I'm still "interesting"

You never want a specialist to think you are interesting. After this visit and this visit over 2 years ago, I hoped I wouldn't be interesting any more. But apparently, I still am.

I had to have medical help to conceive each of my beautiful children. Thankfully, a simple drug regimen sufficed for each of them. But in addition, I have had other irregularities in the past with various aspects of my reproductive endocrinology. Trouble breastfeeding due to lack of milk production, periodic amenorrhea, and a luteal phase defect top the list. I'm grateful that none of those are much to worry about in the big scheme of things. Still, it's unsettling.

Well, the amenorrhea has been a problem again since Michelle's birth 20 months ago. I don't really mind at all, except that it's not the best for your health in the long run - bone density can suffer, primarily, and with osteoporosis in my family, I was concerned.

I went to my family doc (Dr. S) in November, and he got some labs, and they were "normal". He said I was probably racewalking too much (though I only do 25-35 miles per week) and that it was exercise-induced amenorrhea. He said to cut back my training by 25% and see if that helped. Yeah right. I don't think so! My body mass index is totally normal at 22 (or is it 23?), and 25-35 miles per week is definitely not heaping on the miles. I decided that I'd go back to my favorite reproductive endocrinologist (Dr. G) for a 2nd opinion.

So, today was my appointment with Dr. G, and he is just awesome. He took one glance at my labs and said that though the ranges were all normal, they are not really normal. My FSH is greater than my LH, and it should be the reverse. He says this indicates that my GnRH is probably low, which is most likely a function of an incorrect set point for my weight (though there are other possible explanations, including problems with my pituitary). My body thinks I need to weigh more, when in fact I am at a very healthy weight for my height, according to Dr. G. He says I am definitely not exercising too much, and that I should not stop. He was impressed with my weight loss too :) as he remembered that I used to be "chubby". A kind way of saying that I was scarily obese, with a BMI of 38. I digress.

So, what to do about this little problem? Well, he wants to rule out problems w/my pituitary, so he ordered a brain MRI. Cool. I'm going on Sunday to have this done. Should be interesting. He says he fully expects it to come back normal, but since we've had a lot of different issues in my history that suggest the possibility of a pituitary problem, he wants to rule this out.

Next, he is giving me a progesterone challenge, which involves taking progesterone for 12 days and then stopping to cause withdrawal bleeding. If that occurs, that means that there is sufficient estrogen to develop an endometrial lining, which means that I am essentially OK and don't have to worry about bone density, heart problems, etc. If there is no bleeding, then there is not enough estrogen, which would be a problem. He suspects I will be OK since I have no other symptoms (i.e. hot flashes) to indicate low estrogen.

So, if my MRI is normal and I have enough estrogen, basically the amenorrhea is a non-issue, and I can just take progesterone every so often to clear things out. This is what he expects to be the case. If the MRI is not normal, we will cross that bridge when we come to it. If the estrogen is too low, we could consider hormone replacement.

All very interesting. I would prefer not to be interesting, but at least my health is very good in all other aspects, and in the scheme of things, this is a minor problem.