Dear Alice,

I usually get my period every three weeks. But it has been five weeks now and I haven't gotten it. Pregnancy is not an option because I haven't had any sexual intercourse. So what is the problem? Should I be worried?

— Missing monthlies

Dear Missing monthlies,

Waiting for Aunt Flo to show up may be frustrating (Where is she? Why hasn't she called to tell me she'd be late?), especially since she's typically known for being punctual… more or less. Absent menstruation (a.k.a. amenorrhea), which is not considered to be a health condition on its own, typically signifies that another health issue may exist. Amenorrhea rarely indicates a serious underlying health condition, especially since there are a number of reasons for missing periods, ranging from contraceptives to being stressed out. Depending on what may be causing your amenorrhea, a health care provider can help suggest a variety of options for regulating your menstrual cycle. It is recommended that you contact your health care provider when you've missed more than three consecutive periods.

There are two types of amenorrhea: primary and secondary. Primary amenorrhea is characterized by not having menstruated by age 16 and affects one percent of women. More common, secondary amenorrhea, which is characterized by at least three missed periods, affects four percent of women, not including those who are pregnant. Secondary amenorrhea, which may be accompanied by other symptoms such as headache, loss of vision, changes in voice, and increased hair growth, may be due to some of the following:

  • Breast-feeding
  • Pregnancy
  • Stress/anxiety
  • Some medications
  • Significant changes in weight
  • Having a low body weight
  • Hormonal imbalance
  • Hypothyroidism
  • Exercising too much
  • Contraceptives
  • Pituitary tumor
  • Uterine scarring
  • Primary ovarian insufficiency (when a woman under age 40 runs out of ovarian eggs)
    List adapted from Amenorrhea from the Mayo Clinic.

You mention that pregnancy is not an option because you haven't had sexual intercourse. If you have had close sexual contact, even without penetration, it may still have been possible for semen to enter the vagina, so you may want to consider getting a pregnancy test just to rule out pregnancy completely. Another factor to consider is whether you have a family history of missing periods by asking close female family members and relatives whether they've ever experienced something similar. In addition, keeping a menstrual chart is often useful for determining the length of your menstrual cycle as well as tracking any changes that may occur.

Discussing this issue with a health care provider may be helpful for understanding what may be going on and getting your period back on track. S/he can help determine the cause of the missing periods and may recommend a variety of tips to regulate your menstrual cycle. These may include maintaining a healthy body weight and adopting healthy coping mechanisms for stress. If you aren't doing so already, you may want to consider adding some of the following to your routine — regular exercise, meditation, tai-chi, yoga, aromatherapy, eating a balanced diet, getting enough sleep, and confiding in people that you trust. Practicing some or all of these strategies may help with stress management and restore balance.

While it may be frustrating to keep waiting for Aunt Flo to arrive, understanding the reason(s) behind the delay may be helpful in predicting future visits. 


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