Whew, there is a lot going on here girl. I think that I might be able to help you some, but my primary recommendation is to seek a holistic professional such as a chiropractor with wellness credentials or a functional medicine doc. Sounds like you might need some additional testing to see exactly what's going on under the hood. From what it sounds you are stuck in a crazy eight of fluctuating hormones. Symptoms of this have lead to weight gain/loss, PCOS, irregular menstruation, and other. I would need to know more about what is going on with your lifestyle, but from what is sounds there are a couple different scenarios that are most likely at play: 1. The drastic weight loss that you had might have caused some stress to your endocrine function, especially if you were under-eating and over-exercising. This stress will screw up your hypothalamic hormone secretion, and can cause things like amenorrhea. On top of this, if you were carrying around a bunch of fat and heavy on the carb intake from a vegetarian diet, that will also cause serious insulin spiking which contributes to PCOS. Also, the on and off contraceptive use confuses your body pretty bad and further complicates gut, immune, and endocrine function. 2. I'm not saying that this is true, but perhaps there is a combination of some of the above and extra stress from being too concerned about what the scale says. At 5'7 123 that sounds pretty darn thin. I'm not on the gyno's side in saying that you should gain 30 lbs, but I am suggesting that you take it easy on stressing about your weight. Since your estrogen is low and you have some organ developmental delay, this suggests perhaps a long standing battle with hormone fluctuations. Seems like there are some other things causing you some stress that might need to be addressed. However, my best recommendation is that you consult someone who is steeped in the ways of Paleo eating so that you are tackling it the right way. I think you may be under-eating (hypo-caloric) for fear of gaining back the weight and your body has no extra energy to donate to endocrine functions. This is common so don't worry, it could be as simple as adding a little more fat to your diet. This won't necessarily cause you to gain weight, it will only allow your metabolic functions to normalize over time and get you to an ideal weight. I don't know anything about your exercise habits, but if you're heavy on the cardio you need to dial way back on that and donate more time to strength training. Strength training will do wonders for bringing back normal hormone function especially estrogen. Lastly, balancing hormones is all about stress reduction and to do so you need to mitigate mental/emotional stress as well as make sure you're sleeping 8+ hours per night. Now, this is NOT a quick fix. This problem has been around for a long time so it will take time for your body to rebalance/restore proper function. It is all about consistency and time. Best of luck, you are a young woman so this is great that you are tackling these issues now.

I wanna kick your doc in the shins, walk away from her, she is clearly clueless, or operating off of old information.

I have PCOS and I am in the medical field, So here is my spin (I beg your pardon for the bullets, I have many things going through my head regarding your post):

Did they do an ultrasound of your ovaries? That is the way to definitely diagnose Polycystic ovaries. Yes PCOS comes with a melange of blood chemistry problems (LH 3x>than FSH, if testosterone is elevated it could be more PCOS, of DHEA is elevated its more of an adrenal issue; possible hypo/hyper thryoid is often seen, elevated cholesterol), but visualizing the ovaries rules out other etiologies for what you might have going on. Do you have any of the secondary characteristics - hirsuitism, acne, hypertension, oily skin?

There is a Leptin component, which has also been disputed. jcem.endojournals.org/cgi/reprint/82/6/1685.pdf I think Leptin is the new kid on the block and we don't really understand all that it does yet.

PCOS is a hypothalamic-pituitary-ovary axis problem which causes androgen excess.

You were put on the pill for uterine health, nothing else. If you let the contents of a uterus hang out in there for a long time, it puts you at risk for malignancy and other fun diseases. You should have a cycle because it just 'cleans everything out' as it is intended to do. That being said, they could have progesterone cycled you immediately just to clean you out. How it works, you count until you are 20 days into your cycle (or immediately if there is no known cycle) and then start taking progesterone for the remaining 10, on day 31 (or so) you will have a 'withdrawal' bleed and clean everything out/shedding the lining. It does NOTHING to treat the hormone imbalances going on, but it does treat uterine health.

