Teen daughter, no periods, GP blaming weight?

[mumofteenss]

My 16 year old DD has had 5 periods since she started her periods 4.5 years ago. When she got her first period she was of normal weight and height. She gained some weight in the first few years of high school when she quit sports clubs she had done when younger, She was considered overweight a year after her first period and not having a second. Now her weight is at the upper end of normal and has been for around another year, but it has been 18 months since her last period. Her BMI, though not always an accurate determine healthy weight i know, is 24.2, she looks in proportion and doesnt appear overweight. I have taken her to the GP numerous times, she has had blood tests, and an ultrasound for PCOS, these came back normal, bar testosterone which was high. GP is refusing any further investigation, and blaming her weight. She has basically said my daughter needs to lose weight and her periods will "kick in".

AIBU to think there has to be a medical reason as to how a teenage girl can only have had 5 periods in 4.5 years and want her to have some answers regarding future fertility etc now?

When she started her periods she started a tracker, so we can see he had a period June 2020, Aug & Sept 2021, Feb & March 2022, March 2023. She has no spotting between. She also suffers quite badly with acne. Any suggestions would also be appreciated. We have seen the GP atleast 10+ times regarding this issue over the years.

She is aware i am posting here for advice and was happy for me to share this information.

I thought being underweight made your periods stop? Surely most women and girls who are within a healthy weight range have regular periods? I admit I'm not a doctor, but I'd be surprised if your daughter's weight were the cause of this.

There's some really good information about diet and PCOS that came out a few days ago from the Glucose Goddess about insulin resistance, sugar spikes and controlling them:

28 minutes in she talks about how to reverse PCOS.

Of course it might be something else but all the same good to armed with the knowledge to help if it is.

Your poor DD and you. You've been treated very shabbily. I hope you get some answers soon.

bmi is not used for children

Oligomenorrhea and raised testosterone ( likely raised free androgen excess) is pcos.
Rotterdam criteria are now superseeded.

unfortunately weight loss, the cocp and metformin is what you’ll want

but pop and see a good paediatric endocrinologist first.

rude as they were, weight loss is key to fixing this.

I think the weight thing really only applies to those quite underweight. Your poor daughter.

Is there any chance she has an underlying immune system disorder? I didn't have any periods until I was 16 due to health problems.

I would see a new GP or ask to see a specialist.

Clearly you have bigger issues to fry. My point is a lot can be done for hormonal conditions with diet alone. Given a useless doctor, the easiest thing to do that can start today is to go on a really clean diet to see if it’ll make a difference whilst you wait for the fuc4ers to wake up.

Is that true? You need 4 periods per year to keep the womb lining healthy? What happens with women on birth control who aren't having them? 😮

I'm unfortunately very aware of how terrible medical services can be with 'womens issues' - fat and/or hysterical sounds about right.

Can I ask if she has any other symptoms that you are willing to share? Low moods, times of depression, cramping, pains, hows her skin in general?

Go to the doctors again with this

and when they fob you off

say thats ok that you think that, however can you please record your reason for refusing to refer my daughter in her notes

have a look at Benendon ( I think) health - i have a friend who registered and got fast tracked for significantly less than private health care or a private referral. Hope she gets sorted, it sounds like you've had terrible treatment so far . :)

Would agree PCOS. Have a look at the NICE guidance for treatment although in my experience not much of this happens and this is hard to get treated for PCOS... Has gp not suggested the pill or progesterone to start cycle ? Acne is very treatable with antibiotics why hasn't the GP suggested this ? Yes referral to endocrinology would be the best outcome although waiting lists might be long. I did find that it was very sensitive to weight gain and even losing a few pounds made a difference to cycles but for the GP to say that is the only reason is awful, it's difficult to lose weight with it and she's a teenager.... this is the last thing you want to draw attention to. Hopefully you could even see another GP and get referred.

If her weight was absolutely fine for the first year of no periods, and is now healthy now (I used BMI as she is taller than me, and incidentally weighs much less and my periods have been regular as clockwork for nigh on 30 years, so figured although she is only 16, as she is adlut sized, it was an indicator here to her weight), how is her weight affecting her cycle, assuming it is PCOS?

Genuine question, i understand weight can affect the severity of PCOS, but aside from a small time when first dropping sports club, and not an intense one that lowered her weight drastically, when she was just into what was considered overweight, he weight has been fine the majority of the time her periods have been absent. I dont want to encourage her to lose weight when she is perfectly healthy relative to her height, i dont think that is necessarily a good message to send to her at 16 and not obviously or very over weight.

