Medical question

[regentrude]

The hive is a wealth of information, please give me your thoughts.

22 y/o female on hormonal birth control pills is not having periods at all. Ultrasound of ovaries came back normal. Blood tests gave normal thyroid levels.  The only thing that ever came up in any tests is that her triglycerides are elevated and not budging. The woman is of healthy weight that has been stable for years. She is physically active, vegetarian/mostly vegan with a very clean diet cooked almost completely from scratch. (Nutritionist friend suggested addressing the triglycerides by increasing healthy fats to increase HDL and improve ratio).  She supplements vitamins and extra B12. No other medications.

GYN suggested seeing an endocrinologist to rule out PCOS. This seems unlikely to me because ovaries look fine on U/S, weight is healthy, no family history, no other symptoms of any kind. What would the endo check? What would the consequence of a diagnosis be?

What other reasons could there be for lack of periods? What tests would you recommend? 

Thanks

 

[cintinative]

My friend with PCOS had a healthy weight but intermittent periods.  She was also a runner in high school so they blamed her lack of periods on that (at that time). 

I have several friends with PCOS and based on their experience alone I don't know if I can speak to what the consequence of a diagnosis is.  Some of them took medication and were able to conceive. Some of them took medication and used in-vitro and conceived.  My friend took medication, tried in-vitro, and had one miscarriage. That was their only pregnancy.  It really seems to vary and I can't really say why.

My friend is on a special diet for her blood sugars (note that it never came up with an issue before they tried to get pregnant). She spent years dealing with the intermittent periods and it wasn't until they tried to conceive that the gyn said, "oh, well you have PCOS." It's kind of mind blowing that she wasn't told until then.  She could have been treating herself.  

I guess all that to say--it is possible that this diagnosis would be missed, and that missing it would mean consequences for conception down the road. So it is important to rule it out (or identify it).

I am hoping that someone who has PCOS will comment here, because I have more questions than answers about it. 

[Wildcat]

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Edited January 9, 2020 by Wildcat

[Katy]

The most likely reason is PCOS, even with a low/normal weight.  She should see an endocrinologist.

Vegan diet could also be contributing, but there's no way to know without blood hormone testing several times throughout the month.  This is somewhat common in vegans but PCOS is MUCH more common.  Some women cannot keep healthy estrogen levels without eating more fat and less cruciferous vegetables.

[73349]

A BC prescription that is too strong for people her size, if she is small. They are not all alike.

[BeachGal]

The high triglycerides can be a result of PCOS.

My understanding is that young women can have normal looking ovaries and still have PCOS.

She needs to see an endo who's on top of female hormonal issues, not someone who just does what's standard. Is she near a teaching hospital? That's where I'd probably go.

She needs to rule this out because of possible fertility problems down the road and also it can increase the chance of developing uterine cancer. There's a lot she can do to keep herself healthy even if she does have it. So definitely get it checked out.

More information here:

https://labtestsonline.org/conditions/polycystic-ovary-syndrome-pcos

 

Edited January 9, 2020 by BeachGal
added a link

[OH_Homeschooler]

15 minutes ago, whitehawk said:

A BC prescription that is too strong for people her size, if she is small. They are not all alike.

 

This is what I thought of. I don't think it's unheard of for BCP to stop periods completely. They certainly lighten up periods, which is why they are often prescribed when women have very heavy periods. I'm not sure I would be overly concerned--it's not even a real period that you get when you are on oral contraceptives. 

[regentrude]

Thanks. More suggestions? Love to hear from people with experience with PCOS

[Roadrunner]

1 hour ago, regentrude said:

Thanks. More suggestions? Love to hear from people with experience with PCOS

many abnormal hair growth? 
Usually somebody with PCOS will have alleviated testosterone levels and those hormones are tied in with insulin resistance. 

I have PCOS. I am the lucky one because conception wasn’t an issue. 

 

PM me if you want to ask me more personal questions. I will gladly chat. 
 

 

[mmasc]

I was also thinking possibly the bcp, especially if it’s a high estrogen one. Is it possible for her to stop the bcp for a few months and see if she has periods? (Just a thought...I don’t need the answer) Maybe even start with looking up on the internet if her particular pill is considered a ‘high estrogen’ pill. 

[sbgrace]

I was told I had PCOS after missing cycles in my 20's. i did not have a family history, weight issues, or cysts they could see on my ovaries. My cycles before (and after they got them started again a time or two) seemed normal to me. I assumed I was misdiagnosed. 

