I have not had a proper period since May. I am not pregnant and don't have symptoms of PCOS. What kind of conversation do I need to have with my doctor?
September 25, 2012 7:01 AM   Subscribe

I have not had a proper period since May. I am not pregnant and don't have symptoms of PCOS. What kind of conversation do I need to have with my doctor?

I have been tracking my periods this year because I would like to get pregnant, and am a little concerned I have not had a proper one since May. In June, I had an irregular one---three days of that sort of sticky discharge I get just *before* a period, with a little blood mixed in but not a full period amount. Since then, nothing. I do not have symptoms of pregnancy and a home test was negative.

I have always had a long cycle---average of 35-45 days between periods, sometimes a little longer, sometimes I skip. The one time I talked about it with my doctor, years ago, he said I just have a long cycle and that if I ever wanted to get pregnant, he could put me on a low dose of fertility drugs to regulate things a little. But he was not concerned. My periods have always been easy, no cramps, no PMS, about three days of ick and then three days of very light stuff until it's done. I use cloth pads because I am sensitive to corn products and the plastic ones irritate me.

I did some googling and saw a lot of links about PCOS. I am a little overweight, but other than that I have no symptoms---no heavy bleeding, hair growth, nothing. The only potential issue here is that my sister (4 years older) was just diagnosed with pre-diabetes, so that is a concern for me and I am trying to lose the extra weight.

I have been under some stress too. My partner is going through a lawsuit and there has been a lot of 'wait and see' going on with very slow progress. He doesn't always cope well, and that affects me. I know stress can affect your period, but I didn't think it could make you miss TWO periods!

The last proper bloodwork and such that I had was a year and a half ago; my doctor was on leave for a family emergency for several months and not available. The only thing that has ever come up in those was low iron.

You are not my doctor, obviously. But I want to know what sort of conversation to have with him when I go. If I am not pregnant and have no signs of PCOS, what else could it be? What should I ask about or try to get tested for? Should I be worried at this stage of things? Should I lose ten pounds and then go see him only then? I do want to get pregnant in the next year so I am taking this seriously.
posted by anonymous to Health & Fitness (25 answers total) 2 users marked this as a favorite
Just a data point: my mom had a long cycle when she was younger, and apparently had some difficulty getting pregnant because of it. Her doctor (this was back in the 80s, mind you), put her on an HBC pill for a few months to get her more regular, and once she went off things got more "normal". And I'm here, so I guess it worked.

If I were you, I would just go to your gynecologist and explain all of your symptoms, straight up. Don't worry about losing weight beforehand, don't worry about prediagnosing yourself. Tell him what you've been experiencing, tell him what you're concerned about, and then let him do the actual diagnosing.

Good luck!
posted by phunniemee at 7:07 AM on September 25, 2012 [2 favorites]

What you say to your doctor is this:

"I haven't had a proper period since May. I've taken a home pregnancy test and that came back negative. Can you tell me what's happening?"

And that's it. Your doctor will take it from there, and know things to test you for. That's why your doctor went to Med School, after all!

I respect your wanting to know what's going on, and trying to answer the question for yourself by Googling - but there are a SCORE of things that could be causing your change in cycle, not just PCOS. If you're still concerned about that, ask your doctor whether they think it could be that, but mention that you dont' have any of the other symptoms - I'm fairly certain that your doctor would say that they tend not to suspect PCOS unless you've got a host of other symptoms aside from just the missed period.

In terms of what it could be - it could be anything from stress to your body just being weird. You don't say how old you are, but if you're in your early 40's, it could be the very, very early stages of your body entering perimenopause. (I'm 42, and every once in a while my cycle gets a little funky; I haven't checked with my doctor, and I don't have any other symptoms, but I'm chalking that up to "the works are starting to pack up and shut down").

Just ask your doctor to test you. I'm not sure why you think you'd need to lose 10 pounds first -- if you're worried now, go now. Good luck.
posted by EmpressCallipygos at 7:08 AM on September 25, 2012 [11 favorites]

Seconding the weight loss thing. Just get to the doctor with your list of questions and go from there. No sense in trying to determine what it is before you get there.
posted by dawkins_7 at 7:09 AM on September 25, 2012

You don't need to decide what kind of tests to get, your doctor is able to do that. Do not wait until you lose 10 pounds. Call your doctor today, tell them you have not had a period in three months. I can't tell from the way you've worded your question, but if you have been actively or passively trying to conceive you should mention that as well.

