Navigating Five Years Without Menstruation at 27
I’m a 27-year-old woman, white, standing at 5 feet 5 inches tall and weighing 150 pounds. I deal with gluten intolerance (not celiac disease) and have some undiagnosed gastrointestinal issues that include reflux, discomfort, and nausea, though my symptoms have significantly improved since eliminating gluten from my diet. I have a history of anorexia nervosa, but I haven’t exhibited any symptoms or behaviors related to it since 2022. Currently, I’m not on any medications; however, I did experiment with a few cycles of 10-day oral progesterone in 2024. I would like to note that I have a consultation with a new gynecologist scheduled for the end of the month, but I’m seeking additional perspectives or suggestions for lab tests and topics I should discuss with my healthcare provider. Medical History: From the age of 16 to 24, I used the Nexplanon birth control implant. I experienced a severe episode of anorexia nervosa from 2020 to 2021 that led to my hospitalization for weight restoration, during which my weight plummeted from 125 pounds to 80 pounds. While I was using birth control throughout this period, I lost my menstrual cycle. Since being considered fully weight-restored as of the fall of 2022, I had the birth control removed in the spring of 2022. Despite these developments, I have not had a menstrual period for the past five years. Initially, we believed my body needed time to heal after the drastic weight changes. However, it has now been three years since I reached a stable weight, yet my menstruation has not resumed. In addition, over the last nine months, I have gained a notable amount of weight (20 pounds) without significant changes to my eating or exercise routines. My skin feels dry, I experience frequent hunger, and my sexual desire is nearly absent. Although I had lab work done about a year ago, the results did not indicate any concerning issues. My previous physician speculated whether my symptoms could be indicative of a pituitary tumor or primary ovarian insufficiency. I am particularly worried about the considerable weight gain I’m experiencing and, furthermore, the fact that I haven’t had a menstrual cycle in five years. Any advice or insights would greatly be appreciated.
Answers (1)
4/2/2025, 11:40:36 PM
OpenHealth AI
It's understandable to feel concerned about not having a menstrual cycle for five years, especially considering your medical history and recent weight changes. This situation can arise from various factors, including hormonal imbalances, past eating disorders, and other health issues. You're on the right track by seeking further evaluation through your upcoming gynecologist appointment. Here are some key points and actionable steps to discuss with your healthcare provider:
Main Points:
- Absence of Menstruation: This can be caused by hormonal imbalances and other health conditions.
- Potential Underlying Conditions: Conditions like pituitary issues or primary ovarian insufficiency could be contributing to your symptoms and cycles.
- Connection to Weight Changes: Fluctuations in weight and nutritional status can significantly influence your menstrual health.
Explanation:
Your five-year absence of menstruation, especially after a history of anorexia and hormonal contraceptives, indicates that your body might still be experiencing disruptions in its hormonal balance. Both physical and metabolic factors, like weight changes, can play critical roles in menstrual regulation. It’s essential to explore these aspects further with a healthcare provider, as they're trained to help pinpoint the underlying causes.
Next Steps:
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Lab Tests to Consider:
- Hormonal Panels: Request tests for prolactin levels, estrogen, progesterone, and luteinizing hormone (LH) as well as follicle-stimulating hormone (FSH). These can help assess ovarian function and hormonal balance.
- Thyroid Function Tests: Since weight gain and menstrual irregularities can also indicate thyroid issues, ask for tests like TSH and T4.
- Insulin Levels and Glucose Tolerance Test: Evaluating these can help rule out conditions related to insulin resistance, which ties into conditions like PCOS.
- MRI of the Pituitary Gland: Since your previous physician mentioned the possibility of a pituitary tumor, discuss the appropriateness of this imaging test.
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Review Symptoms: Prepare a list of all your symptoms (e.g., weight gain, dry skin, lack of libido) and discuss how they may relate to potential diagnoses.
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Lifestyle Considerations:
- Maintain a balanced diet rich in nutrients to support hormonal health. Ensure adequate caloric intake and consider consulting a nutritionist familiar with your history.
- Incorporate stress management techniques such as mindfulness or regular physical activity, as stress can impact hormonal balance.
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Tracking Changes: Keep a symptom diary to document any changes, such as menstrual patterns, appetite, or mood, which can assist your healthcare provider in diagnosis and treatment planning.
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Engagement in Treatment Discussions: Be open to discussing treatment options that may include lifestyle modifications, nutritional support, or hormonal treatments depending on the findings.
At your appointment, express all your concerns and ensure you get detailed explanations about any tests or potential treatments. You're taking proactive steps by seeking answers, and I encourage you to continue advocating for your health. If you need more guidance on any of the discussed topics, feel free to ask.
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