Her diet is good, she obviously has sweets, chocolate, and fizzy drinks etc in moderation, but her base meals are all very balanced. She does exercise now, and is very active anyway.

I have made notes for blood testing and will request a gynae referral. Thank you

Op I was the same - started my period at 14 but it was probably twice a year if that... I never understood how people could claim to be 'due' a period or 'two days late'... (and no decent maternal figure to discuss it with). I was eventually diagnosed with pcos despite being a very small size 8 person at 24 - ironically with secondary infertility - I fell pregnant with my son at 20 within 2 weeks of coming off the pill.

Some things that helped - despite being classed as underweight then (less than 50kg and too light to give blood). I cut out sugar and processed foods, I increased my exercise and I took herbal supplements of siberian ginseng, agnus castus and black cohosh.

My pcos only showed on the internal scan not the external one, despite cysts being everywhere on both ovaries. You could push for an internal scan or see if you can improvise diet and exercise (not with a view to loose weight but to improve vitamins and minerals and decrease insulin in the body).

Seriously?

Either they have a breakthrough bleed or if it’s progesterone only the lining isn’t building up.

Keep pushing your GP for answers, have they done a test for prolactin?

I had the same issue at 16 and it turned out I had hyperprolactimia, the benign tumour causing my raised levels stopped my periods and needed to be shrunk by medication, it was discovered by blood tests and an MRI.

Its nothing to worry about but please do keep pushing xx

Hormonal birth control suppresses the lining of the womb so nothing much building up to become unhealthy

prolactin isnt one i remember them mentioning, i only remember LH FSH and testosterone. But i will request it

The amenorrhoea and acne/high testosterone is enough for a PCOS diagnosis so I'd raise the diagnosis guidelines with GP again. Dianette contraceptive pill is worth considering, should help with the acne and the breakthrough bleeding limits the risks of no periods and the increased risk is minimal for healthy weight individuals as much as GPs don't like to prescribe it.

Worth reaching out for help if she wants to conceive in future when she starts trying but nothing else they can do until that point I'm afraid.

As a long-term sufferer of PCOS, there are some fairly standard drug combinations that your daughter might get recommended. These include metformin to combat the insulin resistance, or the pill so she gets regular ‘periods’ (though it will be a false one) but what you need to understand is any medical drug intervention will simply kick the problem under the carpet and may even create future problems. See the following book - this was my bible:
https://www.amazon.co.uk/Colette-Harris-PCOS-Polycystic-Syndrome/dp/B00NBJWBXQ

This is why I said what I said in my previous post – diet and lifestyle is everything

I've been overweight to varying degrees since I was about 9 OP. Now at a size 14 adult I'm still considered obese by BMI - it never affected my periods or fertility. Started my periods at 12. I've never heard of anyone's weight affecting their periods this way unless they're very under or overweight. Doesn't sound like this has ever applied to your daughter.

Your GP is almost certainly full of shit and needs to rule out every possible scenario for your daughter. Please advocate for her and demand a gynae referral.

Just seconding everyone else that you need to see a different GP, and push. If it's possible, look into a completely different surgery in your area - a friend did this in respect of her child who was being fobbed off and it literally changed her life (younger, not PCOS related).

I have PCOS. At 16, I was seen by a doctor who decided I was so underweight, and my bone density was low, that it was why my period was delayed - but he flagged potential of PCOS even then. Periods started soon after but obviously v erratic. Age 18 PCOS diagnosed (I have classic presentation on ultrasound - super easy to diagnose), and age 19 went on the pill. Until this point I was underweight but very fit and healthy (5ft4, 48kg) I have never heard of anyone who is overweight (or normal weight) with PCOS being told that's why they're not getting periods although it is, of course, known that overall PCOS is better managed if you are thinner, with the annoying irony that getting thinner when you have PCOS is really hard.

Please also ignore people telling you not to label your child and it's all controllable by diet. Yes, diet is absolutely the first step in attempting management and I 100% agree that diet can be a key differentiator. But it is also an actual medical condition in which your pituitary glands are not doing what they are supposed to be doing! You can't just magically turn that off as an issue.

If she's gained weight, presumably preganancy has been ruled out?

I've never heard of weight gain (only weight loss) being a reason for lack of periods and she's not obese, even if obesity is a problem.

