No period for 1 year

[hr174]

Hi,

I haven't had my period in one year now. My history is a bit complicated as my periods have never been regular. I got my first period at 14, and between then and now, have lost it several times for a year or longer. In high school, I was put on Premarin and a few other pills, none of which had any effect. At 21, I finally began birth control (my mom was very opposed to this for the health risks, which is why I didn't start it sooner). I had a great experience - no side effects, and my periods were finally regular, even while at a lower weight. About a year and half ago, my eating disorder spun out of control, and a year ago I stopped taking birth control pills with the intention of starting them once I recovered. I have not recovered yet and am very fearful for my health as far as osteoporosis and my fertility. I am now 24 and recently had full physical, and my thyroid levels checked out alright. I also attempted to have my annual check-up with a gynecologist six months ago, but it was a horrific experience and I walked out prior to the exam (I overheard the nurse slamming me about my weight to the doctor outside of my room while I was changing into the gown). I am fairly active and have always been throughout my entire life, however, I stopped running a few months ago in an attempt to gain weight. (Ironically, most of my problems with my period in high school and early college were when I was 20+lbs heavier). I also take a daily multivitamin along with CoQ10, fish oil, and a few other supplements. I try to eat healthy despite the disorder, although it's tremendously difficult.

My questions are - 1. Is there any way to know my fertility?
2. What should I do from here and in what priority order? (e.g. scheduling a visit to a gynecologist, gaining weight, etc.)

Thank you so much in advance. This has been a crappy time, for lack of a better word, and I have trouble stomaching the idea of going to another gynecologist after my last visit.

[Elaine Brown, MD]

Hi!
First of all, if you were my patient, I would emphasize that there is NO good reason to go to a health care provider who is not sympathetic and/or concerned about a very serious health issue such as an eating disorder.  Having said that though, I would still definitely encourage you to get care. If you were my patient, I would stress the benefits of oral contraceptives (or other forms--such as the vaginal ring). From your post you sound very knowledgeable about your eating disorder and the potential problems it can cause such as osteoporosis.  
Probably the first priority is to seek care for the eating disorder, as controlling that may solve the other problems and amenorrhea/infertility are not immediately life-threatening while an eating disorder can be.
If you were my patient, I would also reassure you that if you resume ovulatory menstrual cycles, your fertility will probably be normal.  You should (ideally) have a good sympathetic health care team in your court before you attempt pregnancy though, as there are some obvious weight-related issues that arise for women during that time!
Hope this helps!
The best part about bad times is that they make the good times better.
Good luck!
Dr B

[hr174]

Dear Dr. Brown,

Thank you so much for your kind and thorough reply. I appreciate it tremendously.

I am looking for a better physician so I can get proper care, ASAP. Thanks again.