme amounts of exercise. Related, there is condition called Female Athlete Triad syndrome, where female athletes involved in sports that emphasize low weight (i.e. gymnastics, figure skating, diving, long distance running, etc) can experience a combination of: eat disorders, amenorrhea and decreased bone mineral density (for more information on this condition, see Female Athlete Triad Coalition Website).

Other causes of amenorrhea include: other medication use (chemo drugs, antipsychotics and antidepressants), hormonal imbalances (especially the thyroid, but also the pituitary gland), and structural abnormalities with the reproductive organs themselves.

Here is a link to the Mayo Clinic pages on amenorrhea (click through the tabs for more information): http://www.mayoclinic.com/health/amenorrhea/DS00581

Here is to the UptoDate page on amenorrhea (this may require a password or subscription): http://www.uptodate.com/contents/etiology-diagnosis-and-treatment-of-secondary-amenorrhea

Here is the MedlinePlus page on amenorrhea: http://www.nlm.nih.gov/medlineplus/ency/article/001219.htm

Here is the Wikipedia page on amenorrhea: https://en.wikipedia.org/wiki/Amenorrhoea

Ciao

The Pill and my period, full stop

Since I discuss just about everything going on in my life on this blog, I'm going to go a bit more personal for the next few posts. You might wonder, after tearing apart my personality, how could I get more personal? First, let me reassure you, dear reader, that what I'm going to discuss isn't ichy or scary or depressing, but it is of a...womanly nature? Further, I've decided to share this because I expect there are other women out there who have undergone similar problems, and being a librarian, I would like to provide helpful information.

Here's the big share:

I used the oral contraceptive Marvalon for seven and a half years. It was fine. I didn't experience any major side effects, my periods were always very light, mainly just a regular monthly irritation. Late June 2012, I decided it was time to go off 'the pill.' I'd had enough of ingesting extra hormones, and Andrew and I were starting to talk more seriously about the possibility of having children. Therefore, it seemed like a good time to stop.

Okay, so?

So, I haven't had a period since. That's closing in on ten months, and I'm really, really not pregnant. Nor have I been at any point since last June. I also dropped eight pounds in about two months--I know this sounds great, except I didn't change anything diet or exercise wise (I know, I track it all), except that I stopped taking Marvalon.

I'm experiencing something called post-pill amenorrhea. Amenorrhea is the absence of a period in a woman (who had hitherto been menstruating) for more than three months. Opinions seem to vary as to how quickly a woman's period should come back after using the pill, possibly because it varies from woman to woman. However, I am definitely on the long side of normal at this point and I am seeing a doctor to try and get this sorted out. I'll touch on that later.

Here's what I'm going to do over the next couple of posts.

1. I'm going to provide some history on the pill.
2. I'm going to provide some information on how the pill works.
3. I'm going to provide some information on amenorrhea.
4. I'm going to provide some information on what can be done to treat amenorrhea.

For the most part, I'm just going to provide links to information, with a short summary on each topic. I'm not an expert in this field, and there's plenty of information out there so that I don't need to regurgitate it all here.

Ciao,