She definitely needs more investigations IMO and I'd be asking to see another doctor.

The raised testosterone is in keeping with PCOS even with a normal scan. Vaginal scan is the best way to image the ovaries.

Sadly I know a lot about PCOS.
Me, my sister & 4 DDs all had/have it (me & sister now post menopause so thankfully free of all PCOS symptoms)
It can be a hard condition to live with, mentally as well as physically.
PCOS can cause weight gain, acne, hirsutism & hair loss all of which affect women’s self-esteem badly.
We all developed symptoms at around 16yrs but it took years to get a diagnosis.
Some of us had cysts, some of us didn’t.
No cysts absolutely does not mean no PCOS.

Sadly your GP’s lack of knowledge & dismissal of your DD’s concerns is not unusual.
Women are told it’s their weight causing the problem whereas it’s actually PCOS or another hormone imbalance causing the weight gain.
It was no easier for my DDs to get help now than it was for me 40years ago!

Acne, increase in weight, no periods, raised testosterone strongly suggest PCOS to me OP.
Sadly like so many women’s health problems it can take a long time to be diagnosed, particularly with GP’s like your poor DD’s giving such dreadful advice.
I would do some research around PCOS/raised testosterone, arm yourself with info and you’ll feel more confident in arguing for a referral through a different GP.
It may be better to ask to see an endocrinologist rather than Gynae, as scan was ‘normal’ but testosterone raised.
They can do in-depth hormone tests & get a much clearer picture of what’s going on.
Did the GP check thyroid levels?

Good grief! The GP sounds absolutely awful! I was immediately thinking PCOS. They need to investigate further. Absolute madness.

I have PCOS and I made an account just to post this message so I really hope you find it useful!

It sounds like PCOS to me. Diagnosis is supposed to be made using the Rotterdam Criteria so you need to have any TWO of the following:

• Clinical or biochemical hyperandrogenism (i.e. high testosterone on blood test AND/OR signs of it, like excess facial/body hair, acne, thinning/balding hair).
• Evidence of oligo-anovulation (so irregular or no periods)
• Polystic appearing-ovarian morphology on ultrasound (so evidence of cysts on ovaries).

If your daughter has extremely irregular periods and her testosterone was high, then it's likely she does have PCOS as she meets two of the above, which is the official diagnostic criteria. I don't know why the GP has written it off?

GPs don't get enough education on PCOS. Women with PCOS often have some degree of insulin resistance which causes weight gain and stimulates androgen production.

I am not an expert on how this works but this is roughly how it goes:

• Eat carbs
• Produce insulin
• Don't recognise insulin
• Produce more insulin
• React to it - excess insulin stimulates fat storage causing weight gain, as well as stimulating ovaries to produce androgens (like testosterone) causing symptoms like acne, facial hair, hair thinning.
• Blood sugar drops too low - craving carbs again. Cycle continues.

It's so complicated because stress and poor sleep can also cause insulin resistance to worsen. That's why the advice by GPs to "lose weight" is not helpful, because often (like I personally found), trying to exercise more and eat less caused my cortisol levels to rise and then that mucked up my hormones even worse than they were before and I completely lost my period for years.

When I was diagnosed, I had been without a period for 3 years and I was very skinny because I was obsessively eating healthily and overexercising. I had some chin hair and my testosterone was slightly elevated and I had ovarian cysts visible on an internal ultrasound. I also felt exhausted A LOT and had a lot of headaches - does your daughter get this at all? It was because my blood sugar was all over the place.

I found all the drs and the gynaecologist (both a private and an NHS one) useless. One gynaecologist told me I needed to go on birth control (even though I was wanting to try for a baby) and the other told me I need to go on a keto diet forever. I then reached out to a PCOS dietician (Jodie Relf) and after a few months of working with her I got my period back, conceived my son first try with no intervention, and I have a 28 day cycle now. You'll read so much only about how you have to go dairy free, gluten free, sugar free, etc. I just watch my carbs a bit, make sure I eat plenty of protein and fat, exercise mindfully, watch my stress and I take a few supplements (inositol is the main one that helps, but metformin can be prescribed by GP) and it has all sorted itself out with no hassle. I wish everyone got this advice from GP straight off, it's much more gentle and effective for life.

Anyway, this is all assuming she does have PCOS but I strongly thing she does based on the info you've given. Really hope this helps - I feel for your daughter!