Just because a home urine test says you're not pregnant doesn't mean you aren't, or that you haven't been at some point in the past three months.
posted by Lyn Never at 7:16 AM on September 25, 2012

I haven't gotten my period in years. I am not pregnant. There are some totally normal and a few worrisome (but manageable) things that can cause this. Going to a doctor is a good idea since the likelihood is that you have something normal that is causing this. I agree with EC, just say "I haven't had a proper period since May. I've taken a home pregnancy test and that came back negative. Can you tell me what's happening?"

It's true that stress alone can cause this. It's unlikely that being overweight can cause this, so don't worry about that. In my case the nice-but-bruque doctor I had was like "Oh looks like you may have a brain tumor..." which got me losing my shit until I read some more and realized that pituitary microadenomas are not that unusual and can often be controlled with medicine (if you want to conceive, I didn't) or can be just left alone and monitored.

So let the doctor know what you are concerned about and explain that you are looking to conceive. There is nothing in and of itself wrong with not having a period except that it often points to other medical issues that need attention so it's worth explaining why exactly this is a problem for you. I wish you luck getting to the bottom of it.
posted by jessamyn at 7:17 AM on September 25, 2012 [1 favorite]

Write down all of your symptoms, even those that don't seem to relate to your reproductive bits.

Do you have headaches? Feel dizzy? Drink a lot of water? Have dry skin?

If it stands out to you, write it down.

Then discuss it with your doctor. You should not feel rushed, you should feel heard and if possible, perhaps someone can go with you as a scribe, as you might be overwhelmed to properly process all that you are told.
posted by Ruthless Bunny at 7:17 AM on September 25, 2012 [1 favorite]

Call your doctor's office, ask for a 40-minute appointment (if they're normally pretty short) and then follow the advice already given.

You should probably remember to ask "at what point do we need to start being more aggressive about the whole 'trying for a baby' thing?" Being "more aggressive" may mean going to a specialist (or not,) and that can sometimes be a pain in the "we're on a waiting list" sense, so.
posted by SMPA at 7:20 AM on September 25, 2012

I'm writing this as a fellow non-textbook-menstruating female. I want to give you some things to think about and maybe investigate before you go to the doctor.

First, if you have been trying, it may be worth taking another pregnancy test. They can be wrong and you may want to confirm the results with another test.

If you have not yet looked into basal body temperature charting, I would highly suggest it. It sounds like you're into tracking how you feel, which is great evidence to have. Coupled with your basal temperatures upon waking and some other clues, you can get a picture of if you are actually ovulating. Lots of women use basal body temp tracking to find their most fertile days, to avoid their most fertile days and also to see if they're ovulating at all. Look it up--there's tons of info on the web--and try it to see what you can find out about your cycle. Taking Charge of Your Fertility is the landmark book on this, but other resources are available.

You don't say how old you are. Keep in mind that periods can change with age. Mine have gotten lighter with age. I went from really, really heavy as a teen, to now, at 34, much lighter flow with fewer cramps. Weight loss and gain can affect periods, too.

If you and/or your gynecologist suspect you have PCOS, please see an endocrinologist. It's been my experience that gynecologists are either not equipped or not interested in treating the systemic parts of the condition (it has cardiovascular implications) and there may be other issues present (such as hypothyroid/Hashimoto's disease) that you really need an endocrinologist for.

Best of luck. I hope you can get some relief and answers. Feel free to me-mail me if you want to get into any specifics about anything.
posted by FergieBelle at 7:24 AM on September 25, 2012 [1 favorite]

If you are actively trying to lose the weight by restricting calories, that alone could cause missed periods, and stress on top of that and your normal long cycle could be contributing too. But I agree this is a question for your gynecologist, as much to put your mind at ease as anything.
posted by jocelmeow at 7:41 AM on September 25, 2012 [2 favorites]

(I should have included strenuous exercise as a possible cause along with the calorie restriction, too.)
posted by jocelmeow at 7:42 AM on September 25, 2012 [1 favorite]

You could have some kind of hyperplasia going on in your uterus (this is apparently medical-speak for 'clumps of stuff'). I had that ("complex hyperplasia with atypia") and ended up needing a partial hysterectomy (they left the ovaries in but removed the uterus). Mine turned out to be low-grade cancerous, but most are benign.
posted by rmd1023 at 7:43 AM on September 25, 2012

