Eat.Fit.Well
Missing Period? Here are 10 Reasons Why It May Have Left

by Kristy Alpert - May 23, 2017


It’s called the monthly curse for a reason. A women’s monthly cycle is wrought with a mixed bag of emotions for many women, ranging from anger and anticipation to fatigue and fickleness; all often experienced within the same day … or hour! Although few women look forward to their monthly menses, when it goes absent it can feel like something vital is missing.

“Having periods are a sign of good health,” says Dr. Yolanda Kirkham, obstetrician-gynecologist at Women’s College Hospital and St. Joseph’s Health Centre in Toronto, Ontario. “They indicate fertility and that your body is healthy enough to support a pregnancy. During a regular period, hormone messengers from the brain [pituitary] direct hormone release from the ovaries. This causes egg release [ovulation] monthly, around day 14 of a typical 28-day menstrual cycle. Ovulation always occurs 14 days before the next period. In the first part of that cycle, the endometrium [i.e., the lining of the uterus] thickens for preparation of the fertilized egg and sperm [i.e., the embryo}. If there is no pregnancy, the endometrium then thins and sheds in the second part of the cycle, leading to a period back on day one of the next cycle.”

But missing your period doesn’t always equal pregnancy, and Kirkham explains that it can be normal to occasionally skip one or two periods a year, or be late in a cycle. She notes that nearly one quarter of Canadian women coming to her personal practice have been referred to her because of missing or infrequent periods.

“When more than three periods in a row are missed, we call this amenorrhea, or absence of periods or menses, “ she explains. “If women have infrequent periods [i.e., only four periods a year or a period every two-three months], we call it oligomenorrhea, which should also be investigated. Amenorrhea can be further classified as primary, where the patient never had a period ever, or secondary where the patient had periods before and then missed.”

If your flow has disappeared for a month or even a couple months, it could mean something is out of balance in your body. From over-exercise to over-eating to stress or more serious medical problems, here are the top ten reasons you’re not getting your period.

1. Ovarian Insufficiency. This is the most worrisome, and fortunately uncommon, cause for a missed period. Ovarian insufficiency (or premature ovarian failure) can occur at any time for women before age 40, even in a young girl before she has ever had a period. Although it is rare, it’s something your doctor will want to rule out right away.

2. Exercise-Induced Amenorrhea. Although an active workout routine generally leads to a healthier lifestyle, an over-active routine can actually lead to missed periods. Especially when linked to calorie restriction in order to lose weight, working out too much causes the body to not produce enough estrogen, which in turn stops the menstrual cycle. Many professional athletes and dancers suffer from amenorrhea, but any women who pushes herself too hard is at risk for developing bone loss or osteoporosis due to the lack of menstruation, especially anyone with a BMI below 19. For many, simply cutting out a few workouts a week, limiting the intensity of the workouts, increasing calorie consumption, or even gaining a few pounds will bring back their monthly cycles.

3. Pregnancy. Although it’s not the only reason for a missed period, it’s by far the most common reason. Pregnancy symptoms and PMS symptoms are so similar that it can often be hard to detect any differences without the help of a home pregnancy test. The best time to take a test is one week after the date of your missed period to detect human chorionic gonadotropin (hCG), the hormone used to identify a pregnancy.

4. Hypothyroidism. The thyroid may be a miniscule part of the body, but it does a huge job regulating the body’s metabolism, controlling the body’s temperature, and, yes, ensuring a healthy cycle each month. Hypothyroidism means your thyroid is underactive, and is often followed by a few symptoms that include heavy but infrequent periods, weight gain, tiredness, dry skin, and hair loss. Hypothyroidism is the most common thyroid problem related to a missing period, but an overactive thyroid (hyperthyroidism) can also be the culprit, often resulting in symptoms that include weight loss, rapid heartbeat, sweating, and restlessness at night. Your doctor can prescribe the right medication to get your thyroid hormones back in balance and restore your flow.

5. Polycystic Ovarian Syndrome (PCOS). This hormonal imbalance is one of the most frustrating syndromes for women as it often comes with unsightly weight gain, acne, and increased hairs sprouting up on the chin and/or chest. PCOS results in an egg that is unable to mature due to insufficient hormone levels, which results in zero ovulation and zero monthly periods. Your doctor will likely do a blood test to discover if you have this syndrome, but treating it is as simple as leading a healthier lifestyle by eating well, losing weight (when relevant), and regulating hormones with medication.

6. Obesity. Just like losing weight rapidly can hinder the monthly flow of things, gaining weight can also be the trigger that un-triggers your regular period. Being overweight messes with your hormonal balance by producing too much estrogen. The body’s overproduction causes the endometrial lining to overgrow and results in irregular and/or extremely heavy periods. The easiest treatment for this is to lose weight with a healthy and moderate exercise routine and a healthier diet.

7. Medications. Certain antipsychotics can result in a missed period or two, as can certain contraceptives. Often times, women who begin taking a low-dose estrogen birth control pill or the IUD Mirena experience extremely light or non-existent periods as the endometrial lining doesn’t build up enough to shed with those birth control options. Other times women who stop taking the birth control pill will also stop having a period for a few cycles as it can take the body a while to regulate back to having a “non-assisted” cycle without the aid of the hormones. Since it is possible to ovulate without having a period, women going off the pill to try to get pregnant should take regular pregnancy tests just in case.

8. Emotional Stress. Stress can wreak havoc on the body, causing everything from weight gain, heart issues, and skin disorders. It can also do a number on your reproductive system, literally stressing your system to the point of not functioning properly. Stress triggers the production of adrenaline and cortisol, two hormones that signal for the brain to go into a fight or flight mode and choose to only operate the most essential bodily functions (like breathing, walking, etc.). Stress literally causes the body to shut down, but don’t let that figure stress you out, as returning to a calm and healthy lifestyle is all you need to get your body back in tip top, and totally functioning shape again.

9. Prolactinoma. Prolactinoma is a benign tumor in the brain that occurs rarely in women of childbearing age. The signs include loss of period, headaches, and nipple discharge constituting of a milky white fluid. The fluid is brought about by high levels of prolactin, which actually prompt the body to produce breast milk. An endocrinologist will be able to diagnose this right away with a simple blood test before treating the tumor with medication.

10. Other Factors. Other factors that could cause a skipped or missing period for either one instance or recurring instances include drug abuse, chronic disease, chemotherapy or radiation, gonadal dysgenesis (a genetic disorder that affects hormonal pathways or ovaries), or structural anomalies (including blocked or imperforate hymen, vaginal septum, and/or Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

It’s important to seek medical advice and attention immediately if you skip a period or notice a pattern of missing cycles. While the treatment could be something as simple as just adjusting your lifestyle or adding some vital hormones and vitamins your system has been craving, your doctor will be able to help keep you from jumping to conclusions over something often as simple as a skipped cycle.

“While waiting to see your doctor for investigating missed periods, consider evaluating whether there are imbalances in your life that you can correct,” Kirkham adds. “As you can see from the list above, many of the causes for missed periods are related to imbalances in energy input like food and outputs like exercise or activity. If you are not eating enough to support your level of activity or to have a period, then increase your calories. If you are overeating and living a sedentary lifestyle, cut your portions and exercise. A 10 percent weight loss can trigger the return of spontaneous periods. If life is extremely stressful, consider taking a break, and practicing mindfulness, meditation, and other stress management techniques.”

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