The Drug of choice for PCOS is Metformin. It suppresses androgens, makes cells more sensitive to the insulin-glucose complex and therefore decreases insulin resistance. In addition, for those with PCOS who are over-fat, it helps in weight loss, at a minimum helps prevent further weight gain. Assuming you have PCOS, you might do well with a small amount of Metformin (like 500mg 2x a day or 850mg XR 1x per day) to see if you could just cycle off of that. It would suppress the other androgens (testosterones, progesterones, and compounds secreted by the adrenals) and allow the ratio to improve. But be warned Estrogen excess is a problem with fattier people and those with PCOS. Its a fine balance. But I'd want more info before I'd Rx that.

BMI- at 5'7" 123# your BMI is 19.3 Well within the "normal" weight category on the low end, but not borderline, at 160# you would have a BMI of 25.1 and are officially in the overweight category by 0.1. Gimme a break, kick Dr. Bonehead to the curb. That was a dumb piece of advice.

Diet: Yeah for Paleo!! I believe Locarb/Paleo are the only diets that are appropriate for those with PCOS. Not only are they low in glucose spikes and sugars, they decrease inflammation which is a component of female hormone cycling that is negatively enhanced with cystic ovaries. If I were your provider, I would definitely do a dietary analysis of everything you are eating for a week to get a big picture. I am a big fan of Fitday.com or Livestrong for tracking. Both are free and allow tracking of foods with varying measuring types (volume & weight). Livestrong also has an Apple App for your Apple products which makes it real easy. You might not be getting enough fat. Estrogen is made from fat (it is a cholesterol-like hormone), if you have a low body fat regardless of the condition of your ovaries, you will stop menstruating. Look at extreme/professional athletes or anorexics - low body fat due to "activities" and they stop cycling.

Recommendations: Stay with Paleo. Track your diet to see what is your composition/percentages. Add some more fat, maybe consider a fish oil supplement so at least the fat is in the right ratio (see the Whole9 or Robb Wolf for their calculator). Ditch your Doc. Find a Paleo doc in your area, or a Naturopath. They are going to more interested in the whole picture. In addition, you can go see a Reproductive Endocrinologist who will do a more a more thorough work up and an ultrasound. I agree with the "Taking charge of your Fertility" book, its pretty good.

If you have PCOS, it didn't develop overnight, and it won't go away overnight. Breathe, it will be OK.

Start there and let us know!! Good Luck- Wendy :)

Low carb diets are generally helpful for PCOS and fertility issues. Also you might get your iodine levels checked, as there seems to be a connection there. I don't think anyone should ever eat soy.

I was a size 14 back in 2005 and was about 190 lbs. My doctor did some quick math and decided I had a BMI of 33, which was obese. The thing was, I didn't look or feel obese. I was eating the SAD diet, and my blood tests only showed high cholesterol, but I was strong and had physical endurance and some muscle. I figured the muscle mass was mostly a side effect of probable PCOS, but it kept me going. He put me on Medifast, and I was faithful to it for the duration of the six months. At first, I was suspicious, and didn't think I was a candidate for a liquid starvation diet. I wondered if he was getting kickbacks from the makers of Medifast, but I assumed that since he was the doctor, he had a better idea of what was good for me.

I was a model patient! I dropped down to a size 4. I had so little muscle tone I couldn't hold in my own farts (had to go there) and I could feel my butt and thighs jiggle when I walked. I was STARVING, literally, for six months and then afterwords on the tiny portion-controlled meals. I went carb-crazy and gained all the weight back and then some, but didn't get back all the muscle I lost. I even saw the nutritionist he sent me to, but I was suspicious when she told me that the healthiest oil was corn oil. Fast forward four years where my weight had crept up over 210 lbs, with none of the stamina I used to have. I was too ashamed to go back to that doctor, so when I finally decided to go to a different one years later, I was diagnosed with PCOS, prediabetes, vitamin D deficiency, high blood pressure, high cholesterol and hypothyroidism.

I was told to avoid refined starches and sugars by my new doctor, but I had a suspicion that the diet I tried years ago would work better, despite what they had told me about eating beans, whole grains and sugar substitutes. I figured that since I'm the one who has to live with the mistakes and the consequences of following bad advice, that it was ultimately up to me whether or not to listen to the doctor. I took up primal/paleo eating, easing into it, and changing my way of life.
I began menstruating normally for the first time in my life and don't take pills anymore.

