15 yr old not had period for 12 months

[cartreffi]

My dd started her period at 13 years old, had regular periods for about a year, but has had nothing in nearly 12 months. I spoke to the doctor about it 6 months ago and she wasn't concerned, said it's quite common but did a blood check to rule out diabetes to be sure. She exercises a lot and is extremely lean, very little body fat, but she eats really well, lots of protein and good fats as she takes her fitness very seriously, and I've seen her Portion sizes and amount of meals and snacks she has, and it's really good, so I'm not concerned that she's not eating enough on purpose, however possibly she needs to up her calories for the amount of exercise she does, plus she is 5 foot 9 so maybe needs more calories than she realises. Could not having her period for such a long time affect her fertility?

If she has low body fat it's not unusual that she has lost periods.

I lost my periods due to anorexia but I didn't lose them until I started treatment and gaining weight so eating better but by this point my fat reserves were pretty trashed.

It might be worth seeing a dietician to make sure that her diet is sufficient for the level of activity. I had a friend who did a lot of exercise and wasn't much bigger than me when in treatment for my eating disorder but she at 3 meals and 3 small meals sized snacks to sustain the exercise. She did ballet and swam competitively.

It didn't impact my fertility or at least I conceived within a few months of trying. I went on contraception for 12 years from leaving treatment until stopping for conception and before my periods restarted. One thing that I am unsure about is my bone health once I'm past the menopause as I have a history of osteoporosis in my family and it can impact your bone density too.

A little bit older than your DD but at 19 i didnt have any periods for a year. It was dismissed by my GP as related to the stress of uni but at 28 and after many many years of hormone and period related issues, a lovely locum GP finally got me some help and i was diagnosed with PCOS. Although PCOS is usually associated with weight gain, there is a "lean" version which isnt associated with insulin resistance. If she ups her calories and it still doesnt make a difference, then it might be worth asking for a blood test to check her hormones? I was referred to the endocrinology dept at the hospital who sorted out my diagnosis - he told me that long term, less than 2-3 periods a year can increase risk factors for more serious complications later on in life so they can prescribe medication to bring on periods, but it sounds like you are already monitoring the situation, so maybe just push with the GP if nothing changes?

It did have an impact on my fertility (i suppose 9years of messed up periods will do that!) but with a bit of help from the fertility clinic, i have one lovely DD and am pregnant with baby number 2, so hopefully nothing to worry about yet!

Thank you both that's really helpful

Have you heard of RED-S? It sounds like it might be relevant (https://blogs.bmj.com/bjsm/2019/04/22/relative-energy-deficiency-in-sport-red-s-recognition-and-next-steps/). I had this in my mid 20's when I took up running, and lost my period completely for a year and didn't have it regularly for 3 years, but conceived first time of trying last year. It can cause other health problems too so I would take your daughter back to the GP. Also, there's still an attitude that a lot of exercise means you lose your period, but it shouldn't be the case as it can cause problems (particularly with bone density)

Similar story to PP - anorexia caused me to be underweight. In my case my periods cease at BMI 20 on the dot which especially for a sportsperson is not particularly visually skinny. But the threshold varies person to person, I guess I’m saying she might not look emaciated but it still might be low bodyweight/body fat percentage.

So yes I thought of RED-S. I would be less concerned about fertility than about the impact on bone health. As I understand it, if you do not have menstrual cycles this impacts how calcium gets laid down as your bones develop. The window for this process closes in the early 20s so the longer one has no menstrual cycles as a teen the thinner the bones end up and this has impact for risk of fractures and for bone health later in life/post-menopause.

I would encourage maybe a session or two with a sports nutritionist. I had two or three bone scans due to my anorexia and one could see the impact of my low weight on bone health so I would take it seriously.

Thank you so much for this. I'm making an appointment this week for her and I will bring this up.

Thank you, it really does sound like this