No Periods for ‘a While’? Understanding Polycystic Ovaries

Another common problem we see is a woman who has very few periods–sometimes going for months with no period.   Maybe you “kick in ” and have a few pretty regular cycles, then stop again.

First–if you are sexually active (any time in the last year), we need to make sure there is no chance of pregnancy.  EVEN THOUGH YOU HAVE PCOS YOU CAN STILL GET PREGNANT–-so protect yourself until you are ready to try–THEN you MAY need some help

So–no episode of “I didn’t know I was pregnant”?

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Next thing is, “Why aren’t you having a period”?   If you are under age of menopause, then we need to see if your thyroid is normal.  We do that with a blood test.  Another blood test called prolactin may also be done.  Sometimes you don’t have periods because the little gland that wants to control the universe–the pituitary bland–makes too much of the hormone that is made by breast feeding moms.. Sometimes you will have milk coming out of your nipples—but no baby.  This is a different reason why you may not have periods.

If your thyroid is out of whack, then treatment could help get your periods back on track.  Treating prolactin issues can also regulate your periods.

CAUTION!!!  If you ever get thyroid treatment to get your thyroid under control, make sure you use birth control of some sort if you want to prevent a pregnancy.

Now, if your thyroid is normal, then you may  get a prescription for progesterone to take for 7-10 days.

Why do we do this?   Well you need to understand how your period or menstrual cycle works.

Click on the picture–it should open, and be clearer than this!!

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Your ovaries make the female hormone ESTROGEN  all month.   There are at least 40 little eggs (tiny CYSTS),  that we can see get going each month (many more get going, but we can see about 40 on ultrasound), hoping to be the next human being. Thank goodness only one will typically “go all the way”—or we’d be having MEGA litters!   Like “octamom” on crack!!!  If TWO eggs “go all the way”, then you could have twins, if they get anywhere near a sperm!

ESTROGEN starts to build up the lining of the womb (building up a “period”),  —  getting everything ready for an egg–a cozy little bed!

Now, when that egg “pops out”-and usually we don’t feel this–but sometimes you do (see my post on ovaries), you start making the second female hormone —PROGESTERONE.   The egg pops out of a FOLLICULAR CYST–which is about 2-4 cm in size—EVERY MONTH–(a cyst!!).   EVERY MONTH from the time you start your period until you enter menopause, you will have a cyst on your ovary if it is working normally. Things that stop normal follicular cyst development would be: pregnancy, breastfeeding (don’t count on this for birth control), birth control pills, and drugs such as Lupron.

Progesterone also helps the lining of the womb get ready for a fertilized egg—like putting all the bedding in place for a baby.

If the egg is FERTILIZED, then the “yellow part” of the ovary then forms into a LUTEAL CYST that will KEEP making progesterone.  Yes–if you are pregnant,  you will have a cyst on your ovary!   It is called a CORPUS LUTEUM CYST.   ALL PREGNANT WOMEN HAVE THIS CYST!

When the afterbirth (placenta) starts to form, then the placenta will take over the job of the ovary cyst, and the cyst will disappear (usually gone before 18 weeks).

IF YOU DO NOT GET PREGNANT, then the egg will die–and we are NOT talking an egg the size of a chicken egg!   We are talking a single cell–only visible with a microscope!  We actually swallow MILLIONS of cells when we swallow!  So one tiny little microscopic egg is just absorbed.

If you do not get pregnant, then the place in the ovary where the egg came from dies off, and shrivels up, and the progesterone level drops.

When the progesterone level drops, you start your period!

http://www.mayoclinic.org/healthy-lifestyle/womens-health/multimedia/ovulation/vid-20084729

Then you start another cycle–another 40 plus eggs (cysts)—over and over each month, until you either get pregnant, or you get old enough to go through menopause–when the ovaries stop making hormones–and you stop having periods.

NOW—what about if you are in your 20s, 30s, early 40s–and your periods are totally screwed up?   We have checked your thyroid, and it is normal.

So now we are thinking that your ovaries are not producing eggs  that pop out each month.

What we do is we give you 7-10 days of progesterone pills; we “fool the uterus” into thinking that an egg has come out.

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We then stop the progesterone–so your uterus thinks that there has been no egg fertilized by a sperm–and as you can see on the chart, when the progesterone falls off, you start your period. It may take a few days for a “period” to start, so be patient. IF no bleeding by 14 days then let your doctor know. We pick 14 days because occasionally, a woman will ovulate with the progesterone–or just a coinky dink–but THEN it can take 2 weeks to have a period.

You will only have a “period” if a lining has already been built up by estrogen.  If you haven’t had  a period for several months, then you may have built up one helluva period!     GET MAXIPADS– AND BRACE YOURSELF.

If you bleed, then we know you have a problem with ovulation–sometimes known as “polycystic ovary syndrome“.  It is also known as ANOVULATION (not ovulating–no egg coming out!)

