periods stopped in 14-year-old girl

[EAMom]

Does anybody have any insights on this? PANDAS dd first got her period in 6th grade (11.5 years). She had pretty normal cycles until the spring of 8th grade (March) where her period came but was very light. Now, in the past several months, her period has stopped altogether.

 

We saw her pediatrician in July. Ped wasn't concerned but did run a few blood tests (I'd have to look up what they were) which were normal. But since then, the problem has gotten worse but not better.

 

She did have PANDAS anorexia in 2nd grade. At that point she went from the 25th percentile of weight (50th percentile for height) to totally off the growth chart (down to about 43 pounds.) Body weight wise she is normal now (has been since 3rd grade), about 105 pounds and 5 foot 1/2 inch. If you look at her, you wouldn't say she was too skinny, certainly not at all unhealthy looking. Diet wise, I can't say it's the best, she does crave a lot of processed carbs. She also exercises a lot (is a fencer). She doesn't look at all anorexic or unhealthy however and she seems to have plenty of energy.

 

PANDAS-wise, she's doing pretty well. She has some low grade symptoms (weight, food related unfortunately) but her symptoms seem stable or better vs 3-4 years ago. She was on a low dose of Prozac until 7th grade which she doesn't need anymore. Now she only takes Azithromycin 500mg 2-3x weekly. She does have some low grade OCD, but not debilitating. Unfortunately, lots of her OCD that is left is food/weight related. I know she checks her weight (although now we are getting into "normal' teenage girl stuff). She has a strange doorway OCD which is PANDAS/weight related as well. But to the average person, she is a quite normal.

I made another appointment this Thursday with her ped. From what I've been reading, it's not uncommon for teens to be irregular (but I was always regular). One thing I'm worried about the female athlete triad and osteoporosis (my mom has severe osteoporosis from other causes). Then again, she's not super skinny, not like some of those long distance runners w/no body fat. She just looks quite healthy to me actually, so I don't even know if that is the problem, but I am concerned.

"Amenorrhea: Loss of menstrual periods may signal a change in your body's intricate and complicated hormone system. Hormone imbalance from underfueling your body can result in lowered estrogen production. There are also other causes of lowered estrogen levels. A diminished estrogen level can have many effects; the most immediately apparent one can be bone loss. Amenorrhea can often go unreported to medical providers because of the common belief it is "just part of the training effect." We do know that the bone loss that occurs as a result of this is NOT "just part of the training effect" and can start to occur after just a few months with no period. Click for more information on amenorrhea.

Osteoporosis: Loss of bone, especially if you are an athlete, can be an unfortunate setup for an injury. Stress fractures can sideline sports activity and be slow to repair if you are underfueled. Repeated stress fractures and unexplained injuries should be a red flag to further evaluate your eating and exercise patterns. Bone loss that occurs because of amenorrhea can be permanent; osteoporosis is not just a disease grandmothers get!" http://www.brown.edu/Student_Services/Health_Services/Health_Education/nutrition_&_eating_concerns/eating_concerns/female_athlete_triad.php

Does anyone have any insights or tips? Things to ask my ped, what type of doctor to follow up with if ped isn't helpful. (Frankly, I don't think this is an area of expertise for my ped, but I will see her to hopefully get a referral). Also, could this be tied into PANDAS somehow?

[nicklemama]

I think you should go ahead and ask the pedi for a referral. In fact, you might consider seeing a reproductive endocrinologist vs an ob/gyn. I would call and talk to an RE's office and see if they actually see teen girls with this problem. I'm not really sure if they do. I do know they see menopausal women and infertility is their bread and butter. In my mind, an ob/gyn is an expert on pregnancy in women and also does routine care.

[Missmom]

Just wanted to let you know that the same thing happened to me when I was about the same age. I remember not having a period for about three or four months. I was about 14 years old and was not at all sexually active so that did not play into it. Then just as quickly as it ended it started again and was normal. I always had cramps with my cycle and I was also on the slim side although definitely not anorexic. I was what my parents called a "late bloomer". I am totally normal and have never had any issues and have two wonderful children. I hope this resolves for your daughter but try not to worry about this too much. It is probably fine. Only other thing I am thinking is maybe a cyst on her ovaries. Ask her if she is still experiencing cramps around the time of month of her cycle. I did have cramps just no period when this happened to me.

[EAMom]

@Thanks Missmom,

 

I'll ask about a cyst as well. I guess the thing that concerns me is if it is b/c of the female athlete triad, I don't want her bone density to be so compromised, given her family history.

[philamom]

This happened to me in my late teens. The contributing factors were exercising too much daily, and a small pituitary tumor. The tumor was found by an mri with dye and resolved on its own.

[T_Anna]

You may want to check the pituitary. One symptom of pituitary issues is change in menstrual cycle.

 

DS16 hasn't been doing great after a huge break through over the spring and successful return to school. He has had ongoing thyroid fluctuations. The endocrinologist did a Radioactive Uptake Catscan which showed thyroiditis, but nothing trateable (needs to be hyper or hypo in the traditional endo world). Dr.T thought it might be the pituitary messing with the the thyroid hormones, we went for a MRI (with/without contrast) and a 3mm mass was found on the pituitary. It seems these are common, but they can also impact hormone production. We ran follow up hormone tests that showed elevated prolactin and low growth hormone.

 

http://www.mayoclinic.org/diseases-conditions/pituitary-tumors/basics/symptoms/con-20028814

 

In the meantime another teen with OCD and growth issues has had an MRI that found a 4mm tumor. These tumor can cause neuropsych issues.

 

T.Anna

[EAMom]

She got her period today (finally). I don't know how heavy it will be. I may cancel her appointment on Thursday (she has a conflict with an after school activity anyway).