amenorrheic patient

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To all,Some of you may remember my posting earlier this year regarding a youngwoman whom I am seeing in my practice as well as for NFP instructionShe is in her mid 20's, and is amenorrheic with low FSH/LH felt most likelysecondary to low BMI (19) from running 5 days per week=2E She has cut back alittle, and her weight has gone up 9 lbs. Still amenorrheic, with very fewdays 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 ofOCP's by them just to assure an intact outflow tract. She did withdrawbleed to this, but not to Provera tried prior. Her pap was markedlyhypoestrogenic.They wanted to put her on the Pill to "replace her estrogen" and preventosteoporosis. I've never seen a study showing that the estrogen doses onthe Pill are enough to do so, and she doesn't want that as an option forman

y reasons. They then told her that if she won't take it regularly, theywant 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 anwithdrawal bleed and she doesn't have one, we've done enough. Her estrogenis 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 thePill every 3-4 months to have a period.FYI, her fiance and I are still working on encouraging her to gain moreweight and cut back on running. Apparently she did cycle, albeitirregularly, when she weighed 20 lbs more than now, which would still be a quite acceptable weight for her height.

Thanks, Poehailos, MDFamily Physician/STM instructor Diocese of burg methodCharlottesville VA