If you do NOT bleed—then we need to think about whether your ovaries are even making estrogen—basically,  are your ovaries working at all!?  If you are under 40–this would be considered PREMATURE MENOPAUSE!  (That’s another topic!)

Now—-if you are not ovulating as a reason for not having periods–DON’T THINK, “Hey—who needs a period?–I kinda like not having them!”

Remember—you are building up a lining (period) for months or years–and when it lets loose–you can bleed “like a stuffed pig”  (where does that expression come from?–do stuffed pigs actually bleed?).

(I had to look up “stuffed pig”–and it is actually supposed to be “stuck pig”.  It comes from the days when butchering was done in the home–and pigs bled a lot when butchered).

The other thing that can happen if you let this no period–or two or three periods a year keep going, is that, after some years, it puts you at HIGHER RISK FOR CANCERS OF LINING OF UTERUS (womb)!!

So–now we need to know what your life plans are.

If you are trying to get pregnant, then you may need the help of a fertility pill–to force the ovary to pop an egg out.  The most commonly used pills are CLOMIPHENE or LETROZOLE.   That will have to be a fertility talk–but typically you take the pills on days 3-7 (3, 4, 5, 6, 7)  of your cycle, or 5-9–or as I say ‘ split the difference’ and take it from day 4-8 of your “cycle”

Day 1 of your cycle is Day 1 of your period.  You will likely START the pills when you are still bleeding.  Also you will need to make sure you have sex from day 11-17 (days 10, 12, 14, 16, 18 or 11, 13, 15, 17, 19)–every other day will do—-unless it is fun, and you can do it as much as you want!

Typically, a progesterone level is ordered about day 22 of you cycle–give or take a day or two–just to make sure you did spit out an egg, and have a hope of getting pregnant.   I advise to wait until day 40 before you do a preg test.   Give Mother Nature a chance to look things over!

Anyhow—I’ll have to do an infertility blog I guess—so many topics!!

If you are trying NOT to get pregnant–then IGNORE any advice that says you cannot get pregnant—-you just can’t predict WHAT those ovaries are going to do–and just when you least expect it–out pops and egg—meets up with a wandering sperm–and BAMMM–PREGGO!!!!

You need to consider some form of birth control–like the pill, ring, 3 month shot, or Mirena IUD.  You want some birth control that has progesterone in it–because, remember, you are not making progesterone each month.  A copper IUD can help you prevent pregnancy, but it won’t help protect you against all the estrogen—you NEED progesterone.

If you are NOT sexually active, or you have had a tubal ligation, or your partner has had a vasectomy, then you don’t need to take birth control—BUT YOU STILL NEED PROGESTERONE!!!   You can take a progesterone pill every day–and then, if you don’t have a period, we don’t have to worry—the progesterone protects you!

This sums it up!   click to make larger and clearer

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NOW—if you are not ovulating, one of the things OFTEN (not always), that may go along with this is—yes–I’m going to say—-fluffiness–or height-challenged for weight!   Not hating—just a fact of of life.   So–I like to see if you meet criteria for a condition called METABOLIC SYNDROME.  See my post on Metabolic Syndrome.  click here for link

METABOLIC SYNDROME

So–if you have problems with your ovaries spitting out an egg, then we need to check and see if you meet criteria for another condition, called METABOLIC SYNDROME–and now we are talking a syndrome that increases your risk of having a heart attack, or a stroke.

You need THREE OUT OF FIVE CRITERIA:

  1.  a waist over 35 inches for female
  2. low amounts of “good cholesterol”-HDL –less than 40 mg/dl (1.04 mmol/L), in men, and less than 50 mg/dl (1.3mmol/L),  in women
  3. high triglycerides (another fat that hangs out with cholesterol and damages and clogs up your blood vessels)–over 150 mg/dl or over 1.5 mmol/L
  4. high blood pressure (130/85 or more), or being treated for high blood pressure
  5. abnormal fasting sugar (100 mg/dl or 5.6 mmol/L)

Other things ASSOCIATED with this syndrome are:

fatty liver, gout, erectile dysfunction in men, and skin discoloration (acanthosis nigricans)–like on this neck.

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You didn’t think I was going to post a picture of erectile dysfunction, did ya?   There wouldn’t be much to see!!!

HOW TO TREAT?

If you are fluffy–try–again–to lose weight.   HERE IS A GREAT FREE WEIGHT LOSS SITE

You may want to consider something that is working for me and some of my patients (we are new to this)  INTERMITTENT FASTING.   Check out THE OBESITY CODE by Dr. Jason Fung (a Toronto kidney specialist who deals with the end result of diabetes every day).   I really think this issue with TOO much insulin is crucial, and that the information we have been dishing out for years may need to be revised.   JASON FUNG EXPLAINS INTERMITTENT FASTING

If hypertensive, lose weight if you need to, and use meds if you need to.  Discuss with your doctor.

Cholesterol or triglyceride issues–diet, lifestyle, meds.

See my post on weight loss.

So—if you have any questions–please post a comment!

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