post pill amenorrhea fertility and bone density

[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.

Coming off the pill can cause issues with your cycle for up to 12 months, even without your additional difficulties. So you won't know until then whether you will menstruate.

It's very, very rare to ovulate without periods though. How do you know you are ovulating? Periods without ovulation are much more common.

Pregnancy is a very risky thing for you to do.

I check my cervical mucus and experience temperature drops. My gynecologist also told me that she could tell from the transvaginal ultrasound that I was ovulating (and the date she estimated I ovulated corresponded to the date at which my temperature dropped).

can you explain why it is risky? because of my history of anorexia? or osteoporosis? or is it dangerous to consider getting pregnant if you are not yet menstruating?

all the above.

I have a history of severe anorexia (lowest BMI 12) and I used to always have periods until I dropped below BMI 15. I too have osteoporosis. My periods have never settled down in recovery and I tend to get 1 or 2 a year and I am BMI 22. I somehow got pregnant unexpectedly and am now 17 weeks. Anorexia and the hormone changes from being on oral contraceptives will mess with your cycle. Just takes time to settle down.

Ignore the pp, they are spouting ignorance. Not dangerous to conceive if you don’t have periods, I’m guessing you are taking calcium supplements and having a history of an eating disorder will not make you have a high risk pregnancy (unless you relapse of course).

One thing to consider though, work on as many of the body image related issues before pregnancy as I have found the changes in my body and weight very hard to cope with.

Thank you for your message and kind words. And congratulations!!!

The risks of an anorexia history actually worry me the least because I know what might happen, I have strategies to deal with them, and I am able to have very frank discussions with my OB-GYN about preventing relapse. Osteoporosis is more concerning because its consequences during childbirth are unknown and understudied.