Question :

Ammenorea - A Sign Of Infertility?

Dear Ask The Doctor:
I've "self diagnosed" myself with amenorrea. (I know doctors hate the term) I'm 23, 5'4" and between 116-117 lbs. I consider myself a healthy weight. Currently my average caloric intake post exercize is around 1,2000 calories. Recently I started exercising closer to one hour per day, six to seven days a week. Before this, I was exercising three to four days a week, on average only a half an hour. My caloric intake at the time was closer to 900 calories and I was also about three pounds lighter. At the time, I was getting full periods. This month I missed my period but still broke out a week before it was expected, and still received pre-menstaural camps, increased sexual desire, and when I was SUPPOSED to be having my period, I was still cramping. The period should have ceased by now and my cramping has subsided. I remember missing my period for three months when increasing my exercize regime, and one month over the past summer for the same. I never consider myself at an unhealthy weight and do a particular job at making sure my nutrient levels are in balance. This worries me because I would like to be healthy and fertile for the future. I'll schedule an appointment with a doctor in the coming month, but until then,how suverely is this current missed period a symptom of infertility? It has been about a year since this happened last.


Answer :

Dear Patient: 
I do understand your concern, however it may be too premature to state that your underlying problem of amenorrhea is a sign of infertility. Amenorrhea can be a transient, intermittent, or permanent condition resulting from problems of the hypothalamus, pituitary, ovaries, uterus, or vagina. The menstrual cycle is susceptible to outside influences; thus, missing a single menstrual period is rarely important. However, if you have absence of menses for more than three cycles or six months, further evaluation should be done to rule out the cause of the secondary amenorrhea.
There are certain risk factors that predispose to amenorrhea. Decreased calorie intake, exercise, and stress may contribute to the pathogenesis of functional hypothalamic amenorrhea. Both weight loss below a certain target level (approximately 10 percent below ideal body weight) and exercise are associated with amenorrhea. Amenorrhea can be caused by nutritional deficiencies that are not associated with weigh loss or strenuous exercise. Emotional stress and stress induced by illness are additional causes of hypothalamic amenorrhea.
Since you will be seeing your doctor in a month's time, you may expect the following from your doctor. i) A pregnancy test to rule it our as the cause of amenorrhea. ii) A detailed history and physical examination. iii) Basic laboratory testing that may include measurement of serum hCG to rule out pregnancy, minimal laboratory testing should include measurements of serum prolactin, FSH, and TSH to test for hyperprolactinemia, ovarian failure, and thyroid disease. Some clinicians also measure 17-hydroxyprogesterone and dehydroepiandrosterone sulfate (DHEA-S) to look for an adrenal source of androgens. Following the results of these tests, your doctor may base his diagnosis or may request additional tests. I wish you well, take care.


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