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.

High male hormone levels can be a sign of pcos, they need to investigate further as it doesn’t always show all the time and high testosterone is obviously not good, she is within normal bmi range, and hormones can cause excess weight anyway (testosterone bulks)

I have PCOS. I asked my GP about my 15 year old. They shrugged it off. She has all the symptoms. She was on the pill for her acne after starting periods age 11 but her weight exploded. She came off of herself she 14 as she wasn’t taking it regularly so having periods every time she forgot for a few days!! Her periods took a while to come back but they are very heavy and more frequent than should be -2 week gap. She’s definitely overweight. I’ve had her at the GP about something else which could be related and even mention her weight. GP said PCOS isn’t something they consider unless she wants a baby later in life. Hmm. Referred to paediatrician who then wanted to consult someone else about PCOS as she’s never dealt with a teen who might have it. Had no further tests other than bloods. Paediatrician still hasn’t mentioned weight. But my DD is autistic and they’re trying to blame that for her other symptoms - saying she feels things in her body more than NT people. She’s having full on hot flushes and dizzy spells. Anemia ruled out. Low iron dealt with by some supplements but nothing much has changed. Waiting for paediatrician to get back to me after consulting colleagues on PCOS but they keep cancelling out appointment.

I saw a specialist on This Morning the other week who said they don’t like to diagnose PCOS under 18. They talked about healthy lifestyle - eating and exercise - as first port of call anyway. But easier said than done with an autistic teen who avoids exercise and eats the same things a lot.

My PCOS wasn’t picked up until my 30s when I went for fertility investigations. It had been dismissed by the GP as bloods were borderline and I was underweight-healthy weight most of my life. I fell pregnant whilst awaiting fertility results so was never given an answer but when we struggled second time I asked gp what the outcome of my tests were from the fertility clinic and she confirmed PCOS.

Stress and anxiety can cause periods to be missed. PCOS is also a possibility. Usually being underweight causes them to stop. But it’s definitely worth perusing for an answer.

I’m not an expert but I had a colleague who wanted a baby and her doc said if she lost weight her periods would return
She lost the weight and indeed they returned and she had a little boy. There are ex two colleagues actually altogether and a relative and all three lost weight and periods returned

PCOS is a range of medical signs, (as you probably know) some people have several of those, some just a few. I would ask for a referral to an endocrinologist for an opinion, over and above a gynaecologist. You and your daughter are very sensible to be proactive about this, imo. You may need to insist on seeing another GP and aak that person for the referral. I have 2 wider family members with PCOS, both have encountered very varying levels of knowledge and understanding in GP land, I'm sorry to say. Now both under the care of endocrinologists.

I thought she was going to be underweight! I've never heard of being over weight stopping periods. I was at the higher end of healthy as a teen and my periods were like clockwork. I'd be worried about the high testosterone, with things like intersex and Turner's syndrome in my head.

I was going to suggest this too as had the same issue with similar symptoms.

I think you should challenge your GP asking him for a referral to a gynocologist and an endocrinologist . If he says no, they just find another GP ASAP. British GPs seem to think, in my experience, that referring to a specialist somehow means they aren't competent. I live in France and here anything unusual gets referred.

That doesn’t sound right at all. Change your GP asap

I can’t see being in a healthy weight range could affect her periods unless she was extremely muscular and had very low body fat.

☝️☝️☝️This

A family planning clinic might be able to advise the OP. You don't have to be sexually active, but they have so much experience because that is more or less their expertise. I think the OP should take her DD to a clinic, because I don't think a referral is necessary. They probably would know without doing a physical examination, because they see so many women and girls.
It is what I would do. GPs don't know everything.

A family planning clinic can give a letter to a gynaecologist if they think something is wrong. They can also write to GPs.

When weight was indicated in the heading, I was going to assume massively underweight, as very overweight people still get periods.
At 16, and no regular periods, especially if she's concerned, I would be pushing to get this investigated.... can you see a different GP? A female one?

High testosterone and and absence of periods or very long cycles meets the criteria for PCOS even without the polycystic appearance on a scan. They should also check her prolactin levels, as high prolactin can hinder ovulation as well.

Does she have symptoms of high testosterone? Excess hair growth etc?

If her prolactin is normal I would get a book such as Marilyn Glenville or Felice Gerch books on diet and lifestyle approaches to PCOS and see if this helps. The GP would most likely only offer her the pill which isn’t a fix, it only papers over the cracks.

