   
29 years old and irregular
periods
Lack of menses is usually due to anovulation. Assuming pregnancy
isn't the cause of the anovulation, the two most common causes are
polycystic ovarian disease and conditions that produce "hypothalamic
amenorrhea". There are also other things like premature ovarian
failure, thyroid disease etc. a list is available at:
skipping
periods
The fact that you did not have a withdrawal bleed from Provera
makes the category of hypothalamic amenorrhea more likely. Often this
turns out to be stress or medication induced. Might any of these
apply?
Your doctor probably drew or will draw some hormone tests to see if
there are any patterns that can help classify what's going on with
you.
Weight change and skipping
menses
I think its best to get diagnosed properly as to whether this is
something like polycystic ovarian disease, hypothalamic amenorrhea
(like stress-induced), thyroid problem or any of the other causes of
no menses or infrequent menses. Your doctor will probably order some
hormonal tests and possibly an ultrasound of the pelvis to look for
multiple cysts in the ovaries. The blood tests may include TSH,
prolactin, FSH, LH, and possibly DHEA and testosterone.
Missed two menses -
pregnancy test negative
Sometimes skipping one or two periods can be as simple as having had
a cold or flu. If menses are delayed 3 months or more, you need to see
a physician about it. If you are just too uncomfortable now you may
see physician for medicine (a progesterone type medication to start
menses.
How long for menses after
taking Provera®
The menses usually starts anywhere from 2-3 days after completing
the Provera® (i.e., about now) up to 2 weeks. Occasionally it
doesn't induce a menses and then your doctor may need to give you some
estrogen followed by more Provera®. When the Provera® doesn't
work, that usually means there had not been enough estrogen around to
stimulate growth of the endometrium.
Delay of menses after long
term birth control pill use
Birth control pills do not seem to change your body's ovulation
timing no matter how long you are on them. They mask what your normal
cycle would have done had you not been taking the pills. When you
discontinue the pills, your body goes back to whatever its cycle would
have been at this point in your life had you not taken the pills. This
may take up to three cycles to get back to that pattern however.
Amenorrhea and overweight
Amenorrhea itself is not dangerous at all. It doesn't lead to cancer
or premature death, heart disease, diabetes or anything like that. The
only serious effect it has is its effect on fertility. If amenorrhea
isn't due to pregnancy, it generally prevents getting pregnant.
Rarely, a stopping of menses (secondary amenorrhea) can be due to
blockage of the genital tract but that's almost always due to the
consequences of scarring due to a procedure like conization, laser,
cryotherapy, or LEEP to the cervix as treatment for cervical
dysplasia, or D&C of the uterus usually as treatment for abnormal
uterine bleeding.
The most common cause of skipping menses is lack of ovulation on the
part of the ovaries. Anovulation is often due to stress reaction,
medications or sometimes various disorders. Weight doesn't usually
cause amenorrhea per se but is often associated with it. Usually it is
thought that the same stress that produces the overweight may cause
the lack of ovulation.
If the amenorrhea persists into a third month, seeing a physician
would be a good idea.
No menses after stopping
breast feeding
A general rule-of thumb is that it takes about 3 months after
delivery or after discontinuance of breast feeding for menses to get
back to their normal pattern. That pattern can be different after a
delivery. Restoration of normal menses can be interfered with by
injectable contraceptives, stress/depression or sometimes even sleep
deprivation with a new baby. Make sure that you are not pregnant again
also.
Normally an emergency C-Section would not be a cause of something
like this unless there had been an excessive amount of bleeding
usually requiring blood transfusions.
Long term effect of not
having menses
The problem is lack of, or infrequent, ovarian ovulation. Ovulation
produces menstrual slough (if pregnancy doesn't occur each cycle) or
In the long term, absent or infrequent menses can have two effects:
If there is sufficient estrogen from the ovaries such as that seen
with polycystic ovarian disease, a woman has a higher incidence of
endometrial cancer usually at an earlier age. In this case the usual
treatment is to induce a menstrual period every 2-3 months at least so
that the endometrium lining the uterus is not under constant estrogen
stimulation.
If there is a lack of estrogen because the ovary is not being
stimulated to produce estrogen by pituitary hormones, then a woman may
be at risk for premature osteoporosis, heart disease, etc. just as if
she were menopausal. This usually only happens in severe cases such as
anorexia nervosa eating disorder, stress induced anovulation, severe
physical or athletic activity etc. The general category is a "hypothalamic
amenorrhea". If it goes on more than a year or so, most
physicians recommend some sort of estrogen replacement. That
replacement can be oral contraceptives, or, if you are trying to get
pregnant, sequential estrogen/progestin. However if trying to get
pregnant, often ovulation induction medicines are needed such as
Clomid®.
No menses since first
pregnancy
When you were nursing and not having periods, that was expected.
Nursing suppresses ovulation and after you stopped nursing, you
probably got pregnant on the first ovulation before having even one
menstrual period. This time, however, things are different. You have
not been nursing for awhile. If there was nothing wrong, you should
have started your periods. Endometriosis does not cause you to stop
menses. Therefore something is causing a secondary amenorrhea
(anovulation). If you don't ovulate, you can't get pregnant.
It sounds as if you doctor is now doing some tests to see why you
don't ovulate (or menstruate).
Does thyroid disease
cause missed periods?
Yes, either high or low (more commonly low) thyroid disease can
cause amenorrhea.
When I'm late for my
period I feel bloaty and crabby
Its difficult to tell why sometimes ovulation is regular "like
clockwork" and other times it gets delayed. Many women feel like
you do when ovulation is late. It's similar to pregnancy feeling but
you are not pregnant (I assume). It may be that there is just blood
vessel congestion in the pelvis and that's what gives the feeling.
Postpartum 7 months, not
breast feeding, no menses
In the absence of breast feeding, postpartum menses usually returns
by about 2 months. After 3 months we often give Provera®,
medroxyprogesterone acetate in order to induce a menses in the hopes
of stimulating the ovulatory axis. I would say after six months is
definitely abnormal. The causes are many.
Of the three subgroups, low, normal or high gonadotrophins, post
part delay of menses is much more likely to be related to low or
normal gonadotropins. Of those many causes, I would say the following
would be the most common:
pregnancy (again), medications, postpartum (shot of Depoprovera,
anti- depressants, anti-anxiety etc.), stress-induced, thyroid disease
(high, low, inflammation), large weight change (loss or gain) and
reversion to ovulation problems that existed before pregnancy such as
polycystic ovarian disease, thyroid disease etc. The other causes are
less frequent.
Attention should be paid to any unusual events which happened or
medications received at the time of delivery and since. On physical
exam, estrogen effect of the vagina will be checked along with looking
for any abnormalities on the pelvic exam. The next likely study is an
in-office pregnancy test.
The doctor would then usually order gonadotropins (FSH, LH) thyroid
studies (TSH, free thyroxin/T4), prolactin and possibly some adrenal
or other hormones. While waiting for those results, a treatment of
medroxyprogesterone acetate to induce a menstrual bleed would tell
whether or not estrogens are being produced (if they are not, no or
little bleeding will occur).
All of these results would have to be put together and possibly more
studies if needed to determine the cause.
How can I intentionally
delay my menses for the holiday?
If you were to start a birth control pill cycle this month it might be possible
by extending the active pills (i.e., using the three week active pills
then taking another week of active pills and then discontinuing). If
you are much more than a week or so into this cycle, it probably would
not work.
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