Then, when married, I couldn't maintain pregnancies at all. We eventually saw a reproductive endo. at the OB's suggestion due to the repeated miscarriages. The endo also didn't see cysts on my ovaries. She also diagnosed me with PCOS. The PCOS was causing luteal phase deficiency with low progeserone, hence the miscarriages.  That is treatable and my kids are progesterone supported pregnancy. I wish I would have known before I had all those miscarriages.

There are treatments to try to prevent/treat some of the non-pregnancy health issues related to PCOS. Triglyceride elevation is one of those fwiw. 

So...knowing (IF she has PCOS) might help her avoid some heartache when/if she wants to get pregnant in the future (getting pregnant, maintaining pregnancies, and health during pregnancies can all be impacted) and she does need to be aware of the health risks outside of pregnancy that can come with PCOS. 

Having said all that...I would expect the birth control pills to regulate her if she has PCOS! So that part makes me wonder. She is not, on birth control pills, ovulating at all so it's not a direct result of anything like my situation.  It is possible her diet or exercise might be the issue instead. I would want that sorted out I think, and an endocrinologist should be able to sort it.

Edited January 10, 2020 by sbgrace

[mominco]

13 hours ago, regentrude said:

The hive is a wealth of information, please give me your thoughts.

22 y/o female on hormonal birth control pills is not having periods at all. Ultrasound of ovaries came back normal. Blood tests gave normal thyroid levels.  The only thing that ever came up in any tests is that her triglycerides are elevated and not budging. The woman is of healthy weight that has been stable for years. She is physically active, vegetarian/mostly vegan with a very clean diet cooked almost completely from scratch. (Nutritionist friend suggested addressing the triglycerides by increasing healthy fats to increase HDL and improve ratio).  She supplements vitamins and extra B12. No other medications.

GYN suggested seeing an endocrinologist to rule out PCOS. This seems unlikely to me because ovaries look fine on U/S, weight is healthy, no family history, no other symptoms of any kind. What would the endo check? What would the consequence of a diagnosis be?

What other reasons could there be for lack of periods? What tests would you recommend? 

Thanks

 

I know you are focusing on pcos but I would also look at the bcp. Some of them do change formulations,Can you ask your pharmacy if anything changed with it? 

Don't discount the small stuff.There are certain Bcp's that can do that-can you try changing that and seeing if that helps?If you have specific questions feel free to pm.My dd is younger but we have been down that road. I agree with what white hawk said up thread. GL 

[lovinmyboys]

Does the doctor not think it is from the pills? I thought that was a common side effect. I’m in my 30s and taking pills and I don’t remember the last time I had a period. 

[regentrude]

Thank you all for chiming in. I would have assumed it's from the pills, because that would be common. She had normal cycles before bcp. I specifically asked her whether the doc has considered switching prescription, but she said doc wants this bcp because it regulates cycles -huh? 

Do I understand it correctly that there is no actual treatment for PCOS? So, assuming that were to be the case, what benefit would there be in knowing now? Is there anything one would do years in advance to ward off fertility issues down the road?

[wintermom]

8 minutes ago, regentrude said:

Thank you all for chiming in. I would have assumed it's from the pills, because that would be common. She had normal cycles before bcp. I specifically asked her whether the doc has considered switching prescription, but she said doc wants this bcp because it regulates cycles -huh? 

Do I understand it correctly that there is no actual treatment for PCOS? So, assuming that were to be the case, what benefit would there be in knowing now? Is there anything one would do years in advance to ward off fertility issues down the road?

If she had regular periods before, I'd be very tempted to stop the bcp and just see what happens. What could it hurt, especially if her cycles are already irregular from taking the pills. 

[Ausmumof3]

22 hours ago, regentrude said:

The hive is a wealth of information, please give me your thoughts.

22 y/o female on hormonal birth control pills is not having periods at all. Ultrasound of ovaries came back normal. Blood tests gave normal thyroid levels.  The only thing that ever came up in any tests is that her triglycerides are elevated and not budging. The woman is of healthy weight that has been stable for years. She is physically active, vegetarian/mostly vegan with a very clean diet cooked almost completely from scratch. (Nutritionist friend suggested addressing the triglycerides by increasing healthy fats to increase HDL and improve ratio).  She supplements vitamins and extra B12. No other medications.

GYN suggested seeing an endocrinologist to rule out PCOS. This seems unlikely to me because ovaries look fine on U/S, weight is healthy, no family history, no other symptoms of any kind. What would the endo check? What would the consequence of a diagnosis be?

What other reasons could there be for lack of periods? What tests would you recommend? 

Thanks

 

PCOS can exist as a hormonal imbalance without the perceivable cysts I think?  I had similar and what regulated the cycle was extremely low carb eating and serious exercise.  Never establish exactly what the cause was as I fell pregnant.  With a vegan diet it’s possibly she’s going heavier in the grains even if she’s eating healthily?  
 

