AboutEdward Joseph Ramirez, MD, FACOG Expertise I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications American Journal of Obstetrics and Gynecology
Education/Credentials Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
Question Hello, I am 20 years old and haven't had a period in over 2 years. From 18 to 19 I was severely anorexic, but since then I have put the weight back on, and it has been on for more than a year. I eat a balanced diet of 1,200 calories a day and exercise 10-12 hours a week, but I keep gaining weight. I am 5'2" and probably over 130 now, and I just keep gaining no matter what. I went to get blood tests. I tested for everything! It turned out I have "mild" hypothyroidism, and my estrogen, progesterone, testosterone and DHEA are all low. My insulin is normal. I was given levothyroxine (25 mcg) and have been taking it for a week. No difference yet, but I hear it takes 4 to 6 weeks to take effect.
My question is, do you think it would be a good idea to start on the birth control pill as well? Amenorrhea can be caused by hypothyroidism, but I don't think mine is. I think they're two separate issues. Can low sex hormone levels also cause weight gain, and will the birth control fix that? I heard it makes girls gain weight and that's the last thing I need right now. I'm not looking to get pregnant any time soon, but I worry about the future. I've heard amenorrhea can lead to osteoporosis, endometrosis, and different types of cancer. What do you think is my best course of action?
Thanks!
-Christann [writing from Kingston NY]
Answer Hello Christann from the U.S.,
You did not give me specific levels of your hormones, but I am presuming that you have a hypothalamic hypogonadism. That is where the hypothalamus does not stimulate the pituitary enough to stimulate hormone production. Most hormones in your body are produced by this mechanism. It is the reason why anorexia produces amenorrhea as well. If this is the mechanism, all your hormone levels: FSH, LH, TSH, Prolactin would be below normal levels.
Hypothyroidism would decrease your metabolism and therefore could lead to weight gain. You would need thyroid hormone to get that up to normal. In terms of ovarian function, it would be a good idea to go on the birth control pill. If your ovary is not functioning, which it is not at this time, you are not producing the female hormones and this will lead to osteoporosis, heart disease, and many other consequences of menopause. That is not to say that you are in menopause, but the sequelae are the same as someone in menopause. Once you decide to become pregnant, if your ovarian function has not returned, then you would have to take fertility medications (FSH, LH) in order to stimulate your ovary to ovulate.
You should see an endocrinologist to check things out, and see if they can find the cause of these problems. You certainly have gained enough weight to get your hormone production going, but with all the exercise you are still doing, you may not have enough body fat. It is the body fat that is turned into hormone, and weight can come from fat or muscle. Muscle weighs more so that the more muscular you become (the leaner you appear), the more weight you will gain, but still not have any hormone production. Your endocrinologist could have you checked for body fat content.
Good luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
