Period is one of the most accurate health indicators for a woman’s body. If it’s gone for a month or more, your body is telling you something has changed in your lower body.
Amenorrhea is the medical term for the absence of menstruation. Approximately 1 out of 4 female patients who are not pregnant, breastfeeding, or in the process of menopause develop amenorrhea at some stage of their lives.
It can be caused by lifestyle factors, hormone imbalance, or a serious underlying condition that, if not treated, can cause harm. This can have impacts on your bone health, fertility, and long-term hormonal balance.
If you haven’t had any period and you’re not pregnant, there may be some missing period causes that need to be addressed.
What Is Amenorrhea?
Amenorrhea is a condition where a woman of reproductive age does not have her period. It exists in two forms, and it’s important to differentiate between the two, as the causes and remedies are different.
Primary amenorrhea is when a girl has not started her period by age 15, or within three years of her first signs of puberty. It is rare and may be related to structural or chromosomal abnormalities.
Secondary amenorrhea is when a woman who previously had regular periods stops getting them for 3 or more consecutive months. This is the type that most women are facing when they say that their period has gone missing.
Secondary Amenorrhea is a result of a disruption in the hormonal pathway at many stages. These are abnormalities in the hypothalamus, pituitary, ovary, uterus, or cervix.
Some of the most common non-pregnancy conditions are functional hypothalamic amenorrhea, PCOS, hyperprolactinemia, primary ovarian insufficiency, and structural uterine defects.
One of the most crucial initial steps if you have missed your period is to rule out pregnancy. If you think you may be pregnant but are not sure, the first step is always a pregnancy test.
Missing Period But Not Pregnant
If your period stops and you’re not pregnant, there are likely a few different reasons. It is disrupting your hormonal system, or the hypothalamic-pituitary-ovarian (HPO) axis.
Here is a basic explanation of what your cycle is. Your hypothalamus communicates with your pituitary gland. Hormones from the pituitary stimulate your ovaries to grow an egg and to make estrogen. Following the release of an egg, progesterone increases, creating a lining for the uterus. When no pregnancy has occurred, the level of progesterone decreases, and you have your period. If any link in this chain is broken, the entire chain breaks, and there is no after period.
If you have even a slight chance of being pregnant, however, watch for these signs of pregnancy before you miss your period:
- Tender, swollen breasts
- Extreme fatigue
- Mild pelvic cramping
- Light spotting
- Excessive sensitivity to smell
- Sudden cravings
- Darkening of areolas (nipples)
Why Are My Periods Missing?
When pregnancy is excluded, your brain has suspended your reproductive function.
Your hypothalamus is the control center. If it feels that your body is unsafe or unhealthy, it will cease to send the signals that are necessary for egg production.
From a functional medicine perspective, here are the most common missing period causes:
1. Functional Hypothalamic Amenorrhea (FHA):
One of the most frequent reasons for amenorrhea in young women. FHA is a condition in which a woman’s hypothalamus ceases or slows the production of those hormones to stimulate ovulation. It can happen due to the following causes:
- Significant weight loss
- Caloric restriction
- Excessive exercise
- Chronic psychological stress
- Disordered eating patterns
The athletes, dancers, and women with very low body fat percentages are extremely vulnerable. However, FHA also applies to women who are not easily recognized as being underweight, high-stress-load women, those who follow a restrictive diet, or women who do not consume sufficient calories when they are overtraining.
2. Polycystic Ovary Syndrome (PCOS)
PCOS is one of the most common causes of amenorrhea and is frequently accompanied by irregular periods, acne, and weight gain. It occurs in around 8-13% of women of reproductive age.
Hormones such as testosterone and insulin may be excessive in PCOS. This causes the ovary to have a thick wall and fail to expel an egg. When you do not ovulate, you won’t have a period.
Women who have PCOS may experience:
- Abnormal or missed periods
- Trouble losing weight, particularly in the abdomen
- Acne, particularly on the jaw and chin
- Excessive hair growth on the face or body
- Scalp hair thinning
- Darkened skin patches
3. Thyroid Disorders
You may have an underactive or overactive thyroid, that will halt your period. Your metabolic rate is regulated by your thyroid, and so is the rate of production of and elimination of your reproductive hormones.
It can cause:
- Persistent fatigue
- Brain fog
- Cold intolerance
- Weight gain without eating more.
- Hair loss
- Brittle nails
- Constipation
- Low mood
- Depression
A TSH test isn’t enough for an accurate thyroid checkup. A comprehensive thyroid testing, including a thyroid antibody panel, TSH, free T3, and free T4, provides a much more thorough history.
