missing periods -- what is going on??

[Jen_in_NH]

Just a couple of ideas for you. First, it will take more than one blood test for PCOS. Some will need to be fasting, so I'm fairly sure you haven't had them all. Usually, the blood work involves a complete blood count (to rule out anemia), thyroid levels, fasting glucose and a 3 hour glucose tolerance (to check for diabetes or insulin resistance), cholesterol (as PCOS may be related to metabolic syndrome, which gives you high cholesterol), prolactin level, lutenizing hormone, and follicle stimulating hormone. Also, most doctors will check a cycle day 3 FSH to check for premature ovarian failure / premature menopause. You would also need a pelvic ultrasound, GYN exam. The workup for PCOS took me about 2 weeks to get everything done.

Second, it would be worth seeing an OB/GYN. My primary care doc sent me to them for irregular/missed periods. They did all the testing for PCOS, and saw me for about a year and a half for infertility. They were going to refer me out to reproductive endocrinology after failing several rounds of Clomid, but I somehow got pregnant off all of the meds...

Third, you mentioned there were other medical issues to straighten out. Depending what those issues are, they can certainly affect whether you have your period or not. Others have posted that if you're an athlete, that can suppress your periods. Stress, poor nutrition, as well as a number of medical issues, can do it too.

My advice - go to an OB/GYN. It's a good place to start, and they have more experience with menstrual isssues. If they find anything, they can refer you out as needed.

Good luck

Jen

 

[PrincessTiff]

About a week or so later, I contacted her and she said my test results were normal. Now, obviously at some point I need to see a specialist, but what do you all think could be going on? Can a person miss so many periods due to stress or no reason whatsoever? Are there other health conditions that could cause it? By the way, I am 30, so the NP talked about premature menopause but said it is very very very rare for my age group

I'm so glad you asked this, as i've missed 3 months in a row now. I took 2 home pregnancy test, both negative and then went to my doctor. He did 2 tests(blood and urine) and only tested for pregnancy in both of them. He didn't seem too concerned so I let it go. Now i'm going on 4 months and have no idea what's going on. The gyno. said to come in for blood work at the end of this birth control cycle if I still haven't gotten one.

 

[It's A Happy Day]

Ladies please, please, please

If you do not have an OB/GYN get one and visit him/her yearly! I know too many stories of primary care Dr.'s misdiagnosing/not diagnosing problems that have gone on for years never mind months! And it has affected child rearing. An OB/GYN concentrates on only your female body parts and to quote my Dr he said "any, ANY problem that is female anatomy related - breasts, periods, etc. to call him" Call your primary after you have an appointment and get a referral if necessary. Going to a primary can delay a diagnosis and they are not specialized in this area. Yes, I know there are very good primary physicians out there.

I had a breast lump this past year and while my primary wanted to play the wait & see game (after 3 months), my ob/gyn felt it, sent me to a surgeon for a consult, and had it removed and biopsied. While everything did turn out okay for me, I wonder the what if story line and can't believe that a physician would want to leave a foreign object in my body?

There may be a simple reason as others have speculated about why your periods have been sporadic/stopped - mine were due to an underactive thyroid and after being medicated everything returned to normal. Prior to this it was "normal" for me to have a period every other month. You posted that at some point you do wish to have children. Do not wait until it is too late. Chances are that everything will be fine but you do not want to be mad at yourself for sitting on things too long.

Good luck and prayers with you that it is something simple.

 

[poohandwendy]

If you do not have an OB/GYN get one and visit him/her yearly!

This cannot be emphasized enough. OP,you should start with an Ob/Gyn and then go from there. An OB/Gyn has experience with figuring out why periods are not regular...even if it is another system (non-reproductive) that is out of whack.

Make an appt asap.

 

[my4kids]

This cannot be emphasized enough. OP,you should start with an Ob/Gyn and then go from there. An OB/Gyn has experience with figuring out why periods are not regular...even if it is another system (non-reproductive) that is out of whack.

Make an appt asap.

Yes, your nurse practicioner is a stand in for a primary care physician, (although I would still feel more comfortable going to someone with an MD on the end of their name) but she is NOT a stand in for a OB/GYN. Every woman above the age of 18 (or younger if sexually active) , should see their GYN once a year...insurance covers it. You HAVE to have a pap smear done once a year, your primary care is not going to pick up cervical cancer in any exam until it is too late. Cervical cancer can be caused by sexually transmitted diseases and viruses (some that have no symptoms, and you may never know you contracted unless you end up with cervical cancer).

I can not believe a medical professional did not make sure you were seeing a GYN - especially if you are planning on having kids...it may be nothing to worry about, but why take the chance? You should see a GYN right away.

 

[ChrizJen]

I was exactly where you are 4 years ago.
I had similar problems when I was 29-30. I had always had somwhat regular cycles, and then all of a sudden I started skipping months. So I saw my doctor and my OB/GYN, and had tests done (ultrasounds, blood tests, etc) and doctors said that they could not find a reason for it. They said it was probably hormonal and just let it go.

Now I have cycles that are so right on that I could set my watch to them. My partner and I also decided last year that we were going to try to conceive. We've not been sucessful, and I almost wonder if whatever it was that was going on then is perhaps the same thing that is keeping me from getting pregnant now. We've decided to take a break from trying to conceive for now (mostly for financial reasons... )
We're going to take the classes and become licensed foster parents. But that's an entirely different story...

