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Gynecology

Missed period for 5 months

08/11/2008

Question:

I have a question regarding my menstrual cycle. When I was younger I had to be placed on the pill due to irregular periods. Since then I have always been on the pill. Eight months before I got married my husband and I decided that I would get off the pill and we would see what happened as far as starting a family. Well, I did get off the pill and my periods were coming every 35-45 days & some months never (had to take Provera to start periods up again & they always started).

I gained around 50lbs in about a year and half and I really started to see a change in my cycle when I started to gain the weight. I lost about 20lbs & my periods came back like clockwork. Then put the weight back on and the periods stopped and got really irregular again. We officially started trying without contraceptives after our wedding in July 2007. The periods were still very sporadic and I started to temp and noticed that I was never ovulating. Then in February 2008 I had my last period. I of course took 5,000 pregnancy tests, all were negative.

It is now almost August and I have yet to have a period. I have no other symptoms, just no period. Basically my question is—are periods that highly effected by weight? I’d really hate to go to the doctor to be told that I need to either take medication or lose the weight. I’d rather lose the weight and have a normal period again. It is easy to see that in my case my period is effected by my weight. I have never had an abnormal pap or any STDs. About 2 weeks ago I did have the symptoms like my period would start but I only had a little brown/red discharge that went away after a few hours. What should I do now? Just lose the weight or does this indicate that I need more invasive testing?

Answer:

It sounds like you might have "Polycystic Ovary Syndrome", also called "PCOS." This condition is often related to increased weight. Some women's insulin levels become higher when they gain weight, a condition referred to as "insulin resistance." In some cases, these women become diabetic. High insulin levels change hormone levels and decrease the chance of ovulation. Women who don't ovulate will usually have light or absent menstrual periods.

There are several treatments for PCOS. Weight loss is the best, but often the most difficult to maintain. A common medical treatment is an oral diabetes medicine that decreases insulin levels. This alone will sometimes result in pregnancy. If not, the next treatment is fertility pills. This inexpensive and low-risk treatment often results in pregnancy. Other treatment options are available if these do not work.

Women who do not have regular periods should see their gynecologists to discuss treatment options. Missing periods decreases the chances of pregnancy and increases the risk of extremely heavy periods. Years of irregular periods increases the risk of uterine cancer. Treatment can prevent or minimize the risk of any of these problems, and increase the chances of pregnancy.

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Response by:

William W Hurd, MD William W Hurd, MD
Professor of Reproductive Biology
School of Medicine
Case Western Reserve University