No period? Now what.
No period? Now what? First, don’t panic, amenorrhea is common, but it is important to know why your period is missing. Amenorrhea is the absence of menstrual periods. There are two types of amenorrhea -primary and secondary. Primary amenorrhea is no period before the age of 16 and is not the subject of this blog post. Secondary amenorrhea is more common and is when a woman misses her period for 3 or more consecutive months.
If your period is missing, what could be the cause?
1) Hypothalamic Amenorrhea -this is the most common cause of secondary amenorrhea. It is when the brain has an abnormal rhythm of releasing a hormone called gonadotropin-releasing hormone (GnRH). This change or dysfunction in pulsing can be the result of poor nutrition (under eating mostly), chronic stress, or too much exercise. The hypothalamus is a part of the brain that is in charge of your hormones, that tell another part of your brain, the pituitary gland, to communicate to your ovaries to ovulate and have a menstrual cycle.
2) Pregnancy -this is of course a natural cause of secondary amenorrhea. Pregnancy should always be ruled in or out even if you had irregular periods before missing 2-3 in a row because you may ovulate before you have the return of your period. It is possible to become pregnant on that first ovulation, hence no period will come even if you haven’t had a period in 2-3 months. You can have a menstrual bleed without ovulating though. These are called anovulatory cycles and are common in PCOS and perimenopause. Confused? Book an appointment.
3) PCOS -this complex hormonal and metabolic disorder can affect the menstrual cycle and most importantly ovulation as the condition tends to produce more insulin resistance and excess androgens (such as testosterone). There is also often a change in GnRH pulsation, which may be confused with hypothalamic amenorrhea. PCOS, however, always has the presence of high androgens either on lab work or in clinical presentation such as acne, oily skin and hair, and/or excess abnormal hair growth.
4) Thyroid disorders -hyperthyroidism (too much) or hypothyroidism (too low) may cause secondary amenorrhea and other menstrual irregularities like heavy periods. Your thyroid function should always be assessed when it comes to your periods. There are simple blood tests for your thyroid.
5) Pituitary adenoma -this is a non-cancerous tumor growth in the pituitary gland that affects its function and the hormones responsible for regulating your periods. The most common pituitary adenoma is called a prolactinonma, it produces high levels of prolactin, the same hormone responsible for breastfeeding which causes menstrual irregularity.
It is important to have a FULL work-up if your periods are missing in action for more than a few months. Monthly periods are like a report card on your overall health and well being. Other non-disease reasons for missed period may include illness, surgery, traumatic event, stress and some medications.
Talk to your ND whose focus is women’s health about having a full assessment to figure out the cause of your menstrual irregularities or book an appointment today.
PS. Remember that the birth control cannot “fix” your periods. When on oral birth control pills you do not get a period, it is only a chemical withdrawal bleed.