I would recommend finding an OB/GYN who can look further into what may be causing this for you. Like others have said, sometimes you have to take control of your healtcare. Sometimes doctors get busy and don't take as much interest in the individuals they care for as they should.

I really do wonder if my current situation is related to the problems I had before. I wish I would have been more persistant.

Good Luck!

 

[themarquis]

Thanks everyone for the replies. I'll be seeing a specialist at some point soon anyway, so hopefully they can run additional tests and really check everything out. The information some of you shared about PCOS (that it can take more than a blood test to rule it out) was interesting and seems to be the most likely thing to look into.

To answer some of your questions: I'm not a runner nor do I do anything that would normally make a person miss periods. I was never very regular in the past, and missed periods every once in a while (like once a year or so), and did once have a time period where I missed it for several months (many years ago), so when this first started happening, I honestly wasn't that concerned. I've had regular gynecological exams/pap smears for the last three years (not so much before that, as I'll explain later) and those were all normal. I also just recently had a complete blood workup including thyroid, fasting blood sugar, blood cell count, liver enzyme tests, etc. Everything was normal except that I was slightly anemic. (have any of you heard of anemia being the cause of missing periods -- mild anemia?) I have gained some weight recently (da*n gf and her delicious cooking) but have started to eat better and dropped a little bit of it. I do wonder whether weight change could put hormones out of whack or whatever.

Re: why I go to a nurse practitioner clinic and have all my health care done through them, including gynecological exams: I used to be one of those people who had a lot of anxiety about seeing doctors (like ... so much anxiety that my heart rate was aroud 130 one time at a doctor's visit and the dr. and nurse kept asking, "are you okay?" "does your chest hurt", lol) and hence had a lot of health issues sort of build up over time. I also had a few very bad experiences with doctors not taking me seriously, misdiagnosing me, etc.

The nurse practitioners at the clinic I started to go to (it is a teaching clinic and attached to the University here) have a completely different approach to medical care than the MDs I went to in the past. The clinic is small and homey, everyone knows me by name and remembers my medical history, the NPs will sit and talk to me as long as I want (no rush to cram in as many patients as possible into 15-minute sessions). They're interested in not just diagnosing you but also helping you deal with whatever issue you're having, emotionally and physically. I've been to the NP with a nagging cold, the kind of thing that makes you wat to kill yourself because you're hacking up postnasal drip for days or weeks, the kind of thing that if you went to an MD, you'd be told, well its just a cold (you can leave now), and feel kind of silly for having gone to the doctor "for nothing". When I went to the NP, she sat with me for half an hour, took notes, asked about everything, including specific details of when the hacking was worst, what the phlegm looked like, what the cough felt like, and everything else ... checked me out completely ... then gave me specific recommendations about OTC products, suggested sitting in the bathroom with a hot shower running, sleeping propped up on pillows, maybe starting allergy meds, etc. What primary care MD would do all that? When I had a physical with my NP, it lasted two hours (yeah, you read that right!). They were incredibly thorough ....!

Anyway, when I came to them, I had sleep apnea, anemia, unmedicated anxiety and depression, and some other issues. They wanted to take care of all of that first. (they also knew I had anxiety about medical care and perhaps were leery about sending me to a specialist when I already had appointments for a bunch of tests, the sleep doc, etc.) I think that was why they put off sending me to a specialist, though I'm sure if I had been forceful they would have referred me.

To be honest, I've never had gyno stuff done by a gynecologist! I always had my PCP or NP do pelvic exams and all that! I knew some people saw "real" gynos, but I was never sure why really. You guys are totally right that its definitely time for me to see a "real" one!

Anyway, thanks again for the advice and keep it coming ...

 

[Pea-n-Me]

It is a metabolic syndrome, which is why an endocrinologist is the correct person to make a diagnosis.

Why the name polycystic ovarian syndrome? Who knows. A good percentage of women who have the syndrome do not have cystic ovaries, including myself.

However, it is a syndrome which has a lot of other whole body health implications as I said before. Including cardiac disease, diabetes and cancer.

It seems to be becoming a bit more well known, but make no mistake about it: PCOS is not well understood by the medical community. Many women have to take it upon themselves to find help and a correct diagnosis. That was the case with me when I read THIS ARTICLE in Woman's Day back in 2002 and promptly sought out an endocrinologist for myself (and believe me, not only did I have a whole team of doctors who never picked up on it, including an OB/GYN and an oncologist, all of whom are faculty at one of our nation's premier medical schools; I'm an RN myself and had never even heard mention of it in pathophysiology classes).

Anyway, when I called my primary to get a referral to an endocrinologist, they happen to refer me to my reproductive endocrinologist (who'd helped me through infertility) because he happened to be the only endocrinologist with the practice at the time. That was perfect, because he was fully trained in all aspects of the disease and was able to quickly make a diagnosis. In retrospect, I did recall him mentioning probable PCOS during my infertility workup but at that time there was not the treatment available that there is today and I never persued it afterward being overwhelmed by life with new twins. So luckily, I came across the article above and it helped me get the diagnosis and treatment that I needed. I hope now it can help others here (should probably post it on the CB).

I just wanted to add, that you have nothing to apologize about for seeing a NP. You've outlined very well why some people choose to see them. Remember, they have advanced graduate training in a very difficult course of study, and work alongside an MD, often as a very tight partnership. Any difficulties are quickly addressed with the physician.