So my advice is: sometimes, it's good to not listen to your doctor. They may often very well have their own agenda. Last I knew, the doctor who put me on Medifast was trying to start his own weight loss clinic. When the hormones from the pill flush out, you body should be able to regulate itself. A friend of mine told me it took her eight months to get her normal cycle back, but it worked.

Find a new doctor. She sounds horrible. I also can't believe she told you 160 was a target weight for a 24 year old 5'7" woman when you weigh less than that already. I wish I could help you more with specifics.

Another woman on Paleohacks, Gilliebean, has recommended this book before and it looks good and may help you. Informing yourself as much as possible is always a great strategy.

http://www.amazon.com/Taking-Charge-Your-Fertility-Anniversary/dp/0060881909/ref=wl_it_dp_o?ie=UTF8&coliid=I120V7MCJNL7R7&colid=2JSZU2ILXDL3X

edit: i forgot to say, i'm not so sure about continuing to start and stop taking the pill. seems like that would continue to throw your body off more. and i hope it all works out for you,

If you have very low estrogen and everything else is normal (including testosterone), I probably wouldn't lean toward PCOS. Did you get your FSH/LH levels checked as well? If estrogen is truly low, FSH, in most cases, is either low (if it is a pituitary issue) or increased (if it is a ovarian issue). What kind of cysts were found?; I assume they were ovarian due to your suspicion of PCOS, but do you know what type? Also were you tested for HcG and AFP?

This is completely anecdotal, but I have a friend who had very similar problems to you- she had up-and-down weight and wouldn't get her period unless she was on the pill. She went off the pill for good six years ago, and has been exercising a lot, eating nearly paleo (still eats dairy/cheese), but still hasn't got her period. She got her bone density checked this year, and even though she is only 25 and does weight lifting, she is now at the low-end of osteoporosis, presumably because of hormonal imbalances. Not to cause any panic, but she went on the Nuva ring (lower cutaneous dose of hormones) and started to get her period again recently without any side effects. Her bone density has leveled out for now (it's not decreasing), but the damage has kind of already been done.

I can't give any advice, but seeing as you have had hormonal problems for a while, it might not be a bad idea to get an ultra-sound of your heel, just to make sure your bones are all good to go. If they are, that'll give you some time to work around a natural way to get your hormones in check. If they are decreasing in mass (which may or may not be hormone related) it might not be a bad idea to dry OCP or nuva ring as a kind of precaution, just in case.

In the meantime, lots of bone broth and vitamin D! Hope you feel better soon and everything gets sorted out!

Someone I worked with recently told me a simalar story as yours. She didn't have her period for 4 years. She said she tried everything. Finally she went to a Natropath who told her to check the cosmetic prodcts that she was using for parabens. Apprently these lotions interact with hormones in the body. She had been faithfully using oil of olay for years. She said she started using paraben free products a eventually her period returned.

I just wanted to point out that it is not a good idea to deride a weight number over the internet. While 160 is likely a high end for someone of her height, 135 is pretty far on the other end of a low end for someone of her height (depending on frame), even though both numbers are within currently-acceptable (for now) weight parameters, we have no idea of body type, of muscle mass, etc., and weight can absolutely affect fertility, both being underweight and being overweight. It could be that 135 is too little weight for her frame. Also, it could be that body fat (rather than weight) is a factor. Too little and too much body fat also affects fertility. Also, big history of women + numbers (weight) = bad/disorders... I don't know about here, but it has been pretty prevalent for women. While I'm lucky enough to have avoided disorders, it has taken some pretty serious willpower to focus on how I look and how strong I am rather than on the number on the scale. I've weighed less, but been less strong/healthy than I am now.

That being said, I would suggest finding a health-care provider who listens to you. No matter how great anyone is, if he/she doesn't listen to you, then he/she is not a good fit for you. I also recommend acupuncture. I used it for migraines, and it worked, and I know it's also used for fertility issues. Even if it doesn't work for you, at least it's not a practice that will dump more drugs/hormones into your system.

