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.

@Chimichurrie as PP’s have said low carb/sugar diet plus Metformin, DD is 32 now and has more regular periods and has been told there can be some improvement between 30 and 35 when testosterone levels drop naturally and it can be a bit easier to conceive, she doesn’t have children yet.

It took a long time to be given a diagnosis of PCOS though, I hoped things might be better these days.

She does exercise now, and is very active anyway.

How active? Is she doing the equivalent of an hour or more day every day of the week? As if she is BMI is beyond useless for her.

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

Please make sure either her or you get print outs of all her blood tests so you get the ranges with them.

What were her iron levels like on the blood test, OP?
My DD’s periods stopped, no cause found. But her iron level was just in the ‘normal’ range, GP tried her on iron tablets for a while and sure enough they worked. She’s on high dose ferrous fumerate now and her periods are more or less like clockwork.

But whatever the cause obviously your DD needs an answer. Good luck.

Do any family planning clinics near you that have gynecologists? In my area you can self refer, and they tend to be fantastic, much preferable to experiences I’ve had with hospital referrals.

So using the advice on here i have just called the practice and spoken to the manager.

I mentioned how she is showing 2/3 of the Rotterdam criteria which is a diagnostic tool for PCOS and is also within NICE guidelines.

I mentioned how the GP misled me by saying blood tests for PCOS came back normal, without telling me that high testosterone is a marker considered for PCOS.

I mentioned how her weigh, whilst being healthy, its the higher end of healthy, could be attributed to the PCOS due to insulin resistance (please tell me i go this right).

I mentioned there are other health conditions that her lack of periods could be attributed to if it isnt PCOS, yet none of these have been explored or addressed, we were just told "diet and exercise to lose weight".

I mentioned how i feel we have been fobbed off for years, and that telling a young girl within normal weight range to lose weight can be damaging to her MH and body image when there is clearly an underlying medical issue that needs addressing.

I said i understand that diet does have an impact on PCOS, however, there are also treatments, and that having the diagnosis also allows her to explore treatment options that can potentially help with her weight, her acne, and regulate her periods, and that not even allowing us to discuss these options is not acting in the best interests of my daughter.

She is speaking to one of the GPs, not sure if its the same one my daughter has been seeing (our surgery tries to keep appointments with the same GP you initially saw for consistency) or another within the practice, and then she will call me back.

She cycles her paper round 6 days a week, which is 2 miles there, does the round, 2 miles back up hill. She cycles to college which is about another 2 miles away. She also cycles regularly on weekends for fun through the local woods etc.

Please push for a 2nd opinion/change G.P. I was constantly fobbed off by Dr when I hadn't started my periods at 16 with 'oh she's just small' even though mum had started hers at 12. Until I seen a locum GP who was more on the ball and had me tested for Turner Syndrome and bingo I had it. If it hadn't been for her that day who knows how long they'd let me go on. It meant I was too late to start growth hormones 😡

My periods started when I was 12 and came regular as clockwork for 40 years. I was overweight when they started. Your GP is quite outrageous - are they even medically qualified? Time to find a new GP, ideally a woman if possible.

The GP we have been seeing is female

No words. That’s even worse. I’m so sorry.

OP I'm glad you complained to the practice manager.

I said some rude words when you put more detail into your posts as it is clear you and her are being fobbed off.

That's outrageous. Even more so that a woman GP is so out of touch regarding this subject. Your daughter is within the healthy range of BMI, so how on earth would her normal weight be affecting her periods?

I'm seriously baffled at this GPs attitude. I've come across a few in my time that seem to have no interest in actually getting to the bottom of things, but just assume everything is fine and/or everybody is a liar/exagurates. It's not on. Your daughter should definitely have regulated her periods by now, I don't know a single friend from when I was at school that had 2 years worth of up and down random periods before they settled. Personally, I was like clockwork from day one, as were almost all of my friends, bar a couple, including one girl who did have PCOS.

You said all the right things by the way. New GP and someone a bit more on the ball and they will be all over this and able to figure out the problem.

I've been researching period issues for my DD. I was pointed at a You Tube channel for Dr Gail Busby. I watched a really interesting video yesterday about PCOS and how diagnosis in adolescents is different to adults.

To answer an earlier question too they don't do internal scans for young adults who are not yet sexually active.

Watch the videos and push for a gynaecologist.

my only marker for cysts on my ovaries was high testosterone. no diagnosis as this was part of investigations for recurrent miscarriage and I’m now pregnant so only monitoring of cysts.

fwiw I regulated my cycles from 40+ days to 28 by cutting out sugar and UPFs. however I’m in my thirties not a teen.

I would suggest asking GP to look for secondary PCOs, particularly prolactinoma. Mine started in my late teens and has cause problems ever since.
It’s very much a specialist area, but because of the pill, it may actually be more common than realised because the pill will mask the symptoms.
High prolactin can be the result of a benign tumour in the pituitary or secondary to thyroid problem. It’s easy to miss, my lack of periods was put down to stress, uni exams, final exams then starting a high pressure job.

There are two reasons to push for investigation of prolactin levels. Firstly it often doesn’t come to light until you are trying for a family. It’s associated with high miscarriage risk. Secondly it significantly increases your risk of breast cancer and coronary heart disease.

