Perhaps you’ve missed a few periods, and you know you’re not pregnant. While it might be nice to have a break from your monthly cycle, missing three or more periods unexpectedly can be a sign that something is wrong – especially if you are younger than 45.
Several conditions can cause oligomenorrhea, the medical term that means you’re having rare, irregular menstrual periods, or amenorrhea, the medical term for the absence of menstrual periods. Both can be a sign of a hormonal problem such as perimenopause, polycystic ovarian syndrome, or thyroid disorders. Left untreated, these conditions may put patients at increased risk of long-term health issues such as endometrial disorders (like cancer), osteoporosis (bone loss), and heart disease.
That said, there are some situations where it’s totally normal to not get a period:
- When intentionally stopping menstruation with continuous use of hormonal birth control or a hormonal IUD
- When experiencing hormonal changes during pregnancy and breastfeeding
- When entering and progressing through menopause and the ovaries “retire” from ovulating
Thankfully, most patients who are diagnosed with oligomenorrhea can resume regular, normal periods with proper treatment. Here are a few common questions about oligomenorrhea and amenorrhea that patients often ask our providers in the Department of Obstetrics and Gynecology as well as some of the treatment options we can recommend to help you get back on track.
“A lot of patients tell me ‘I knew missing periods wasn't normal, but I just liked not having to deal with it each month, so I didn't think it was a problem.’ But ignoring a symptom doesn’t make a potential health problem go away.”
What health conditions can disrupt your period?
Primary amenorrhea is rare and typically diagnosed during the teen years. This is when periods haven’t started by 16, breast development hasn’t started by 13, or periods don’t start within three years of developing breasts. It can be genetic or caused by a developmental disorder. A pediatric gynecologist can help identify and treat this condition.
Secondary amenorrhea is when it’s been more than three months since your last period or your monthly cycle becomes very irregular. According to the American College of Obstetricians and Gynecologists (ACOG), one in 25 women who aren’t pregnant or breastfeeding will have amenorrhea at some point before menopause.
Hormonal imbalance
More than half of amenorrhea cases are caused by the hypothalamus or pituitary glands over- or under-producing important hormones. Your body needs the correct mix of different hormones to trigger the menstrual cycle: gonadotropin releasing hormone (GnRH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone. If any of these are off kilter, it can affect the timing, length, or intensity of your period.
Too little thyroid-stimulating hormone (hypothyroidism) also can lead to overproduction of the hormone prolactin, which can disrupt GnRH production (hyperprolactinemia).
Treatment options: A blood test can show the precise levels of each hormone in your system. We might prescribe birth control pills or thyroid medication and help you pinpoint some life changes to reduce stress.
Ovary dysfunction
Ovary dysfunction causes about 40% of amenorrhea cases. The ovaries’ job is to release an egg each month (ovulation). If that egg isn’t fertilized, you get your period. Hormone imbalances can interfere with ovarian function.
Polycystic ovary syndrome (PCOS) is one of these imbalances, affecting about 10% of teenage to middle-aged women. With PCOS, the body produces too much of the hormone androgen, causing cysts to grow on the ovaries and disrupt or stop ovulation. PCOS is often associated with obesity and, along with missed or irregular periods, can cause excessive body hair, insulin resistance leading to weight gain, dark and thick skin patches, severe acne, and subfertility.
Treatment options: If you’re not trying to get pregnant, your doctor might prescribe a combination of a hormonal birth control such as the pill, diabetes medication, androgen-blocking medication, and a diet and exercise plan. It is possible to become pregnant after PCOS treatment; ask a health care provider about treatments to regain or preserve fertility.
Obesity
Having obesity can cause your body to produce too much estrogen, creating a hormone imbalance in women that is associated with menstrual disorders such as PCOS. If you’re diagnosed with PCOS, having obesity increases your risk of amenorrhea.
With weight loss, fertility can resume, as shown with the “Ozempic babies” phenomenon. Some women with a history of period problems and subfertility who lose weight with GLP-1 medications are getting their regular cycle back and finding that they are able to become pregnant.
Treatment options: If you need help losing weight, we can refer you to our Weight Wellness Program to visit with obesity specialists who are experts in endocrinology and nutrition.
Very low body fat
Research has shown that most women need a body fat percentage of around 22% to maintain regular menstruation. When body fat dips below this level, the body reduces its production of estrogen in defense against starvation. This is why eating disorders, such as anorexia nervosa or bulimia, can cause missed periods.
Low body fat is also associated with hypothalamic amenorrhea, which is when the hypothalamus gland in your brain needs energy to produce the hormone called gonadotropin-releasing hormone (GnRH) that triggers your cycle. Hypothalamic amenorrhea is reversible, but the longer it goes on unmonitored, the more likely it might lead to complications.
Gynecologic cancers
Amenorrhea can be a symptom of endometrial cancer. Early detection is critical, so don’t hesitate to call your doctor if a missed period comes with pelvic pain or unusual bleeding or discharge.
Treatment options: Depending on the location of cancer and whether it has spread, a women’s cancer specialist may recommend chemotherapy, immunotherapy, radiation therapy, surgery, or a combination of treatments to remove or contain the cancer.
Chronic health conditions
Chronic health conditions that can cause menstrual problems include:
- Cushing syndrome, an adrenal disease associated with excess levels of cortisol, the stress hormone.
- Autoimmune disorders such as celiac disease in which patients are allergic to gluten.
- Inflammatory conditions such as Type 2 diabetes.
- Chronic kidney disease, which is associated with vitamin D deficiency and bone loss.
Treatment options: Chronic conditions can affect many areas of the body and often require a team approach to care. A specialty team can recommend a personalized treatment plan for you that may involve medication, diet and exercise changes, or procedures to manage symptoms and reduce flare-ups.
How do you diagnose the cause of missed periods?
We’ll start with your personal and medical history. Do menstrual problems run in your family? Are you taking another medication that might be linked? What are your eating and exercise habits like? Did your period stop during a specific event in your life?
Then we’ll conduct a physical exam. This will be very similar to your usual gynecology checkup, with lab testing to check hormone levels, including thyroid hormone levels.
We might also recommend imaging such as an ultrasound or an MRI to get a better view of your reproductive organs.
Don’t ignore unexpected missed periods
Here’s your takeaway for the day: Your period is like a vital sign – regular periods are a sign that your hormones are in sync. It’s OK to intentionally suppress your period if your doctor approves. But if your regular menstrual cycle stops unexpectedly, there’s a reason for concern. Don’t let it go more than three months before you call your doctor.
To talk with a gynecologist about missing or irregular periods, call 214-645-8300 or request an appointment online.