The Pill is used to treat PCOS and get some women's systems rebooted, but I don't know about the low estrogen end of it--i've only heard of the high testosterone end of the testing. Of course, I'm not a doctor or RN or anything else, so that's just what I've seen/heard. You know, going to an NP (nurse practioner) might be helpful. I've found mine is MUCH better than a lot of MDs who are reluctant to refer me out to specialists (ego? I don't know), and who do not listen to me and my issues.

My wife just yesterday read a study suggesting that d. alata (Chinese yam) rebalances hormones. The study was on post-menopausal women but the hormone effects might be relevant. In particular, the study was considering yam as a replacement for soy.

Good luck!

Oh i am so grateful to have found this thread, I really could use advice in this department.

I am 5'8 141lbs I have cysts on my ovaries and have been on Diane 35 very high estrogen Pill for close to 10 years straight.

My Body fat % is my problem. No matter how hard i work out (avid cross fitter, former National level cyclist, junior triathlete etc) I can not get my body fat % where I would like it which is 20%. My Ironman scale tells me it is 35%...but thats wrong because when i lay out the formula with my measurements it says 25%

I eat strict strict Paleo, but have had weird moments of sugar addiction like episodes where I binge on pastries for a week (out of nowhere) it only happened once. Then i got back to strict Paleo.

Anyway...any advice on whether I should get off the pill to lower Bf% or keep seeking help for emotional eating things or just stay Paleo forever and hope for the best....would be helpful.

Thanks

Carbs are not completely evil, you should stick to Paleo, but use one day a week to "cheat". I've read that this helps refill glycogen stores and improves serotonin levels. Your weird sugar addiction episodes (same happens to me) are probably around a week before your period (if you are having your period) The hormonal wack could probably send your cortisol up and that is why you crave carby stuff, usually with some fat (like pastries, croissants, etc) if your cortisol is high AND your serotonin is too low, you'll probably end up craving the carby stuff but even sweeter (chocolate, ice cream) to get the levels of serotonin up quickly. Give into it, and don't worry too much about it. Your body wants it. That's my take on it :)

Did they check your prolactin? I have a pituitary prolactinoma. All my hormones are within normal range, with the exception of prolactin and estrogen. My prolactin is high, causing my esrogen to be low. I haven't had a period in over 4 years, and am also very worried about my bone density, etc. I have found that high (good) fat and high protein diet makes me maintain my weight loss the best. I recently switched to soy base diet, and gained 4 pounds in 3 weeks. Ugh! I'm sticking with what I know works best for now. Best of luck to you... but have your dr test your prolactin just to see.

I'm not sure what the general feeling is in the community about it - but have you tried acupuncture? I was diagnosed with PCOS 7 years ago, had only 1-2 cycles a year. The doctor wanted to put me back on the pill, but I wanted an alternative to the added hormones. I started 2x weekly acupuncture treatments for a year (the time it took to regain my cycle and have it regularly). I've been regular (like freaking clockwork) for the past 5+ years, with no issues. Just a thought.

Full disclosure here - I am an acupuncturist and a midwife.

Going back on the pill will definitely not solve any problems. Although it will make you bleed, this is not a normal physiologic "period" as we know it with the dance of hormones doing what they should. Going on and off the pill causes the uterine lining to shed, but it is not a reflection that your hormones are in balance, and in fact it drives you deeper into the hole of hormonal imbalance.

The paleo diet is good for getting your hormones balanced. If you are getting enough calories, enough rest and managing your stress your body will come back into balance, but you may need a little help in the form of acupuncture or herbal therapy. Your first priority should be getting your period back, not maintaining any certain weight. You may gain a little, you may not, this does not matter as much in the big picture as gaining your fertility back and maintaing bone health.

Acupuncture would be extremely helpful in un-doing some of the damage that has already been done with the pill. Herbs would also be great, but you have to see someone that knows what to recommend and can do a full health history. Find an acupuncturist that specializes in women's health.

And once you get the book Taking Charge of You Fertility you should start charting your temps, that will tell you a lot about whats going on.