Where has my period gone? Some causes of amenorrhea

The period, menstrual period or menses has been described as the “fifth vital sign” since it tells us a lot about the underlying health of our body. So that being said, a missing period is not something to be ignored and often the longer it is left unattended to, depending on the root cause, the longer and more challenging it may be to get it to come back. 

There are many reasons why you may experience the loss of your period so this article won’t be an exhaustive list by any means. However, this should be a good place for you to start thinking about why your period might be MIA. In all cases of amenorrhea (no period for 3 months in folks with regular menstrual cycles or loss of period for 6 months in individuals with irregular periods) a thorough history and workup should be done by your health care provider to find and address the root cause.

What is a “normal” period though?

Firstly, let’s discuss what a “normal” period is since there’s a lot of misinformation out there on this topic. Since each one of us is a brilliant and unique individual, periods also have a range of “normal”. A regular menstrual cycle (the day from the first day you bleed until the day before your next period) may be anywhere between 27-35 days (give or take), not necessarily the classic 28 day cycle you often see in the “textbooks” or talked about online. Another thing to consider about your period is does your menstrual cycle last about the same number of days each cycle. (example - does your cycle last about 32 days every cycle or does it fluctuate between 25 to 30 to 23 to 34). The more regular the cycle is the better.

Generally, a healthy period (when you are bleeding) lasts anywhere from 3-7 days. You may notice egg white cervical mucus around day 14 or about halfway through the cycle, as a sign of ovulation (however many women will ovulate earlier or later than day 14, especially if you have a cycle that is longer or shorter than 28 days and this is perfectly normal!). There shouldn’t be spotting between periods and there should be minimal symptoms leading up to your period. But again, each individual is very unique and so too is their menstrual cycle and period!

Ok, I understand that periods are variable, but why has mine gone missing?

As I mentioned above, there are many reasons your period may occur at longer increments or has just straight up done a disappearing act. So, let’s talk about some causes of amenorrhea.

Pregnancy

Ok I realize this may seem like an obvious reason but hear me out! If you are someone who has longer cycles or has an irregular cycle to begin with you may not initially suspect pregnancy. Some early signs of pregnancy that some women may not be aware of are fatigue, constipation, breast tenderness and uterine cramping - which are all symptoms you may pass off as normal or as premenstrual symptoms. You may even have implantation spotting which some women may mistake for a period. If you experience any of these symptoms, try an at home pregnancy test and if it’s negative and these symptoms persist take another test or book an appointment with your doctor.

Hypothyroidism

Ok so now that the “obvious” is out the way, a very common condition experienced by females (and males) is hypothyroidism. Your thyroid gland, a structure that sits in the front of your throat, produces hormones that regulate metabolism, temperature, digestion, the nervous system and even your menstrual cycles. Hypothyroidism is when the thyroid gland is under functioning - thus it isn’t producing enough thyroid hormones (T4 and T3) but the pituitary gland is producing too much thyroid stimulating hormone (TSH) in an attempt to stimulate it more.

Some signs of hypothyroidism are feeling cold all of the time, low mood, unintentional weight gain, constipation and fatigue. If you’re experiencing longer menstrual cycles, amenorrhea and any of the other signs of hypothyroidism you should ask your doctor to check your thyroid function (and I mean a full thyroid panel, not just TSH!).

Hypothalamic Amenorrhea

The hypothalamus is a structure in the brain that releases hormones that then tell other structures such as the pituitary gland to then release other hormones, causing a cascade of hormonal communication. For example, the hypothalamus releases thyrotropin-releasing hormone which tells the pituitary gland to secrete thyroid stimulating hormone (TSH - you’ve likely had this tested before if your doctor was looking at your thyroid function) which then binds to receptors on the thyroid gland to let it know it should create and secrete thyroxine (aka T4).

Therefore, hypothalamic amenorrhea (HA) is when your period stops because the hypothalamus is having trouble telling the pituitary gland to release luteinizing hormone (LH) and follicular stimulating hormone (FSH). LH and FSH tell the ovaries to carry out the various phases of the menstrual cycle. Thus, if there is a problem communicating between the pituitary gland and the ovaries you may not have a regular period. 

Some common causes of hypothalamic amenorrhea are stress, excessive exercise, or not taking in enough calories. If the body senses that it is under too much stress or there is a scarcity of food it will “shut down” the need for having a period since this wouldn’t be the optimal environment to have a baby in. If you think this might be the case, ask your health care provider to help you dig deeper into whether or not your hypothalamus and pituitary gland are functioning properly and then work on reducing stress, exercising to a healthy degree and making sure you’re getting enough fuel to support your activity level if these are the causes of your HA.

Polycystic Ovarian Syndrome (PCOS)

You may have heard of PCOS before, but for those who haven’t it’s a condition where women tend to have menstrual cycles that are longer than 35 days, they may have signs of hyperandrogenism - high androgens such as testosterone - causing cystic acne and excessive dark hair growth on the chin, upper lip, chest and other areas of the body and they may also have cysts on their ovaries. Since PCOS is a syndrome, womxn have varying presentations of this condition. There is also often a degree of insulin and blood glucose dysregulation, but not always.

Individuals with PCOS often have an imbalance of LH to FSH which causes disruptions in ovulation. To learn more about PCOS you can read my blog about it here. If you are experiencing any of the symptoms mentioned above it may be a good idea to have an assessment done with your health care provider to see if you fit the criteria for PCOS. 

Once a diagnosis of PCOS is made, there’s lots that a naturopathic doctor can do to help balance hormones and correct insulin and blood glucose regulation to hopefully get you back to ovulating and menstruating more regularly.

In Summary

These are by no means the only causes of amenorrhea. And as I said, missing your period is not something to ignore! It’s a sign of your overall health and should be assessed by a knowledgeable and licensed health care practitioner.

If you’d like help finding the root cause of why your period is irregular, you can book an appointment with me here.