What should I do if I've missed some periods?

Dear Periodless,

Noticing when your body and its functions have changed is the first step toward identifying an issue if there is one. Amenorrhea is the medical term for not having your period for an extended amount of time. When you stop taking the pill, it can take a while for your body to re-adjust to its natural hormone production schedule which may contribute to your missed periods. It could also be attributed to other causes ranging from pregnancy, changes in physical activity or eating habits, to medical causes (more on this in a bit).  Treatments can vary based on the cause of amenorrhea. Since you have missed over three consecutive periods, it could be wise to make an appointment with a health care provider. They may be able to help determine the cause(s) of your missed periods and recommend treatment.

One of the most common reasons that people with a uterus stop menstruating is pregnancy. If you’ve already ruled that out, some other reasons for lacking menstruation may include weight loss, hormonal changes, strenuous physical activity, mental or emotional stress, and eating disorders such as anorexia. Amenorrhea may also be due to medical conditions, including:

• Problems with the hypothalamus: The hypothalamus is the part of your brain that helps controls the production of the reproductive hormones that regulate the menstrual cycle. Problems with your hypothalamus can make your periods stop for months at a time. 
• Thyroid malfunction: Overactive or underactive thyroid functioning can cause menstrual irregularities, including amenorrhea. 
• A tumor in the pituitary gland: This can also result in abnormal hormone production, and, ultimately, halt menstruation. 
• Polycystic ovary syndrome (PCOS): PCOS causes high, stable hormone levels rather than the fluctuating hormone levels that accompany normal menstrual cycles, which can also impact the frequency of periods. 
• Structural problems: Uterine scarring, structural abnormalities, or missing reproductive organs can also cause amenorrhea. 

List adapted from the Mayo Clinic

Amenorrhea can harm the reproductive, endocrine, and muscular-skeletal systems. That said, one complication of missing periods may be infertility, as they may not be releasing an egg that could be fertilized. In addition, if the cause of amenorrhea is due to low estrogen levels, there may be a loss of bone density (this is particularly relevant for competitive athletes in physically demanding sports). Regardless of diet and physical activity programs, athletes can have significant reductions in bone mass when their periods are stopped. No matter the underlying cause, missing your period for an extended period is worth discussing with a health care provider. 

Treatment for missed periods is typically specific to the underlying cause. In some cases, treatments may include contraceptive pills, hormone therapies, or other medications. In meeting with a health care provider, it’ll be helpful to share a thorough history of your activities, diet, and workload. You can also describe any other symptoms you may be experiencing, even if they seem insignificant. These clues can be beneficial in figuring out what is causing your missed periods. Best of luck in discovering what's causing these changes.