I know this is a bit conspiracy theorist or something and not scientifically proven but I know so many people who seem to have had hormonal problems after being on the pill for a few years.  I know doctors will say it’s related to the time of life PCOS kicks in but to be honest it doesn’t seem to be a giant leap to think that putting artificial hormones into your body every day is eventually going to mess with the ability to regulate itself.  Anyway you can dismiss that as it doesn’t have any scientific basis just observation, anecdotal evidence and gut feel. 

[Ausmumof3]

14 minutes ago, regentrude said:

Thank you all for chiming in. I would have assumed it's from the pills, because that would be common. She had normal cycles before bcp. I specifically asked her whether the doc has considered switching prescription, but she said doc wants this bcp because it regulates cycles -huh? 

Do I understand it correctly that there is no actual treatment for PCOS? So, assuming that were to be the case, what benefit would there be in knowing now? Is there anything one would do years in advance to ward off fertility issues down the road?

Low carb eating and heavy exercise have helped many people regulate cycles.  Insulin resistance and type 2 diabetes can eventually be a result so managing it through lifestyle is really important.  I know you said she has a healthy lifestyle but pcos people effectively have to work a tonne harder than the average person to keep it that way.

[Ausmumof3]

One other thing which is rare but I remember when I was having testing etc there is the potential though rare for pituitary gland rumour to cause similar symptoms.  It would be extremely unlikely but I guess worth ruling out. 

[sbgrace]

1 hour ago, regentrude said:

Thank you all for chiming in. I would have assumed it's from the pills, because that would be common. She had normal cycles before bcp. I specifically asked her whether the doc has considered switching prescription, but she said doc wants this bcp because it regulates cycles -huh? 

Do I understand it correctly that there is no actual treatment for PCOS? So, assuming that were to be the case, what benefit would there be in knowing now? Is there anything one would do years in advance to ward off fertility issues down the road?

 

BCP are commonly used in PCOS to try to regulate hormones and cycles.

As I mentioned in my (wordy) reply previously, normal seeming cycles don't preclude PCOS or related fertility issues in my experience. 

There are treatments, lifestyle (like low glycemic diet) and medication, that could help both fertility and other health impacts of PCOS. She does have the elevated triglycerides, which is often part of the picture.

Maybe her triglycerides are unrelated to PCOS of course. I mentioned upthread that the birth control pills alone make it a bit of a confusing picture that I might want sorted. 

I think I would want to know, one way of the other. I wish I had known.

[TechWife]

I was always told that it's a normal side effect of bcp and that it's nothing to worry about. Before I had my son, I didn't have a period after about one year on bcp. After I had my son, I had a period while on bcp. Either is normal, or so I understood from a few different MD's.

[mominco]

Regent-could the elevated triglycerides be a side effect of the Bcp?Look it up!

[Arctic Bunny]

Stupid question, but... if this is her first time on BCP, does she know the off days to have a cycle? I remember you could get BCP with or without the placebos. 

[regentrude]

2 minutes ago, arctic_bunny said:

Stupid question, but... if this is her first time on BCP, does she know the off days to have a cycle? I remember you could get BCP with or without the placebos. 

Been taking bcp for several years. And the *GYN* is concerned abut lack of periods - I figure she would know whether the prescription should have periods or not

[Arctic Bunny]

5 minutes ago, regentrude said:

Been taking bcp for several years. And the *GYN* is concerned abut lack of periods - I figure she would know whether the prescription should have periods or not

Yep, I just thought I’d ask the most elementary question. After DS1, the dr gave me a BCP that was new to me, and didn’t have placebos in the package the way I’d always had. And I had to be told, lol, because he assumed I would know....

[KidsHappen]

i have two dds that are very thin vegetarians and they have very light periods, And then one dd on bcp who doesn't have periods at all, all are perfectly healthy with no problems, Could be either of those problems,

Quote

 

 

[BlsdMama]

This one has me stumped.  I assume she will follow up on the PCOS possibility? I'd like to hear the update.

I will say that DD went to the gyn because she has been losing weight and because of missed periods and nausea.  She has intermittent cycles.  This was a traditional gyn with natural tendencies.  Her metabolic panels for the last year have been whacky, but the rest of testing looked decent.  GYN suggested she go gluten and dairy free (because we have other GF family members) and see what happened.  We're in week two.  The nausea is cutting down.  DD #8 gained weight when she went GF.  I don't fully understand the gluten tie, but for some reason it exists.  

