To some women, it sounds like a dream…
And when it happens to you, at first you might think… “Hey, that’s really not so bad.”
But as a functional medicine practitioner, I can assure you:
Your period going missing IS a problem.
(Or rather, it indicates a problem!)
Today, let’s dig into why your period is so important, and why it might have gone missing (AKA amenorrhea). Plus, how worried should you really be?
Why Your Period Is Really, Really Important
For women of reproductive age, there’s really no other health marker as important as your menstrual cycle.
A normal menstrual cycle is anywhere from 24-35 days long and includes 4 parts:
- Menstrual Phase – this is what we think of as your period, the part of your cycle when you bleed. Hormones are lower at this point.
- The Follicular Phase – this occurs after your period, and is really the start of a new cycle, when the body prepares for potential pregnancy. Hormone levels rise during this part of the cycle as the body prepares an egg to be released during ovulation.
- Ovulation – this is the day somewhere in the middle of your cycle when your body releases an egg in response to peaking LH (luteinizing hormone) levels. Ovulation causes progesterone levels to rise.
- The Luteal Phase – this is the phase after ovulation, when you either get pregnant (which must happen within a few days of ovulation), or don’t. If you don’t get pregnant, you move back to phase 1 and have your period again.
And while talk of the menstrual cycle is very procreation-focused, your menstrual cycle actually isn’t just about getting pregnant or not.
The hormones that are driven to rise and fall by your menstrual cycle play other important roles in your health – most importantly, progesterone, which keeps bones strong and healthy and lowers the risk of certain cancers.
Not only that, but your hormones are meant to exist in balance: each hormone is counterbalanced by another, and if you’re not moving through each phase of the cycle, you can become dominant in one hormone – most commonly estrogen, which should be balanced by adequate progesterone. Estrogen dominance can lead to symptoms like weight gain, mood swings, tender/swollen breasts, and loss of libido.
That’s why moving through each phase of your menstrual cycle is so important, even if you’re not looking to have a baby now (or ever).
If Your Period Is MIA, You Probably Aren’t Ovulating
When you ovulate, an egg is released from the follicle. That follicle becomes the corpus luteum. The corpus luteum produces progesterone, which tells the body to build up a thick lining in the uterus.
If you don’t become pregnant, the corpus luteum withers, and the uterine lining is shed as your period.
What this means is that having a period – where you shed blood – is entirely dependent on ovulating. If you don’t ovulate, there won’t be a follicle to turn into the corpus luteum, so your body won’t be told to build up the uterine lining, and there won’t be anything to shed.
What I’m getting at is that a missing period tells us you’re not ovulating. And that’s what really matters, because it is ovulation that produces estrogen-balancing, bone-protecting, cancer-risk-reducing progesterone.
Now there are a couple exceptions: some women who ovulate irregularly may have bleeding, even without ovulation. It is more likely that you won’t – but it can happen.
Secondly, women who are on hormonal contraceptives (the birth control pill), may bleed every month, but are not ovulating (because hormonal contraceptives suppress ovulation). The “period” that you have on a hormonal contraceptive shouldn’t be thought of as a true period. Instead, it is actually a “withdrawal bleed” because the bleeding is triggered by the withdrawal from the artificial hormones during the placebo week of your birth control pill.
Is Your Period Up and Gone, Or Just Flaky?
When I’m working with a patient who has missing periods, here are some of the questions I ask to help point me in the right direction toward the cause, and ultimately, the solution.
Did you ever have normal cycles?
If you used to have normal, predictable cycles – and then suddenly they stopped or became unpredictable, that suggests to me something has disrupted your otherwise healthy hormones. If you’ve never had a normal cycle, all’s not lost- it just points me in a different direction.
Has your period been gone for months (or years) straight, or is it just unpredictable?
A period that comes and goes can suggest oligoovulation – which means ovulation is unpredictable. Anovulation is the complete absence of ovulation. Again, neither one means all hope is lost: this can just help suggest what might be going on.
Did you have any major life changes around the time your period disappeared?
This is another important detective question. The menstrual cycle is delicate – and is designed to prevent pregnancy during times of extreme stress or upheaval (since having a baby in a famine or war wasn’t really ideal for our ancestors!). It’s a good idea to try and create a timeline of when your period went missing and what was going on in your life at that time.
Reasons Your Period Could Be Missing
Now that you know why it matters that your period is missing, let’s get into the good stuff: figuring out why your period is gone!
Here is a list of the most common causes of a missing period I see with my patients:
Ok, this one is pretty obvious: if you’re pregnant, you won’t have your period. Luckily, it’s also really easy to rule out: if there’s any chance you could be pregnant, take a pregnancy test and know for sure.
On the opposite end of the spectrum from pregnancy is the possibility of perimenopause. Perimenopause is the years-long period before the onset of menopause, when your hormone levels start fluctuating and your periods can become suddenly abnormal. In perimenopause, you might have longer cycles (34+days), skip a few cycles, or have lighter or heavier periods. Other perimenopause symptoms include mood changes, hot flashes, and night sweats. Perimenopause begins for most women sometime in their 40s – if you think you’re experiencing perimenopause early, that is something we can address. Even if you’re the “right age” for perimenopause to have begun, it is a myth that perimenopause has to be a horrible time. There is so much we can to help stabilize hormones and provide symptom relief as your body goes through this big (normal) change.
Polycystic Ovarian Syndrome (PCOS)
PCOS is a hormonal disorder that affects millions of women (myself included). It is distinguished by elevated levels of androgens (male hormones) and the absence of regular ovulation. (Remember, no ovulation = no period.) PCOS is complex to both diagnose and treat – but it can be done. Click here to read my ultra in-depth blog post on all aspects of PCOS and learn more about treatments.