Symptoms include gradual onset of amenorrhea, fatigue/lethagy ( basically lack of oomph) and discharge from the nipple. It does n’t pour out but often leaves a crusty crystalline residue.

The symptoms are very subtle and easy to blame on other more obvious problems like weight or stress.

Push for a prolactin level, or maybe ask for referral to private women’s clinic. Where they have an endocrinologist.

Do by all means push for a referral, but you need to read up on PCOS. You don't actually have to have cysts to be affected. It's not all about weight. I would say take a serious look at your daughter's diet and exercise once you've read up.

I was diagnosed with PCOS in my late teens and the GP I saw to follow up with told me it was all in my head (even though the scan had shown something). My periods came back by themselves, but the lack of support (and Internet!) then meant it was years before I learned more. It doesn't have to be that way for your daughter.

I found this useful just the other day: Diary of a CEO podcast with the Glucose Goddess.

Simple steps can be taken!

It may seem harsh what the GP is saying, and he is certainly not giving you precise enough information, but those with PCOS need to eat more carefully and exercise more than those who don't have it.

It's so miserable having acne :( Please fully support your daughter to explore and make the lifestyle changes alongside pressing for any more support from doctors.

Good luck!

BMI of 25, is breakpoint for overweight. To get from 24.2 to 25, is probably 1KG. Very close.

Not sure why instant reaction is that Dr is wrong/bad/awful.

Try keep an open mind. Perhaps consider a goal get BMI closer to midpoint or BMI of 22 for 6 months. Then see doctor if there’s no improvement.

Seeing a private Dr, and explaining you are there because nhs Dr told you that weight loss could help.
But that you think Dr is wrong. Can indicate that you are being somewhat negligent. Also puts him/her in defensive situation where they feel cannot tell you same diagnosis. Then you are “Dr shopping”

Weight loss will either correct “problem” by eliminating excess fat as contributing to lack of periods & acne. If it doesn’t correct with periods starting, then you have successfully eliminated excess fat as contributing factor. And, your child is at a healthier weight.

I have a child that gained a lot of weight in teen years, I was desperate for support with weight loss from nhs (did not get any). It’s always less calories, more moving around. Mostly less calories. Whole family needed to lose some kg, big changes to meals.

I fully grasp her weight is the higher end of what is considered healthy, my issue is the refusal to explore if there is an an underlying medical reason causing no periods as i find it incredibly hard to believe her weight is the ONLY factor, which is what the GP is suggesting.

It is not as simple as calories in and out and exercise if you have PCOS, it tends to cause weight gain in itself due to insulin resistance. I don’t think the OP’s DD needs pressure to lose weight as well as coping with the distressing symptoms she is having.

My DD has managed to get much closer to a healthy weight since being treated with Metformin.

@pointedlypointless it’s based on such minimal information. A lot of lean athletes who build muscle even non professional have high bmi’s. It’s not one size fits all. OP’s DD is active and fit and could be lean of body fat but come out high for lots of other reasons. Waist to height ratio is far better. I just gave myself as example of high end normal bmi but lean of body fat

Just FYI - my BMI is 20.8 and this is my "natural" weight when doing some exercise and eating healthily. Has been for 20+ years. If my BMI got up to nearly 25, assuming I hadn't gone to town on strength training, I'd be 11kg heavier; much of which would be unnecessary fat. This actually happened about 25 years ago and pictures from the time clearly show someone who was an unhealthy weight. BMI is a very crude measure of what's healthy in the context of weight.

Your GP has made their assessment, given some advice, and it's evident that you disagree with it. Nobody on here is privy to the exact information the GP has to make their assessment. Including any knowledge whatsoever of your daughter.

Just ask to be reassessed by different GP and see what conclusion they come to, rather than "pushing" for a variety of (potentially expensive and unnecessary) tests on the basis of a non-medical Internet forum.

OP I had a thought - and I should have posted before - you shouldn't really be using BMI like that for someone under 19. It supposed to be a age, sex and height based percentile comparison.

I have PCOS, ( not sure if being post menopause that still counts as active). I wasn't ever overweight, I had shocking acne, very greasy hair and skin, regular periods, very hairy everywhere. I also struggled to conceive and had multiple miscarriages. The point I'm making is that it's not necessary to have every symptom of PCOS to actually have it
And doctors really ought to know that. It took me ages to get a diagnosis. I had hoped that in the 40 years since I did, there would be better diagnosis and better knowledge of it.
I thought immediately that your DD had PCOS. Please carry on asking your GP for a second / third opinion.

I agree, checking the percentile she has followed will be useful to track across time. It’s not like we measure babies or toddlers BMI’s, they haven’t stopped growing yet, many teenagers have growth spurts and gain fat and lose it through puberty. The BMi is a frustratingly useless tool that wasn’t meant to be used on children. If a child has always followed the 80th percentile then that’s a good indication they are following a track. Everyone has a different body shape and stores body fat in different areas. There are 3 main types of body shapes and a BMI doesn’t account for any of them. @Whoknows101 I would look unwell at BMI 20, I would have to drop muscle, am not built that way I am more of a mesomorph shape with not much fat in the middle area but even when I get my body fat down I am still top end, if someone was an ectomorph and gained weight it would be very visually obvious and not suit their frame shape

High testosterone + irregular periods =PCOS

You need two out of the 3 criteria for diagnosis of PCOS. 3rd is polycystic ovaries on scan but she already has 2 of the 3.