[bensonduck]

How much is the woman exercising? Does she restrict her food intake at all? The woman might be interested in reading articles on the female athlete triad - it really varies from person to person when the lack of a cycle begins to become apparent.  (Anecdotally, my BMI was about 17 when I lost my period and I was running 5-8 miles per day.  But, I know of women in the eating disorder recovery community who lost their periods at BMIs between 19-20.)

If I were this woman, I would ask my dr if it made sense to stop the bcp for 6 months or so to see if the cycles came back. Then I would know whether it was the hormonal birth control causing the issue or whether there is an underlying biological issue to be addressed. 

[regentrude]

3 minutes ago, bensonduck said:

How much is the woman exercising? Does she restrict her food intake at all?

Not excessively exercising, just a moderate healthy amount. Not restricting food intake (in terms of calories; she is vegan).

[J-rap]

Did she have regular periods before going on BCP?  Or have they always been irregular?  If they've always been irregular, that's one thing.  If they've only been irregular since being on BCP, that's maybe another thing.

I have PCOS.  I don't know of any family history (that had this before me).  My sister doesn't have it.  I rarely had periods, sometime just one/year!  I was a runner back then.  I had some excess facial hair but nothing a little facial hair bleach couldn't take care of.  I did have some cysts now and then, but I don't think I had my first one until I was in my mid-20's.  I was of normal weight and ate a balanced diet.

I did have infertility problems.  No surprise since I only had one period/year!  Or sometimes, I'd have light bleeding for two solid months, but don't know if I ever actually ovulated.  

After three years of trying to become pregnant, my doctor put me on Clomid.  That did the trick!  Pregnant within one month.  It was a simple cure for me.  Other than that, PCOS has barely been an issue for me.  

I have four dd's, and three of them have PCOS.  

I remember one thing my doctor wanted to check early on was my pituitary gland.  That was before doctors knew much about PCOS, and I guess pituitary gland problems were thought to sometimes be a cause of irregular periods.  

My doctor also put me on BCP in high school to see if that would kick in regular periods.  It did, actually, for the period I was on them.  As soon as I went off of them, my periods became extremely irregular again.  I never had regular periods until after my 3rd child.  For some reason, things seem to balance out more hormone-wise then, and I was able to become pregnant with my 4th and 5th child without fertility drugs.

 

[Sunshine State Sue]

Around 1986, when I was 25 or so, I had PCOS (detected by ultrasound).  I was normal weight and omnivore.  My periods had always been extremely irregular and very heavy for the first day or two when I did have them.  I had surgery.  They cut me open "bikini cut" and cut off 1/4 of my ovary and called me cured.  Eventually, they started doing that surgery laparoscopically (sp?).  Eventually, they started using lasers I think.

My periods stayed irregular until I got pregnant at 34 without any problem.  After I had my son, my periods became very regular.  Yay.

FWIW: I was on bcp for maybe a year in college, but never liked putting drugs into my body.  I went to NFP (Natural Family Planning) classes at the local Catholic church around 24 and used NFP to avoid/achieve pregnancy until menopause.

Definitely facial hair.  I had regular electrolysis appts.

Edited January 11, 2020 by Sue in St Pete

[Roadrunner]

If she ends up being diagnosed with PCOS, she needs to start watching her carbs. It’s tied to insulin resistance and eventual diabetes. So even a healthy diet (brown rice, beans, lots of fruit) can be a wrong diet for somebody with PCOS.

[Soror]

On 1/10/2020 at 7:10 AM, regentrude said:

Thank you all for chiming in. I would have assumed it's from the pills, because that would be common. She had normal cycles before bcp. I specifically asked her whether the doc has considered switching prescription, but she said doc wants this bcp because it regulates cycles -huh? 

Do I understand it correctly that there is no actual treatment for PCOS? So, assuming that were to be the case, what benefit would there be in knowing now? Is there anything one would do years in advance to ward off fertility issues down the road?

 

On 1/10/2020 at 7:20 AM, wintermom said:

If she had regular periods before, I'd be very tempted to stop the bcp and just see what happens. What could it hurt, especially if her cycles are already irregular from taking the pills. 

I was nodding along with pursuing PCOS and also female triad (even women w/ a normal BMI can end up with cycle disruption due to exercise and food intake). But this info makes no sense to me, why does she need cycles regulated when her cycles were normal before? Too many dr's are very pro-bc's without acknowledging any side effects.  I had listed side effects from bc but was told it was all in my head or wasn't caused from bc by 2 different gynos. The obvious answer is to try another BCP. If that is the big thing that has changed I'd pursue that before exploring more testing for other things. I'd push that personally, it is her body and her choice.