Is it normal to miss periods?

A disappearing period may seem ideal for many women, but if it stops suddenly or unexpectedly, there may be cause for concern.

Secondary amenorrhea, or the absence of menstruation for three months or more in a patient who previously had normal cycles, affects up to 5 percent of menstruating women every year. While pregnancy is the most common cause, Geri Hewitt, MD, Ob-Gyn at The Ohio State University Wexner Medical Center, says that a variety of factors can cause a period to disappear, and many can be – and should be – evaluated and possibly require treated by a medical professional.

“Missing periods may indicate of poor health,” Dr. Hewitt says. “If a woman notices her period goes away and doesn’t come back for a few months, she should rule out the possibly of pregnancy and seek medical attention to figure out the cause.”

What can cause my period to disappear?

According to Dr. Hewitt, there are a variety of reasons why a woman’s period  pattern may change and even disappear over a period of time. 

• Pregnancy: Amenorrhea is a common and expected side effect of pregnancy. If a woman is sexually active and her period suddenly stops, she should first take a home pregnancy test to determine if that could be the cause. 
• Hormonal contraceptive use, like the birth control pill shot or a hormonal IUD can cause periods to become very light or even disappear.  Extended cycle use (never having a placebo or “off” week) of the birth control pill, patch, or ring can also result in no periods.  Some women chose these types of contraception to minimize menstrual bleeding.
• PCOS:  Polycystic ovary syndrome (PCOS) affects upward of 5 million women in the U.S. every year and is associated with prolonged time between periods or no periods at all.  Patients with PCOS often have small cysts on their ovaries, and signs of elevated testosterone levels such as acne and hair growth.
• Stress and lifestyle factors: When a woman is experiencing high amounts of stress, she may also notice a disruption to her menstrual cycle. Increased levels of the stress hormone cortisol impacts the production of female sex hormones that control menstruation.  Eating disorders such as anorexia nervosa and undernourishment with intense exercise both lead to this type of amenorrhea.  
• Hormonal imbalances: Hormonal changes associated with tumors on or near the pituitary gland or associated with thyroid disease can also lead to amenorrhea. 
• Uterine causes: Scar tissue within the uterus after multiple procedures or infection can also lead to a lack of periods.
  Menopause: Women in their 40s and 50s will begin to notice irregular to absent menstruation as a result of menopause, the natural decline in reproductive hormones.
  
  

What should I do if my period has suddenly stopped?

“It is important to keep track of your periods—when they occur, how long they last, and how much bleeding,” Dr. Hewitt explains“Changes from baseline, including skipping periods or not having them all together could be a sign of a problem.  It is important to address these changes with a provider to investigate why the change and address any potential problems.”

Your physician will start by talking to you about your current menstrual pattern, medications, and past medical history.  They will rule out pregnancy by testing your urine and perform a physical exam checking for things such as weight, vital signs, acne, abnormal hair growth, or other signs of hormonal imbalances.  Based on these findings, your physician may also draw your blood to measure some hormone levels.

The most common blood tests to check in a patient with amenorrhea are serum levels of prolactin, thyroid stimulating hormone (TSH), and follicle stimulating hormone (FSH).  Prolactin is usually only present in pregnant or nursing women, but it can be a sign of a pituitary tumor, eating disorders, thyroid issues or diseases affecting the hypothalamus in the brain – all conditions that can impact your period. TSH screens for thyroid disease; FSH confirms menopause.  If there are signs of PCOS, like acne or hair growth, testosterone levels may be drawn as well.  Sometimes a 17-OH progesterone level is checked to rule out Cushing’s disease, too.

Once a diagnosis is made, Dr. Hewitt says that the physician will work with you on a treatment plan.

“Many causes of menorrhea can and should be treated to avoid long term problems,” she says. “Not having regular periods due to PCOS can be associated with abnormal growth in the uterine lining that can, over time result in cancer.  Birth control pills and hormonal IUDs are common treatment options for hormonal conditions like PCOS to prevent uterine cancer.“

Also, menorrhea usually means that you are not ovulating.

“Any time that periods stopped, that is a clinical sign of lack of ovulation,” Dr. Hewitt explains. “Lack of ovulation means a lack of fertility, and you must get to the cause to correct it.”

Dr. Hewitt adds that for those women suffering from eating disorders, female athlete triad and/or extreme stress, can lose bone mass from lack of estrogen when they are not having periods.  Therapy concentrates on treating the underlying cause may require increasing caloric intake, decreasing exercise and seeing a psychiatric specialist.  Return of the periods is a sign of improvement of the underlying condition and recovery.

Can a missing period negatively affect my health?

Missing your period in and of itself does not tend to be detrimental to your health. Rather, the causes of amenorrhea are the most serious. If left untreated, more serious conditions like eating disorders can lead to low bone density, and diseases like PCOS can increase the risk of uterine cancer.

“Untreated menorrhea can cause medical issues down the line. This is why it is important for women to track their menstrual cycles and see a physician if they notice any abnormalities,” Dr. Hewitt says.

The best way to make sure you’re menstruating regularly? According to Dr. Hewitt, it easier than ever to track your cycles.

“There are a lot of apps that can help a woman pay attention to her body and her cycle,” Dr. Hewitt explains. “Apps like Flo and Glow make it easier to track your ovulation, fertility and periods, and will even point out any issues or causes for concern.”