QuestionI am able to get my period on birth control pills but when off them, I do not
get even a spotting. This has been going on for years. I stopped taking the
pills again in March because they are expensive and nothing. I went to the
OBGYN in June and they did a scan and said I do not have polysistic ovarian
syndrome and that I am healthy. I do overexercise and I have an under active
thyroid which are the two things I would blame this on. My questions are, am
I harming myself by not forcing myself to have a period on the birth control
(long term effects)? Am I still ovulating? I read on many sites you can still
ovulate without a period. But how would I know if I am? If so, would it be
possible to get pregnant with my secondary ammenorea?
AnswerHello Nikki from the U.S.,
PCO is diagnosed by a myriad of tests and NOT by ultrasound alone. Basically you only need to meet two of the criteria found in PCO. One is a menstrual dysfunction, like you have, and the other can be things like ovarian appearance on ultrasound, hormone testing showing an inverted FSH:LH ratio, obesity, diabetes, insulin resistance, elevated androgens (testosterone) levels, increased facial hair growth, etc.
You might want to consult my blog where I discuss a similar patient who is not having periods due to increased exercise. This disorder is called exercise induced hypogonadism. Basically, if you exercise heavily, you deplete the fat stores in your body and fat is required for hormone production. Also, you block the function of the hypothalamus that stimulates ovarian production.
The purpose of the birth control pills is NOT to make you have a period each month, which you don't necessarily need to have if you are not forming an endometrial lining (you do if you form an endometrial lining because this lining needs to be sloughed otherwise it can form into endometrial cancer), but the purpose is to replace the estrogen that your body is not making if you are not ovulating. Estrogen is an essential hormone for a woman's body and affects many areas such as bone, heart, brain, skin, vaginal lubrication, etc. Without this essential hormone, your body will deteriorate in the same way that it deteriorates in menopausal women.
If you are not having a period, then you are NOT ovulating. With ovulation, if pregnancy does not occur, then a period will start 14 days after. It is an exact occurrence. So, your ovaries are not functioning for some reason, and the reason needs to be found. PCO is only one of the possible causes. There are others. Testing needs to be done to check for these other causes.
If you are not ovulating, then you are not giving off and egg and therefore, pregnancy is not possible. That is how the birth control pill works. Your Ob/Gyn is obviously not checking you properly. Maybe you need to see another one.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf
