amenorrheic patient

[Guest guest]

To all,

First, my apologies if this appears twice. I tried sending from a

proxy server at work, and I don't think it's working, so I'm

resending through Yahoo directly.

Some of you may remember my posting earlier this year regarding a

young

woman whom I am seeing in my practice as well as for NFP instruction.

She is in her mid 20's, and is amenorrheic with low FSH/LH felt most

likely

secondary to low BMI (now 19) from running 5 days per week. She has

cut back a

little, and her weight has gone up 9 lbs to the current BMI. Still

amenorrheic, with very

few

days of mucus on her chart and flat temps.

She's getting married in 3 weeks.

All endocrine workup has been negative, and she was given one month

of

OCP's by them just to assure an intact outflow tract. She did

withdraw

bleed to this, but not to Provera tried prior. Her pap was markedly

hypoestrogenic.

They wanted to put her on the Pill to " replace her estrogen " and

prevent

osteoporosis. I've never seen a study showing that the estrogen

doses on

the Pill are enough to do so, and she doesn't want that as an option

for

many reasons. They then told her that if she won't take it

regularly, they

want her to do so once every three months to prevent hyperplasia.

I feel that if I try to give her progesterone every 3-4 months to

induce an

withdrawal bleed and she doesn't have one, we've done enough. Her

estrogen

is so low that I think there is no lining to shed.

She and I want to know is there any legitimate reason for her to

take the

Pill every 3-4 months to have a period.

FYI, her fiance and I are still working on encouraging her to gain

more

weight and cut back on running. Apparently she did cycle, albeit

irregularly, when she weighed 20 lbs more than now, which would

still be a quite acceptable weight for her height.

Quick replies would be appreciated, as she and her fiance are

wondering if they need to discuss the q3month Pill use with their

priest prior to the wedding.

Thanks,

Poehailos, MD

Family Physician/STM instructor Diocese of burg method

Charlottesville VA