Amenorrhoea, polycystic ovaries and eating disorder recovery

[Loogoo]

Hi,

I'd really appreciate your advice:

I'm in recovery from an eating disorder where I restricted food to exceedingly low levels and spent hours a day over excercising.

As a result of this my period stopped completely well over a year ago now. I've been in recovery for around 6 months, regaining well over 2 stone in weight. I'm now in the healthy BMI range, and eat more than enough calories every day.

I was concerned that my periods hadn't returned so went to see my GP. She prescribed me norethiesterone to try and get things going, though nothing happened. I was then referred to a reproductive endocrinologist. I went to see her a couple of weeks ago, where she prescribed some oral contraceptive pills, ordered a bone density scan and took some bloods to measure my baseline hormone levels.

I also had a scan while I was there which showed I had polycystic ovaries. Though because prior to my eating disorder my periods had always been very regular and I showed no other symptoms I was told that it was not PCOS, and that this was normal in around 20% of women.

The appointment was quite overhwelming for me at the time (I still find it difficult to talk about my eating disorder, and I hate that I still have a physical / medical 'hangover' from it, despite being psychologically better), so I realised after I had a few questions I'd like answered, ie:

- Will the fact that I have polycystic ovaries affect my chances of having children if I ever want to in the future (I'm 26 at the moment and this is not on the cards any time soon, but I'd like to know for the future)?

- Were my ovaries likely to be polycystic prior to my eating disorder? So is it a genetic thing or something that came about because of the stresses I put my body under at this time?

-If my lack of periods has cause osteoporosis, is this something that is reversible at all, or something I'll have to live with forever?

- Also, the lovely doctor I saw said that it would just take time for things to regulate themselves and for my period to return, do you have a more specific timeframe, or is it just a really wait and see type thing? I am sometimes afraid I've rendered myself infertile.

Thanks so much, as you can see I'm a bit of a worrier, and any words of advice would be really appreciated!

[Infertility Network UK]

Hi Loogoo

Well, first of all let me congratulate you on the huge effort you have made with your weight gain, never an easy thing to do, so well done! Regarding your fertility, of course if we lose or gain large amounts of weight, it can interfere with our hormone profile. This is why it is always considered the first priority to get back to an ideal BMI. Women can sometimes have polycystic ovaries, but not the full blown PCOS, which is more serious. The reason for this happening is not always clear, but if it should continue and a problem with ovulation should occur, then appropriate drug treatment would be prescribed to rectify it; followed by the possibility of IVF should it fail. This would be the same with any woman not ovulating – for whatever reason – and not because of your eating disorder. Osteoporosis is often caused through lack of oestrogen, and replacement if usually recommended. It cannot “cure” the osteoporosis, but hopefully will stop it advancing. Certain exercises recommended will prove to strengthen you too. As you have already stated, in time your periods hopefully will return naturally, but remember as with many women hormones often need a “helping hand”. I do wish you well for the future, which is already looking brighter for you.

[Mr. Hugh Byrne, MRCOG]

Please do not worry - your periods are bound to return eventually and when you least expect. The bone issue is reversible as you gain weight and exercise normally. Why be on the pill though? also norethisterone tells you nothing in the long term apart form the fact that your uterus responded to that dose, so best stay of that too.

[Dr Masud Haq]

Hi
Having polycystic ovaries is not uncommon but doesn't necessarily mean you have polycystic ovarian syndrome. Patients typically have other features such - irregular periods, excess hair growth and sometimes weight gain.
It's therefore possible you may have had polycystic ovaries for sometime. Provided you maintain a healthy weight your periods should return to normal in the future and your chances of falling pregnant should be good.
With regards to the fact you have been diagnosed with osteoporosis, I think it's appropriate that you remain on the pill for at least 6 to 12 months before having a trial without to see if your periods have returned. The additional oestrogen will help stabilise your bone density with the pill so I would continue with this for now. Other causes of osteoporosis should be excluded - overactive thyroid, raised prolactin and vitamin D deficiency.
It's essential your bone density scan is repeated in 18 months to 2 years time to ensure the density improves. It's unlikely your bone density will return to normal but hopefully will improve.
Best wishes
Masud

[Dr Madhurima Rajkhowa]

Hi, I thought I would join the conversation. As mentioned previously in most patients , periods do recover as your BMI improves, though it is very difficult to predict exactly how long the resumption of periods may take. It is essential that you take some form of estrogen replacement treatment such as staying on the pill until your BMI is improving, as lack of estrogen is not good for genral health such bone density etc. In additon the estrogen replacement is important for the uterus to ensure that the lining of the womb stays healthy for future conception. The finding of polycystic ovaries on scan is probably an incidental finding. When you have absent ovulation and periods due to eating disorders it is due to the suppression of hormones called FSH and LH which gives the ovaries a multicystic appearance, which sometimes is mistaken as polycystic ovaries. This usually reverts back to normal once your hormone profile improves with weight gain. Worse case scenario, if your periods do not resume after weight gain and given enough time, fertility traetment called Gonadotrophin ovulaion induction is very successful, and can give you an excellent chance of a healthy pregnancy and live birth. So the most important thing is to keep your efforts to gain weight. Best wishes