The menstrual cycle averages 26 to 32 days in most women and thanks to technology there are now smart phone applications to track when you started bleeding (day 1) and when you are predicted to bleed again. This cycle is governed by a chain of events that go back and forth between your brain and your ovaries; however, outside influences can get in the way and cause you to miss a period…or stop all together. Here are the most common reasons for skipped, irregular, or absent cycles.
1) Are you pregnant? Sounds basic but a number of women chalk a missed period up to other reasons in their life never thinking it's pregnancy. First things first, take a pregnancy test.
2) Are you breast feeding? Some women report getting their first period back after birth and then missing it again for months. This can be normal due to the hormones of breast feeding.
3) Are you stressed out? Severe, life altering stress (like the death of a loved one) or ongoing stresses that build may cause the body to focus on that stress instead of a period. Stress hormones (cortisol) may also cause the hormone prolactin to elevate enough to stop a period. Prolactin is the hormone that rises for milk-production but can slightly rise even when not pregnant or breast-feeding due to cortisol.
4) Have you flown recently? Anecdotally, women report that flying long distances often changes their circadian rhythm (think jet lag) and causes them to skip that month.
5) Are you an avid exerciser or competitor? The training required for those sports or competitions often push you into very low body fat content and shift your hormones such that you stop bleeding all-together until the training lessens. Think gymnasts, dancers, marathon runners, cyclists, or extreme exercisers.
6) Are you underweight? The body requires a certain amount of body fat before menstruation occurs. This can cause a delay in menstruation onset as a teenager or in adulthood if a lot of weight is lost.
7) Do you have polycystic ovarian syndrome? This condition is classically described as having irregular menstrual cycles (or none), acne, hair growth in places you don’t want (called hirsuitism), and obesity (due to insulin problems). Typically on ultrasound there could be multiple cysts on the ovary while lab work shows elevated androgens (testosterone and DHEA) with elevated blood sugar and insulin as well.
8) Do you have a thyroid problem? A very common low thyroid symptom is the loss of menstrual cycles. Make sure to have your TSH, T4 and T3 tested. If thyroid problems run in your family make sure your thyroid antibodies are also tested.
9) Have you recently gone off the pill or gone through fertility drugs? These outside hormones put into your body can really take their toll such that the body has a hard time getting back on track once they are discontinued. In a sense, they interfere with the communication between the brain and your ovary, therefore you don’t bleed.
10) Are you peri-menopausal? During this transition time, the menstrual cycle seems to do strange things all the time. From skipping 2 months to bleeding every 2 weeks, women are never sure what to expect which is normal during menopause.
If you feel you can answer yes to these questions, talk with your health care provider about appropriate testing or ways to help you get back on a regular track.
References:
1) The Female Athlete Triad
http://www.medscape.com/viewarticle/717390
2) Review in Polycystic Ovarian Syndrome Today and Tomorrow
http://www.medscape.com/viewarticle/739208
3) Fertility Awareness-Based Methods: Another Option for Family Planning: Breast Feeding
http://www.medscape.com/viewarticle/589936_8
4) Stress and Disorders of the Stress System
http://www.medscape.com/viewarticle/705906
Reviewed July 13, 2011
by Michele Blacksberg R.N.
Edited by Alison Stanton