No periods, small uterus and baby worries

Dear Dr Mitchell,
I am 28-years-old and unmarried. I started having my periods at age 16 but after that they stopped. I went for treatment and the doctor gave me a medicine called Diane 35 - it's 28 tablets and I had to take one daily. I had my periods and took it for six months then stopped. When I stopped, my periods also stopped. I went to another doctor and she said my ovaries are not working but eggs are there, and my uterus is so small I can't become a mother. Is there any treatment?

The irregular pattern of your menstrual periods seem to be due to the fact that you do not ovulate. Diane 35 is an oral contraceptive pill which is sometimes used to regulate the menstrual period. It will cause you to have a withdrawal bleeding and have regular predictable menstrual periods as long as you continue it.

When you do not ovulate, then the menstrual period is not regular, and is unpredictable and as in your case, does not come unless medication is given to stimulate the lining of the uterus. Some of the causes of failure to ovulate (release an egg every month) include polycystic ovary syndrome, problems with the adrenal glands, anorexia nervosa, high prolactin levels, hypothyroidism, disease of the pituitary gland in the brain and premature ovarian failure.

Polycystic ovary syndrome cause irregular menstrual bleeding, hirsutism (excess hair growth on the body) and obesity. Excessive psychological stress, exercise or weight loss may also cause failure to release an egg every month and result in the absence of the menstrual periods. The fact that your problem has been present since age 16 when you had your first menstrual period suggests that you have definitely not been ovulating. You need to get a detailed physical examination followed by a detailed ultrasound scan and blood tests to determine the cause of your failure to ovulate. The blood tests should include tests to assess your thyroid gland, pituitary gland and ovaries. Most cases of failure to ovulate can be treated once you identify the specific underlying cause.

Polycystic ovarian disease can be treated by weight loss, Clomiphene citrate and Metformin. This form of treatment will induce ovulation and help you to become pregnant.
Elevated prolactin levels can be treated with a drug called Bromicriptine and once the hormone level is controlled, ovulation and regular menstrual periods will occur. Hypothyroidism responds well with supplementation of thyroxine tablets.

Premature ovarian failure is a real challenge and the success with trying to induce ovulation and establishing regular menstruation is poor. However, there is still hope because you can actually receive donor eggs from an appropriate donor and do in vitro fertilisation (IVF). In vitro fertilisation is also an appropriate option for patients with polycystic ovarian disease who do not respond to the usual drug therapy that is used to induce ovulation.

The small size of your uterus needs to be evaluated. A hysterosalpingogram - which is an x-ray which outlines the cavity of the uterus and fallopian tubes - will help in identifying any abnormalities of the tubes and uterus. This test can be done at most of the places that do ultrasounds and x-rays and is a safe and simple test.

If your investigations done show that you have premature ovarian failure, then consider doing IVF with donor eggs. Adoption is also a good option and brings a lot of real joy to women who cannot conceive. Consult your gynaecologist who will examine you and do all the appropriate investigations to determine the underlying cause of your failure to ovulate and menstruate.
Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via e-mail to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.

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