Womens Health

Menstrual Delay or Skipping: Answers to Your FAQs

From Woman's Diagnostic Cyber
Frederick R. Jelovsek MD

29 years old and irregular periods

I am 29 years old, haven't had a period in a year, before that time had irregular periods. I did get pregnant almost three years ago although my periods were irregular. I was sent to an endocrinologist, who prescribed Provera, well, it didn't help me, still no periods! What could be my problem, help me!

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'm 21 and overweight. When I was 17 and just starting college (and a huge weight gain), my periods stopped. My gynecologist gave me progesterone and I was supposed to take one a day for the first twelve days of the month. Well, I ended up taking only one a month for about three months and my periods continued normally for several months and then stopped again. I went back to the doctor and got more pills. (and a shot) Anyway, my weight stabilized somewhat and I haven't gained or lost any for a while. Also, I've been working with kids for several years. Last semester, I thought my periods were coming back ok, like I would spot once a day for 12-20 days, not even enough to wear protection. It would stop and come back the next month. Sometimes the flow lasts normally, light discharge for two days or so. But it comes at such irregular intervals, like three days after I think it has stopped or three weeks after, I don't know. Are my hormones just really messed up and trying to stabilize themselves or should I ask my Dr. for more extensive tests? p.s.: I'm a virgin, if that makes any difference.

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

I am 28 years old and have always had basically regular periods. I am not on bc pills, but my husband and I do use condoms. My last menstrual cycle ended on March 8th. (Today is May 4) I have taken two pregnancy tests and both were negative. My lower back aches and my abdomen is bloated. What could be causing this? I am very concerned because I have not had any significant changes in my lifestyle, nor have I been under any type of stress.

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®

I saw my Dr. 8 days ago and then took Provera® to start a period. How many days will it take before I get one? I took 5 pills, 1 each for 5 days. This is day 8 now.

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

I am 29 years old and have been on the pill for about 12 years. I decided to take a break and my first period occurred on day 36. It has been 50 days since the first day of my last period. Before I went on the pill I used to have 35 day cycles. I am not pregnant - can anybody explain. It seems this may be normal after going off the pill! Is it?

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

How serious is amenorrhea? I am 22 years old and have always had very regular periods. I am definitely not pregnant and have not menstruated for 2 months. Should I see my doctor right away? I am 50 pounds overweight. Could obesity be the cause and if so how?

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

Help! I had a baby and breastfed for somewhere up to 2 1/2 months and I had some periods not very regular then had one a few weeks later even than the others, now I haven't had one in 2 months....you could almost tell time by them before the baby and now I'm wondering if something is really wrong. By the way, baby was born by emergency c-section if that makes a difference.

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

I'm 31 and am trying to get pregnant (my second). The problem is whenever I go off birth control (both the pill and depo- Provera) I don't have any periods and don't ovulate (Before I went on the pill I had a very irregular cycle). When I got pregnant the first time it was exactly two weeks after I stopped taking the pill and I assumed my cycle was regulated by the pill allowing me to get pregnant. Now, the question, since I have this irregular cycle when I am not on birth control how will this affect my body long term? Over the course of my life I have frequently gone months, and even up to two years without a period. Does this do long term damage of any kind?

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

I would like help. This is an awesome web page I wish I would have found it earlier. I have had three children in less then 4 years. None the less, I have not had a period since my 1st pregnancy. We are trying to conceive now, after being diagnosed with endometriosis last September. I had a second opinion from another GYN and he agreed to my laparoscopy. My Dr. removed the endometriosis with a laser. Since this time I have still not received a period. Yesterday I saw him in hopes that I was pregnant...not the case. He put me on Provera® for 5 days and also did blood work on my thyroid, and checked the hormonal levels. They will be back in a few days. Until then I sit here wondering why it's such a big deal not to have periods. He seemed quite upset that I was not having them. I have nursed our babies, and upon completion, have become pregnant. What a miracle with the endometriosis!!! Anyway what are your thoughts?

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.

I am done nursing this last baby now 14 months and still no pregnancy, or period, what should I do?

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?

Does the thyroid have anything to do with a missed period?

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

I'm usually very regular but I've noticed in February and in March that my periods get a little later. It's April and almost the end of the month and still nothing. I feel cramping every now and then and that reassures me but why would I be this late? I have considered stress a factor and have been using reliable birth control. What's up? I've been bloaty and crabby and all of the tell-tale signs are there of impending menstruation. I can't put my finger on it and would like some input.

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

I am a 23 year old mother of two. My last child was born over 7 months ago and afterwards I had a tubal. I do not breast feed. I have yet to start my period. Should I be worried?

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?

Going to a nude beach over holiday weekend!! My period will start about 1 or 2 days into my vacation. I am not on the pill, is there any safe way to postpone my start date with less than a month to go?

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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