amenorrhea after pill

[menvo19866]

I am three months off long term (around 6 years) use of oral birth control. I am ovulating but still no period. It is very important I re-establish it because I have osteoporosis (I am only 32).

A bit of background: I had an eating disorder in my 20s (lowest BMI was 13). I had amenorrhea for about 2 years between age 20-22. I am pretty sure I would have noticed amenorrhea at other points in my 20s but I have been on birth control for the past six years. My history of eating disorders undoubtedly caused my osteoporosis. I have been in recovery for the past three years and am up to a 17 BMI. This is still underweight but I was naturally very thin before anorexia. I have a very narrow frame and this is my pre-anorexia weight. I used to get my period regularly at this weight and I eat around 1500-2000 calories a day (and occasionally more, around 2500 or so).

I have been to different doctors who say wildly different things. My gynecologist thinks I just need to wait a few more months. She also did a transvaginal ultrasound and says my ovaries are in good shape and that I'm ovulating. She says it doesn't make sense to test my hormones because they vary so much. She is optimistic about my ability to have a baby (although we did discuss the dangers of an anorexia relapse).

But my endocrinologist is much more pessimistic. He told me there is no way I will menstruate with a BMI of 17 (even though I have) and wants me to go on HRT ASAP. He hasn't done any blood work yet - this is just based on my BMI and the fact I haven't menstruated since going off the pill - but wants to test my hormones. He says there is no way I can get pregnant without IVF.

I am so confused! Please help me make sense of this conflicting advice.

I only have experience of amenorrhea as a result of exercising too much, not from low BMI - but if you’re on Facebook there are a few useful groups for people experiencing/recovering from hypothalamic amenorrhea where there will be people in a similar situation who can give you advice. Good luck.

You wouldn’t qualify for IVF unless you have a minimum of a BMI of 18. Some clinics require a minimum BMI of 19 or even 20 if you don’t menstruate regularly — they tend to be more flexible with higher BMIs (private cycles might allow 36 or even 37 BMIs) than lower ones because of the impact of weight on periods. I suggest you make an effort to gain weight healthily with protein shakes etc.