It should be noted that PCOS can occur alongside another cause of a missing period, commonly hypothalamic amenorrhea (HA).
Hypothalamic Amenorrhea (HA)
Hypothalamic amenorrhea (amenorrhea is the technical term for a MIA period) is a hormone imbalance that prevents ovulation caused by 1) over-exercise, 2) stress, 3) undereating, or 4) some combination of all 3. If you used to have normal cycles, and suddenly lost them, HA is one to consider. Your physiology is designed to prevent ovulation (and therefore, reproduction) when stress is high or nutrition levels are low, and HA is a result of this. Some women experience HA even when at a normal weight, or doing an amount of exercise that is deemed normal by society. Developing HA is all about crossing your body’s threshold, and that level is different for all women.
There is no definitive test for HA, and it is usually diagnosed by eliminating other causes of a missing period first. If you have HA, learning to manage stress, eating more, and exercising less can all lead to the restoration of normal cycles, though the process can take time.
HA can occur alongside PCOS, but doesn’t always.
Premature Ovarian Failure
This condition occurs when the ovaries stop functioning normally at an early age. This can cause irregular, come-and-go periods, rather than a complete stop.The exact cause of premature ovarian failure is unknown, though its thought genetics and autoimmunity may play a role. Unfortunately, premature ovarian failure usually causes infertility, but treatment with bioidentical hormones can help manage other symptoms.
Prolactin is the hormone that causes the breasts to produce milk, and it also suppresses ovulation. If you’re breastfeeding exclusively, high levels of prolactin can keep your period at bay. But if you’re not breastfeeding, high prolactin indicates a serious issue. It can be a result of a tumor on the pituitary gland or thyroid issues. Besides a missing period, tell-tale signs to look for are a milky discharge from the breasts, vaginal dryness, and acne.
Hormonal contraceptives (AKA the birth control pill, patch, ring or hormonal IUD) work by suppressing your body’s natural production of hormones and replacing them with artificial counterparts. Most hormonal contraceptives suppress ovulation, and the only “period” you get is a withdrawal bleed during the placebo week of the pill. Some pills allow you to skip the placebo week – sometimes called continuous pills – and skip the withdrawal bleed altogether. One exception is the hormonal IUD (Mirena), which doesn’t always stop ovulation, but often still causes lighter or absent periods.
So, does this mean hormonal contraceptives are bad? It’s a little more complicated than that. Hormonal contraceptives have a time and place. However, there are other non-hormonal birth control options I prefer – check those out here. And I don’t like seeing hormonal contraceptives used as a “treatment” for hormone issues like PCOS or heavy periods, because all they can do is cover up these issues, not fix the root cause.
Post-Pill Amenorrhea or Post-Pill PCOS
Recently stopped using hormonal contraceptives? That could be a cause of a missing period. Post-pill amenorrhea is a condition where periods remain absent after going off the pill. When you’re using hormonal contraceptives, your body’s normal hormone production is shut off. When you quit the pill, it can take time for hormone production to normalize, and a missing period can be the result. This should resolve in a couple months – if it takes longer, seek help. With my clients, focusing on diet, lifestyle, and key supplements can help speed up this process. Post-pill PCOS is similar – when hormones come back online after using the pill, androgens (male hormones) may surge, causing a temporary state of PCOS. Jumping in right away to help normalize hormone levels can help prevent this imbalance from becoming permanent. See this post for more on PCOS.
Stress, Illness, or Travel
One of the simple explanations of a missed cycle? Periods of intense stress – whether psychological or physical, which can result in missing or delayed periods. The “stress hormone” cortisol is to blame. When you experience stress, your body produces more cortisol to help you respond to the stress. However, cortisol also interferes with communication between your brain and ovaries, where hormones are produced, preventing ovulation and therefore, your period. One missed or late cycle after a period of stress is likely NBD – as long as things normalize again quickly. But if you are chronically stressed, there are steps we can take to support your body in managing cortisol to hopefully take the burden off your menstrual cycle.
This is one of the less common reasons I see for missing periods, but it does happen. Again, your body will shut down reproduction first thing if it senses you’re not well enough to successfully reproduce, as a protection mechanism. If you have a chronic disease that is constantly taxing your body, it makes sense that your cycle could be disrupted. Most commonly, I see this with women with undiagnosed or poorly managed Celiac disease, since Celiac prevents proper nutrient absorption and causes chronic inflammation. Treating the chronic condition (and getting it under control) can help restore normal cycles again.
An overactive or underactive thyroid (Hypo or hyper hypothyroidism) can also be a cause of missing or skipped periods, among other symptoms like feeling hot/cold, weight gain or loss, and hair loss. If you’re missing your period, and don’t know why, a full thyroid panel is a great place to start to rule out the possibility of thyroid issues.
How Do I Know Why MY Period Is Missing?
Now that you know the most common reasons your period could be missing, the next step is to narrow it down to what the issue is for you.
Some of these potential issues are easy enough to rule out, but for the rest, testing is the next best step. With my own clients who are struggling with amenorrhea, I use a combination of blood, saliva, and urine tests to help narrow down the root cause. (And if you are working with me, I’ll help you figure out which tests you can ask your regular doc to order and bill through insurance, too!)
Once we know the root cause, we can create a customized treatment plan to help restore ovulation and normal, healthy cycles.
If you’re missing your period and need support finding the root cause and getting it back, book a free 15-minute consult to get started working with me. This no-obligation first call is like a coffee date where we can test the waters and see if working together might be a good fit.
Whether you’re trying to get pregnant or just worried about what a missing period means for your ehealth, I’d be honored to help get your cycles back on schedule.
PS – If there’s ONE thing you take from this article, let it be this: missing your period is NOT normal, and needs to be addressed! In fact, a missing period is a major red flag that something is not quite right with your health. Don’t ignore it!