QuestionDear Mr Ramirez,
First of all, I would like to thank you for taking the time to read my question.
Mr Ramirez, I suffered from anorexic-bulimia. Due to which I lost a lot of weight when I was 19 and as a result my periods stopped completely and I also developed bilateral, simple, unilocular ovarian cysts.
I took contraceptive pills as prescribed by my gynaecologist for two years, to shrink the cysts, but they did not shrink and I got them removed by leproscopy.
I used to get withdrawal bleeding with the contraceptives.
I continued using the contraceptives until February 2008. All the while getting withdrawal bleeding. Once or twice I stopped taking the pills for a few months to see if my periods were back to normal but without the pills there used to be no periods.
My BMI is normal now, I have regained the weight I had lost, I am 26 years old now and am married.
Recently my hormonal levels were checked, and also my ovaries and tubes were checked through leproscopy. The tubes are patent, the ovaries and un-scarred and fine, the hormonal levels are fine, yet I am having no periods and I am not ovulating.
My gynaecologist says that I will need some injections to induce ovulation (I got married last year and we are planning on having a baby), with the help of which I would be able to conceive.
What I fail to understand is that if everything is ok, then why am I not able to ovulate normally and why do I not get my periods? Is there something we are missing? Is there something more I need to do? Do I need to gain more weight? (My BMI is 18 - 19).
Kidest regards,
Sarah
AnswerHi Sarah,
I understand your question, yet I don't have enough information to answer it. Certainly, your BMI is adequate but you might try to increase your weight a bit more. A BMI of 20-25 might help. Can you tell me what your FSH and LH were? Before you became anorexic, did you have regular or irregular cycles? What is your weight and height?
If you are ready to begin getting pregnant now, then the best method is to proceed as your doctor recommends with ovulation induction. From the fact that your doctor recommend injections, I presume that he thinks this is a Pituitary disorder (the basis for the lack of ovulation with anorexia). He will be giving you the hormones that your ovary needs to cycle. This stimulates the ovaries, not like birth control pills, which just simulate the cycle without stimulating the ovaries. These medications should make you ovulate, thereby giving you an opportunity to become pregnant.
If you can wait a little to become pregnant, then I would recommend that you see a reproductive endocrinologist or internal medicine endocrinologist to further evaluate why you are not menstruating, and to rule out other disorders. It is possible you may have other problems in your thyroid, pituitary or adrenal glands. Correction of these problems would lead you to normal cycles.
Sorry for the vague answer. Best I can do without additional tests and information.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
