Question:
I am a 19 year old female (obviously). I had my first period when I was approximately 11 years old and for the first three to four months I had a regular cycle. After that period of time my cycle became irregular (which is in no way odd for someone of that age), being that I would menstruate every other month rather than every single month. After approximately 4 to 5 months of this my menstruation stopped completely. Over the course of the next 3 years I would have a period perhaps once every 5 to 6 months, and there would never be any mood swings, cramping, bloating, or overly heavy flow. The intervals between menstruation began to increase from there, lengthening to 8 months between periods (give or take two months).
This month and last month, however, I have had my period. Two months in a row after almost 13 months without anything. This past month, however, I have experienced severe cramping and moodiness. I know that it is not uncommon for cramping to occur after a prolonged period of time without menstruation, but the fact that I was incapacitated and in bed for two days was unbelievable to me.
I have had no problem developing secondary sexual characteristics, which would probably be signals of a pituitary or other glandular disorder. I am not obese, nor am I incredibly tall or short, which, from what I have gathered, excludes most thyroid issues.
I have no health insurance at current. During the course of my teenage years I would occasionally see an MD for various checkups, and I would bring up the matter of my irregularity. Every doctor I has ever seen has sloughed off the issue as probably having to do with "stress". This answer does nothing to satisfy me, as it seems like a knee-jerk reaction because they were either at a loss or because I could not afford whatever tests might actually tell me.
My worry, for quite some time now, has been the question of fertility. I have no actual plans to have children at any point in the near future, and I am not (nor have I ever been) sexually active. However, I need to know if I even CAN have children, for my own piece of mind. I know that without an examination, there's only so much you can tell me, but any information on what you might think is amiss would be greatly appreciated.
Answer:
Thank you for your question. For a 19 year old, your writing is incredibly sophisticated and impressive. You seem to be well educated. Most women do not know about "secondary sexual characteristics" or how the "pituitary or other glands" affect their cycles. Bravo to you for this knowledge.
Your irregular period is far from normal. There is a very common disorder, which you seem to be alluding to, called polycystic ovarian syndrome or PCOS. This is an ovarian dysfunction disorder caused by the ovary not processing the pituitary hormones correctly, leading to the lack of ovulation. Without ovulation, there is no subsequent menses, assuming you are not pregnant. We know that this disorder begins in the teen years in many women. So the doctor's previous explanations of "this is normal for your age group", is incorrect. There are problems that occur from PCOD in the long term such as increased weight gain, diabetes, increased facial and body hair growth, excessive bleeding episodes, irregular bleeding, endometrial cancer and infertility. Because of this, we DO NOT recommend continuing with the irregular cycles.
In women that are not attempting pregnancy, we use the birth control pill protocol to over-ride the ovaries and keep a normal cycle. This gives the essential female hormones, estrogen and progesterone, that your ovaries are not producing, and that you are lacking, because of the lack of ovulatory cycles. When you decide to become pregnant, this has to be substituted with ovulation inducing fertility drugs. PCOD is a clinical diagnosis, and although we do hormone testing to check the thyroid, pituitary and other hormones, it is not a diagnosis made by these lab tests. From your description of your symptoms, you probably suffer from it. If you do further internet searching, you will come upon a description of patients that have this disorder, that you do not fit. However, keep in mind that there are variations on this theme and even normal appearing females can have a milder form of the disorder. Not all patients are hairy and obese :).
In terms of your future pregnancy, bravo for getting through your teen years without having had a sexual experience. When you do contemplate getting pregnant, I do not see any reason that you would be unable to become pregnant, except for your ovulatory disorder. Assuming that this is corrected with fertility drugs, you should have a pregnancy rate commensurate with your age group. I have had many PCOS patients that get pregnant with the proper protocol , though sometimes they need more than one try before they get their cycle exactly right.
I would advise you to seek another opinion with this information in hand, preferably a good OB/Gyn.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF program
Monterey, California, U.S.A.
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