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.

In my experience the NHS won't look at anything regarding fertility until you've been trying to conceive a year with no luck or had 3 consecutive miscarriages. They blame weight for everything of you're even slightly overweight. In my experience they just don't actually care...

There's something going on hormonally that warrants some more explaining, at a specialist level. Either gynae or endocrinology referral seems sensible to me.

Amongst some of the other possibilities that have been mentioned already, another (extreme) rarity that could look like this would be a mild version of congenital adrenal hyperplasia - and that would be managed in quite a different way to other conditions so is probably worth excluding. Definitely specialist territory to consider all the relevant possibilities appropriately rather than ignoring the situation.

I've heard of weight affecting teen girls starting periods - but it's been that they need to be a certain weight first never overweight.

Your GP sounds unkind anyway. Another saying ask for a second opinion

Check her thyroxine levels. My daughter was the same and it’s turned out that she had next to zero thyroid function.

Flabbergasted that your daughter isn’t even overweight and they’re still trying to blame her weight for her health issue. Women and girls deserve so much better than this.

I have PCOS and have been told so so many times that it’s basically not there or not a real health issue (no cysts are showing in a scan; you can’t have it because you’ve been able to conceive).

Absolutely ask to see a different GP and say your daughter needs a referral to a specialist.

Just a reminder that the Healthy BMI range is vast - it spans some 3 stones or 20 kilos. It has been defined so that most people can expect to find their healthy weight at some place within it. It does NOT indicate that a person is a healthy weight for them at every weight within the Healthy range!

I’m the secretary to an endocrinologist and I’ve typed hundreds of letters saying precisely this.

you can’t have it because you’ve been able to conceive

This is the thing that irritates me the most about dealing with PCOS. As my specialist was at PAINS to point out, repeatedly, while I was going through assessment and treatment for PCOS in order to have children, conception is not usually the problem. The problem is that there's no bloody egg there to conceive with. Her little bug bear is that this is why so many woman who DO have PCOS don't necessarily realise it until they're older because the young ones with PCOS are having so much more sex usually that they've got a better chance of hitting the window when there is an actual egg there and conception at that point is as likely for a woman with PCOS as one without.

@ItallwentwrongwhenBowieleft post menopause, do you find it easier to lose weight, and keep it off. A doctor told me that as I enter into perimenopause tha tmight happen to me but no sign of it so far!! I am losing weight currently, slowly, with intermittent fasting so I'm happy, but I've yet to find real success with traditional weight loss of just fewer calories, less fat etc.

Watch a couple of videos by Dr Mindy Pelz on You Tube. She does a lot re imbalanced hormones, diet and menstrual cycle. Very interesting

This is dreadful - I’m so sorry. A dermatologist I went to for painful acne sent me for PCOS testing. She said it was unlikely but it was important to check (thanks heavens for her thoroughness!). An internal ultrasound showed it is PCOS and a low GI diet and the pill turned life around for me. What possible reason can the GP give for not doing a gynae referral?! Ask and insist they write in your daughter’s notes that they have refused - this can sometimes prompt action.

Wow, a GP dismissing female concerns. Never heard that one before! Get a second and third and however many is necessary opinion!

Deffo see another GP - you need a 2nd opinion

They could look at thyroid, adrenal gland, hypothalamus, pituray gland, genetic testing and POI. The fact she had periods and then they stopped, they need to be investigating every possible cause. Ultrasounds will be the first stop, but if nothing showing there, there are other tests that can be done.
If you Google scholar (where you will find knowledgable research, not normal Google engine) for Amenorrhea and you may possibly see some other symptoms connected with an issue that could narrow it down.

Seconding this recommendation to test for congenital adrenal hyperplasia – CAH is under diagnosed and presents very similarly to PCOS, but has different root causes and is managed differently.

Bmi of 24 is high for a 16yo. Shocked so many are saying it isn't! That's the top end of healthy for an adult woman. Most women are much slighter when they are 16 even if the same height. Mine was probably about 22 at 16 and I was definitely the chubby one!

Although I've not heard of that effecting periods- too light yes, but not too heavy unless we are tlaking grossly obese.

I would pay for private investigations as this point. But I would also be watching her weight, for other reasons.

This is indeed dreadful from the GP and should be reported further.

I would change GP practice and in the meantime complain about this particular GPs conduct to the practice manager.

Your DD needs a diagnosis first and foremost and I would look into seeing a gynae privately. I suggest that action as waiting lists for gynae in many areas of the UK are miles long.

PCOS is a distinct possibility here. LH and FSH levels should be checked as part of a day 2 blood test and these levels should be compared against one another. Looking at them separately is a waste of time, they must be compared.

You should not have to pay for private

• complain to the practise manager and ask to see the gp who specialises in women’s issues or just a female gp
• ring 111 and tell them you are not happy with local gp service (local Peds nhs hospital told me to do that)
• go to a participating chemist and get her the combined pill - it’s free - that should hopefully get her started and help her skin.

I get LV life insurance for less than 15 a month and it comes with a GP app where you can ask for a second opinion. I've never tried it but might be worth it for this. You can include your family in your GP appointments and it's unlimited appointments through video.

I'm shocked. I'm no expert but believe that being very underweight leads to missing periods whilst overweight girls are more likely to start early. And she's not overweight. The GP's response sounds lazy to me. Why not say s/he doesn't know and refer her on?

I just put it her age height and weight into the NHS childrens BMI calculator and its shows her to be within the healthy range, again im aware its the upper end. But i dont believe encouraging her to lose weight at 16 when everything points towards her weight being ok would be the best choice for her. Yes i encourage her to make healthy choices, and have certain foods in moderation, but i dont want to try and tell her she is overweight when she isnt. That could impact her relationship with her body for life being told that by your mum at 16.

It’s frustrating. I’m having the same issue. My daughter is 17 and in the middle of the healthy weight range, and hasn’t had a period for over a year. Lazy gynae has advised to put her on the pill after a couple of blood tests and an external ultrasound. I’m going private.

First, see a different GP.
Second, complain to the practice manager about the original GP. Your daughter isn't overweight and the advice was inappropriate. Unless she's really tiny height/build wise then that BMI is perfectly fine.
Third, request a referral to gynaecology and/or endocrinology.

What your daughter is experiencing needs investigating and cannot be fobbed off with 'oh well she's not skinny' (which is effectively what the doctor is saying). Fwiw, cysts do not need to be present on the ovaries for a PCOS diagnosis. The high testosterone and lack of periods combined is enough to tick the 'PCOS' box. But it might be something else and needs investigating.

With an interim assumption of PCOS, regular exercise (especially with weights) and a Mediterranean diet that's lowish in refined carbs is a good start and is a good lifestyle for almost everyone.

But do push for another GP and a referral - and DEFINITELY complain!

I had a friend at school who had really irregular periods like this and turns out it was PCOS, so I'm seconding this.

The B.M.I. isn’t really reliable tool in terms of body composition. I am B.M.I. 23/24 ish zone and I do not in any way look overweight or even remotely overweight as my weight is distributed on my bottom half more than the top and I have a fairly muscular physique as in I have big visible thigh muscles. The BMI would say that Dwayne Johnson was obese and he is one of the leanest men on earth tbh! You could measure her waist height ratio for a better idea of her body composition

Diet does help PCOS for sure but you need to get to this point of working out what’s going on

But that's why there's a range
Some will be lighter and some heavier
I was always the tallest broadest person, and I've never been light even as a lanky teen with a normal BMI
My petite narrowed shouldered friend was a lot lighter