I'll quote what my doctor said to me when I went to her with a similar problem: "No woman's periods are exactly alike. There is no such thing as a typical period." I hope that you do go to the doctor soon, rather than stressing yourself out by googling around. Stress, travel, weight loss, weight gain can all have an effect on your period. Good luck!
posted by Ziggy500 at 7:48 AM on September 25, 2012

Don't wait, go see your doctor. You'll probably get a pregnancy test anyway. Anecdata: I had a similar situation to yours: irregular periods with long intervals between (32 days, average), one day of spotting about three days before my next expected cycle. No periods since then. I am pregnant. No nausea or other symptoms other than perhaps a bit of breast tenderness that is no worse than the premenstrual kind. I'm also more than a little overweight.
posted by Kitty Stardust at 7:55 AM on September 25, 2012

Ask for a blood workup and an internal ultrasound (your dr should order these regardless, but ask if she doesn't). I have classic PCOS according to the clinical tests (hormone levels, many tiny cysts) but my only symptom is irregular/ difficult periods. I've been on the pill to control it since age 11 (off and on, mostly on) and became pregnant without too much difficulty. However, If you're under a lot of stress at the moment it might well be that.
posted by goo at 9:35 AM on September 25, 2012 [2 favorites]

I agree with EmpressCallipygos except for one thing: the diagnosis of PCOS is not made by your physical symptoms, it's made by blood work (hormone levels) and ultrasound. You do not have to have 'typical' PCOS symptoms to have PCOS. I should know, not only am I a doctor who never thought that I had any symptoms of PCOS (except irregular periods) - I have PCOS! I was completely surprised by the diagnosis. I am not even overweight, I have what's called "lean PCOS". I went to an OB/GYN first and he missed the diagnosis despite working me up with some of the proper tests. It took me 6 months to decide to see a reproductive endocrinologist who figured out what was wrong with me, and I got proper treatment and am now 5 months pregnant.

Please see your OB/GYN and don't discount the possibility of PCOS based on googling. And if your OB/GYN doesn't give you answers that satisfy you, ask for a referral to a reproductive endocrinologist.

You didn't say if you are actively trying to get pregnant, but I would suggest 1 year of trying maximum without seeing an RE if you are <35, and more like 6 months if you are 35 or over (this is because of the irregular periods, not for 'normal cycle' people). Don't let your most fertile years pass you by and don't let any doctor tell you that is acceptable. MeMail me if you have other questions.
posted by treehorn+bunny at 9:37 AM on September 25, 2012 [3 favorites]

I went through the same thing and after an initial diagnosis of PCOS, my OB/GYN identified the pituitary adenoma that jessamyn mentioned via bloodwork tests for prolactin.

My endocrinologist has me on the medicine to shrink it. If/when I'm ready to have kids, she wants me to stay on the medicine until I become pregnant. Good luck.
posted by icaicaer at 9:52 AM on September 25, 2012

Hypothyroidism can cause long, irregular, or absent cycles as well.
posted by meijusa at 10:16 AM on September 25, 2012 [3 favorites]

If your doctor doesnt suggest it (but I think he will) ask for a trans-vaginal ultrasound. I have no symptoms of PCOS either, except that my ovaries are covered in cysts--which we never could have known without that ultrasound. Are you taking basal body temps? If not, you should start, and share that data with your doctor. My wacky temp chart is what made my doctor think to screen me for PCOS even without any other symptoms.

When you make the appointment, ask for a "pre-conception" appointment--that indicates that you are very serious about getting pregnant in the next year or so, and may encourage him to take your concerns more seriously. If you feel he is being dismissive, find a new doctor.

FWIW, I was able to conceive naturally a few days before starting a drug that helps women with PCOS conceive. My cycles wil probably never be regular, but I haven't been rendered infertile as I feared. Good luck to you!
posted by peanut_mcgillicuty at 11:09 AM on September 25, 2012

I had something similar before. I went actually 8 months without a proper period before seeking help. After an ultrasound and bloodwork all came back normal, my doctor explained to me that everyone has the same amount of fat cells; some are just bigger than others. Fat cells, apparently, produce a very small amount of estrogen. I was really overweight at the time - about 260lbs, and my physician told me to start a diet and exercise plan. She told me that I wasn't supposed to be that large. My fat cells were producing just enough estrogen that I wasn't ovulating. Therefore; no period. Even if I had wanted to get pregnant - I couldn't.

