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Loss of Period
September 2000

Q. I had gastric bypass a year ago and have lost a great deal of weight. I'm still maybe 25 pounds overweight. My doctor said that my period would likely return once my weight got closer to normal, but it hasn't. What tests would you recommend? What could the cause be? Could it be that I will never have a period again and what would that do to my body? Could it be dangerous? I'm only 28!

A. The type of menstrual failure you have is termed Secondary Amenorrhea. This means that you did menstruate in the past, but for at least the last 6 months, you have not. There are several causes for this; Weight loss, often associated with vigorous exercise (commonly seen in athletes, and Anorexia Nervosa) and stress are common causes. The other possibility is Polycystic Ovarian Syndrome. Most of these women have excessive hair growth (hirsutism), obesity, and infertility due to excess androgen hormone. Thyroid disease and pituitary tumors of the brain can also cause amenorrhea. Pregnancy should be ruled out also. Also, after one stops the Birth Control Pill, it may take many months for menstrual periods to resume. It is important to evaluate this problem so that the underlying cause can be treated. Also, there may be a significant increase risk of developing premature Osteoporosis (thinning of the bones) if this disorder is not corrected.

Many of these disorders can be screened for by blood tests. You should have a TSH, FTI, Beta-hcg, prolactin level, LH, FSH, and Estradiol. I also would check a vit B-12 level which may drop after gastric bypass. The results of this evaluation will help your doctor help guide you with the next step. Sometimes hormone replacement therapy with Provera is used to try to induce your menstrual period. I also would suggest backing down on any strenuous exercise. Walking at a leisurely pace should be ok. Make sure you are getting adequate nutrition as well. In most cases, women can be helped with the above treatments and will resume having menstrual periods.

Good Luck

Reference:

  • (Journal of) Obstet Gynecol 1985 Jul;66(1):5-8 Citation Ids: PMID: 4011070 UI: 85241237

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