Sorry to jump into OP's post, but @rockstuckhardplace I'd be really interested to hear how you got on since I could have written your post

GP not overly concerned as DD has had regular periods in the past. GP thinks periods will just kickstart soon now DD has put on weight. I actually held off seeing the GP for a few months so that that theory could be ruled out. DD is booked in for bloods this week to test hormone levels. @Uni24Woes

That isn’t true
I was diagnosed with PCOS in my twenties. My mother has it too. We are both very overweight and, despite yearly checks, neither of us have ever had diabetes
The DR said it increased the risks (hence the regular checks) but does not mean diabetes will automatically follow!

Thanks @rockstuckhardplace

I'm trying to persuade DD to go back, GP was so breezily dismissive when she went over a year ago now (blamed on exam stress, activity levels and weight). None of those factors apply now but she's still not having periods. It's a worry. Hope you get somewhere

And I thought I read that periods only arrive when a girls body achieved 17% body fat?

I had my period only few times a year from 12 to 19. Then I went on birth control (progesterone+estrogen) and got my period every month like clockwork. Have you tried this?

Not surprised you DD doesn't want to go back.

I would worry about her bone health though I'm not sure of the best way to show a teen you can get fractures from 50s onwards, as that age is ancient to them.

Wow. Although I don't have this experience myself even I've known about insulin resistance for almost 20 years as it has been mentioned on the news. How come the doctor doesn't so many years later? Demand to see a gynaecologist. Say thanks but we need a referral. If she has insulin resistance the best way to get pregnant one day is metformin or whatever diabetics take. I've seen it help women.

@mumofteenss hey op, I have PCOS myself, and now my dd 14 is seeing a dermatologist about her acne - the derm wants to do bloods to check for PCOS as a likely cause. I'm so sorry you're had such a crap experience with the GP, but well done for questioning things, advocating for your dd and being assertive. Hopefully armed with some research and NICE guidelines you'll be able to get your dd referred. It's an endocrinologist she needs to be referred to.

I have what's called lean PCOS btw, I'm part of a charity support group and there are lots of us out there who aren't overweight or are slim, so it's not true that being overweight is always a factor in PCOS. Also PCOS can't be cured or reversed as some claim, symptoms can be decreased and managed though. I'm so glad you're not focusing on your dd's weight and please ignore those saying restrictive eating can cure PCOS!

I highly recommend the PCOS charity Verity, they've been v helpful over the years for me, and you can also join their private Facebook group if you want to ask questions or discuss your concerns about anything. Just search for Verity UK
PCOS in Fb groups.

Here's a link to the Verity website you may find useful, as it lists the blood tests recommended for diagnosing PCOS:

www.verity-pcos.org.uk/diagnosing-pcos.html

I was also diagnosed with a prolactinoma after my periods stopped completely. Ask for her prolactin levels to be checked. It’s only a blood test and you should be able to do this via your gp. I was referred to an endocrinologist after this and put on medication. Once diagnosed it was very easily managed. Good luck op

@mumofteenss I havent read the whole thread but imo it sounds like PCOS (even if all the bloods have come back “normal” this time). I have PCOS and it was only properly diagnosed by an endocrinologist - you need to try to insist she is referred to one by the GP (if you can) who will do repeat bloods and possibly more detailed scans to look for cysts as well as making notes of other indications like acne, excess body hair or hair loss (from the head).

You can get “slim” PCOS (where the person is not overweight) and acne and erratic periods are two of the major signs -as is your daughter’s age as many women are first diagnosed in their late teens/early twenties (luckily as if you wait till later when you are trying for children it can sometimes be much harder).

If your GP refuses to refer her another option is to ask/beg them to prescribe her Metformin. That’s the first med the endocrinologist will likely prescribe anyway if they diagnose her, as generic Metformin is super cheap compared to most drugs (and may even help acne too on top of regulating periods - it does have nasty gastrointestinal side effects at first though).

You could also try Myo- inositol, a supplement that does the same thing as Metformin (but without the gastrointestinal side effects) - it works in a slightly different way to Metformin (so you can even take both - I do). Mix 2mg of the powder morning and evening in a cold drink and it should regulate her periods if it is PCOS within a few months (and should do her no harm if it isn’t PCOS- it’s a very safe supplement as we get smaller amounts naturally in our food. I use the Lamberts brand personally but there are lots out there ). HTH!

I think she needs to see an endocrinologist. In your position I would see a different GP and request this.