Q. Why do I not get period for over a year after quitting birth control pills?

Answered by
Dr. Sameer Kumar
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Feb 19, 2020

Hello doctor,

I do not get my period for over a year after stopping birth control. I have stopped the birth control pill last year and have not had a period yet. I do eat a very healthy diet and do not do excessive sport. My periods before being on birth control were regular and I do not have a history of PCOS. Why am I not getting a period? I do not want to go back on the pill. What can I do instead?

I have attached my lab reports.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology


Welcome to icliniq.com.

I have gone through the reports (attachment removed to protect patient identity) and your hormonal profile is normal just that progesterones are way too low indicating that you are not ovulating and hence no menses. Sometimes, amenorrhoea is seen after prolonged use of oral contraception, however, this can be given a restart by offering a withdrawal bleed with progesterones.

You can be prescribed progesterone-only pills for five days and in the next three to five days, and you shall get withdrawal bleed. You can discuss it with your medical provider and opt for the same.

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Thank you doctor,

Do you think my testosterone is too high? Do my FSH and LH ratio indicates PCOS?

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology


Welcome back to icliniq.com.

The FSH/LH (follicle-stimulating hormone and luteinizing hormone) ratio is reversed. Yes, which by books indicate PCOS (polycystic ovary syndrome). But again for one to diagnose with PCOS, both clinical and ultrasound criteria have to be fulfilled.

One needs to have acne, hirsutism, acanthosis nigricans, reversal of FSH/ LH ratio and most importantly the presence of multiple sub centimetric follicles in each ovary more than ten in each. Also, the AMH (anti-Mullerian hormone) levels of more than four depict PCOS. The free testosterone levels are normal but total is borderline high indicating SHBG (sex hormone-binding globulin) binding to testosterone, again a sign of PCOS.

Nevertheless, even if you satisfy the PCOS criteria (both clinical and ultrasound), still a withdrawal bleed would be mandatory before initiating treatment for PCOS.

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