Question
When I was 20 my periods stopped. From the ages of 14 to 20 I had normal periods, and after blood tests, etc, showed that there was nothing abnormal, the doctors put me on the pill in order for my periods to return (which they did). I didn't like being on the pill and have since come off it, but still have secondary amenorrhoea (in other words, my periods have vanished again). Although I am slim, I am doubtful that this is a contributing factor, as I have always been this way. Do you have any suggestions as to the cause? Is there anything I can do to try and get my periods back? The older I get, the more worried I become that I will have trouble starting a family one day.
The consultant
Janice Rymer
The fact that your blood tests showed a normal hormone profile is reassuring, because it means your ovaries aren't the problem - they're just 'sleeping' for some reason. The most likely cause is because your brain is telling you not to menstruate. The brain is very sensitive to changes or strains in the body, particularly stress, being underweight and too much physical exertion (many elite female athletes have irregular or no periods). If your Body Mass Index (BMI) is under 19, you need to put on weight. If you are over-exercising, this will also be affecting the hypothalamus, the area of the brain that has an indirect influence on ovarian function. Seek help from a specialist if you find it difficult to put on weight by yourself. Finally, if stress is an issue, try a relaxation class, counselling, massage or a night out with friends. Relaxing and eating healthily will almost certainly solve the amenorrhoea.
· Professor Janice Rymer is a consultant in Obstetrics & Gynaecology at Guy's and St Thomas's Trust, London
The dietician
Jacqui Lowdon
It's not unusual for periods to stop due to dietary imbalances or low weight. Working out your BMI will give you a good idea if you are underweight. Divide your weight in kilograms by your height in metres squared to find out your BMI (or visit www.nhsdirect.nhs.uk/interactiveTools/bmi.aspx). A healthy BMI is between 19 and 25. Under 19 is on the low side - your body may decide you're too lean to have a healthy pregnancy, hence the lack of periods. If this is the case, contact a dietician (British Dietetic Association, 0121 200 8080) for advice on nutrition and tests for dietary deficiencies such as iron (a common cause of amenorrhoea). If your body lacks iron, red meat, green leafy vegetables and pulses are all good sources. Taking vitamin C can help absorb iron, so drink an acidic fruit juice with your meals, but avoid tea and coffee, as these can inhibit absorption. If there is no improvement after you've changed your diet, seek further advice.
· Jacqui Lowdon is a registered dietician at the University Hospital of Wales, Cardiff
The acupuncturist
Angela Hicks
The pill is really a short-term remedy that doesn't treat the root cause. In Chinese medicine there are a number of possible causes for your problem. The most common cause in young people is a poor diet, or one lacking protein. Over time, this lack of nourishment depletes your energy and blood. Two other possible causes are over-exercising and emotional strain. Acupuncture is an excellent way to restart your periods. It will identify the cause and support the organs that Chinese medicine says create blood - the uterus, spleen, liver and heart. There are many valuable points: for example, one on your lower leg has been compared to a nourishing 'chicken soup'; another, on the lower abdomen, is a 'gate' that builds the blood in the uterus. Contact the British Acupuncture Council (BAcC) on 020 8735 0400 for advice or email info@acupuncture.org.uk
· Angela Hicks is a member of the British Acupuncture Council and joint principal of the College of Integrated Medicine
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