4. Primary Ovarian Insufficiency (POI)
POI, formerly known as premature ovarian failure, is when the ovaries do not work normally before 40. Ovaries no longer make enough estrogen, periods stop or get irregular.
The prevalence of POI is about 1% of women under 40 years old. It may be due to autoimmune diseases, abnormalities of chromosomes, chemotherapy or radiation, or genetics.
POI increases women’s risk of osteoporosis and cardiovascular disease if untreated, because they have very low levels of estrogen. Hormone replacement therapy is typically recommended until the average age of natural menopause (around 51) to protect bone and heart health.
5. Medications
Several medications are known causes of missing periods; these include:
- Hormonal birth control (some progestin-only options, the hormonal IUD, and the contraceptive injection usually stop periods)
- Antipsychotics
- Certain antidepressants
- Chemotherapy and radiation
- Corticosteroids used long-term
- Metoclopramide and some blood pressure medications
If your period is missed when you begin taking a new medicine, there may be a connection, and it should be explored with your provider.
6. Significant Weight Changes
Weight loss, as well as in some instances, weight gain, impacts the menstrual cycle. Obesity in women can result in estrogen dominance and irregular ovulation in several ways.
BMI under 18.5 is a high risk of FHA and missed periods. A sudden 10-15% drop in body weight (from a healthy level) can cause amenorrhea within a few weeks.
7. Perimenopause:
It is your natural transition period before menopause. For women in their late 30s and 40s, erratic estrogen and progesterone levels can lead to irregular periods before they cease altogether.
How Amenorrhea Is Diagnosed?
A complete evaluation of amenorrhea involves a comprehensive evaluation of your entire system. Here is what a complete workup should include:
Pregnancy test: It is the first step to rule out any possibilities.
Detailed history: Your doctor will consider the history of your periods in detail, your stress, any changes in weight, new medications, and illness. Or how regular were your cycles previously?
Blood hormone panel: This typically includes FSH and LH, estradiol, prolactin, thyroid panel, total and free testosterone, and DHEA-S, which screen for PCOS and adrenal causes.
Metabolic and nutritional evaluation: If metabolic dysfunction is suspected, iron and ferritin, vitamin D, magnesium, fasting glucose and insulin, and HbA1c tests are done.
Pelvic ultrasound: This is done to assess ovarian morphology for PCOS, ovarian volume and antral follicle count for POI, and uterine structure for fibroids, polyps, or signs of Asherman’s.
Actionable Steps to Get Your Cycle Back
The key to regaining your period is to stop trying to fight your body and start to support it. But conventional medicine will simply prescribe a birth control pill to induce an artificial period. This is not a solution to any of the problems. This is what you should do:
1. Eat Enough Food
Stop restricting calories. Eat nutrient-dense foods. To let your brain know it’s safe to reproduce, you need plenty of carbohydrates, healthy fats (such as avocados and olive oil), and good-quality protein.
2. Back Off Intense Cardio
Chronic cardio causes stress to a stress-prone system if you’re suffering from stress-induced amenorrhea. Replace long and tiring aerobic workouts with weight training or soothing yoga. Studies have confirmed that raising calorie intake and lowering exercise intensity will quickly restore menstruation.
3. Maintain healthy blood sugar levels
High insulin disrupts ovulation. You should have a protein-rich breakfast within an hour of getting up. Do not eat unprocessed carbohydrates without any other food. Always combine them with a fat or protein to avoid a glucose crash.
4. Regulate Your Nervous System
You cannot supplement your way out of a stress-induced missing period. It is best to get 7-8 hours of sleep. Reduce caffeine consumption after 12 pm. Use deep breathing techniques to help reduce cortisol physically.
5. Get Comprehensive Testing
What you can’t measure, you can’t fix. The best laboratory tests to determine the true imbalance are a full thyroid panel, fasting insulin, DHEA-S, LH, FSH, progesterone, and testosterone.
Bottom Line
If your period is late, it’s an obvious warning sign of trouble in your body. The treatment for amenorrhea will depend exclusively on the cause of the amenorrhea.
For instance, if you suffer from PCOS, your provider will concentrate on lifestyle changes to address insulin resistance or may prescribe Metformin for serious insulin resistance.
At Kairos Health and Wellness, we go beyond the obvious and get to the bottom of why your period has stopped, and develop a plan of action that is unique to you to bring your hormones back into balance naturally.