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

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