So 9 months later and after losing almost 80lbs, my period came back and was regular for several months before I got finally got pregnant. (Which wasn't planned, huge surprise!)

I'd start a diet and exercise plan. Just count calories, 1200 a day, and work out for 20 minutes a day. You should see your period start to come back and regulate as normal.

Hope this was helpful!
posted by AbsolutelyHonest at 11:56 AM on September 25, 2012

I agree with the folks who are saying this may be caused by stress and weight loss, and to go see your doctor. I will add that when my husband and I started trying to get pregnant, my previously written in stone menstrual cycle went completely bonkers. Just the idea of trying got my hormones in a tizzy.
posted by Specklet at 12:39 PM on September 25, 2012

When I was diagnosed with PCOS (via an ultrasound and hormone test), my only symptoms were a year of missed periods, 5 (literally) stray hairs, and being a little overweight. I now have regular periods, about 20 stray hairs, and am still a little overweight. I still have PCOS.

Regardless, though, you can't know whether or not you have PCOS without an ultrasound and some bloodwork. Don't wait to see your doctor, AND don't feel like you have to go into the appointment with the results. If you're not happy with the way your doctor treats you and that is what is making you want to figure everything out before going in, maybe see a new doctor. (Do you feel like he or she is thorough? Do you feel listened to? Those are important things!)
posted by snorkmaiden at 3:08 PM on September 25, 2012

Another vote for (after an additional pregnancy test, if needed) seeing a reproductive endocrinologist instead of a general practitioner. PCOS/infertility/insulin resistance, etc. is really complicated and in my experience general practitioners and even OBGYNs are all over the map in terms of their understanding of it. Good luck!
posted by ravioli at 4:24 PM on September 25, 2012

Small note, when I was anemic, my periods were super light, sometimes just a but of Brian one day, never any red. I attributed it to being on the pill for more than 20 years until I got my iron straightened out, and now my periods are almost normal.
posted by Occula at 9:49 PM on September 25, 2012

I am another one who has no symptoms of PCOS besides very long periods. When I went to my GP and was referred to a scan - voila! lots of ovarian cysts.

Definitely get yourself tested now to check just what's going on. What I also did when I was trying to get pregnant:

- start charting my cycles (using temperatures) to see if I really wasn't ovulating, or what was going on generally with my body
- lost some weight - it did make an amazing difference
- start a low-GI diet - it helps for PCOS and is good for you generally

Good luck with your pregnancy journey!
posted by low_horrible_immoral at 3:27 AM on September 26, 2012

Yep - could be a million things.

Charting your cycles is super helpful, I <3 it when people bring those kinds of things in (and yeah, try to see if you can get a longer appt to go over things if you can). It will also help you figure out if you are, in fact, having any signs of ovulation at all.

other things that can help, just to repeat what a lot of people have already said (sorry);

- exercise (losing even a little weight, nothing dramatic, can majorly increase your ovarian function, and it feels good to be in shape anyway, not that i really know right now..)

- get yourself screened for blood sugar problems/insulin resistance! I see people get treatment on metformin/other stuff for blood sugar problems and then, uh whoops, they have an unintended pregnancy since they haven't ovulated or had a regular period in forever...

- your health provider (OB/GYN, CNM, WHNP) can do some basic workup for things like low thyroid, diabetes screening, etc. they can also do serial bloodwork for hormone levels throughout the month (not just estrogen/progesterone, but the hormones that start developing your eggs), give you pills (progesterone) to make sure that your body responds to changing hormone levels, etc etc etc ad nauseum.

Stress can really mess up your cycle, and the process of trying for pregnancy can also be very stressful, so I'd encourage you to focus on thinking about these things as healthy lifestyle changes that you're making to improve your quality of life, not just for an end goal of a pregnancy.

I guess it depends on your insurance, but I don't think I would refer someone to a reproductive endocrinologist immediately if they were young, hadn't been trying for very long (eg, < a year of regular unprotected sex), otherwise pretty healthy and without having done a basic workup to rule out common issues that can create difficulty with conceiving. endocrinologists are expensive, they are the big guns, and you'll save yourself extra visits if you get labs/work/testing done before you see them, to give them all the information possible.

I will say, if your doctor that you mention is a primary care provider, I would probably skip right to a women's health provider.

also, yeah, that book Taking Charge of Your Fertility is majorly awesome, I can't recommend it highly enough!
posted by circle_b at 7:51 AM on September 26, 2012

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