No Normal Menses at 17 years old
Question
I’d like your opinion on this: a teen gets her first menstrual cycle at 16.5 years old. She has 2 light cycles, and then nothing else for the past 8 months (She is small- 5 2′, 105 lbs). Â Tests were done- the only thing noted was her lack of production of estrogen. The suggestion by the Dr. is to put her on a low dose of birth control pills. I’m not crazy with this idea- yes, her body needs/should produce estrogen, but will this cause her ovaries to not kick in on their own, seeing as how the estrogen is being supplemented? I realize the concern with osteoporosis down the road. She takes a calcium supplement and does weight bearing exercises. She is not sexually active, and doesn’t plan on being so until marriage for religious reasons, so the the idea of being on “birth control” Â has an uncomfortable stigma attached to it also. How necessary do you feel this is? Is the lowest dosage of “birth control” pill still possibly too much for her situation? Can you suggest any alternative? We meet with the doctor again in 3 weeks, so I have to make a decision. Thank you.
Answer
Last Updated: July 23, 2013
I would not worry so much about osteoporosis later, as osteoporosis or osteopenia right now. A dexa-scan can be done to determine her bone density at the present time. If it is low (osteopenia, or osteoporosis) she should have some type of estrogen supplementation to prevent further bone loss, and put effort into improving nutrition until she has more regular menses and better estrogen on her own. If her bone density is normal, I would concentrate on better nutrition with specific weight goals and follow her bone densities until higher estrogens are established. If she is engaged in competitive athletics and has decreased bone density, it may be more difficult to raise her BMI. Athletics are a choice, and some girls choose competitive athletics and estrogen supplementation rather than decreasing athletic activity.
If it is determined she needs estrogen, bioidentical estradiol patches can be given (at the higher dose ranges to keep her estradiol levels in a normal range), along with bioidentical progesterone pills (prometrium) for 10-12 days each month. These natural hormones will protect her bones, produce withdrawal bleeding (like a period), and are safer for future fertility and for cancer prevention than oral contraceptives. If she gains weight, she can go off the hormones for 3 months and see if her own natural periods are returning. The natural hormones do not cause the same side effects as oral contraceptives, which are 6-10 times more potent than necessary.
M. Davenport, M.D.
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