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 can be frustrating or worrisome (Where is she? Why hasn't she called to say she’d be late?), especially if she's typically known for being punctual. Amenorrhea, or the absence of menstruation, isn’t considered to be a health condition on its own. Rather, it’s usually due to an underlying cause such as contraceptive use or high stress. While the conditions that cause amenorrhea are rarely serious, it’s a good idea to talk with a health care provider, particularly if you’ve missed more than three consecutive periods. They can recommend the appropriate plan for regulating your menstrual cycle.

There are two types of amenorrhea: primary and secondary. Primary amenorrhea is characterized by not having menstruated by age 14 to 16, and secondary amenorrhea is characterized by missing at least three consecutive periods, not including those who are pregnant. Secondary amenorrhea, which is sometimes accompanied by other symptoms such as headache, changes in vision, increased facial hair, hair loss, changes in breast size, and milky discharge from the nipple, may be due to some of the following:

  • Contraceptive use
  • Breastfeeding
  • Pregnancy
  • Too much physical activity
  • Menopause or family history of early menopause
  • Stress or anxiety
  • Some medications
  • Having a low body weight
  • Underactive or overactive thyroid
  • Pituitary tumor
  • Uterine scarring
  • Polycystic ovary syndrome (PCOS)

Even though you haven't had sexual intercourse, it’s worth thinking about any other sexual contact you’ve had. Depending on the activity, it’s still possible for semen to enter the vagina, so you may want to take a pregnancy test as a precautionary measure. Another factor to consider is whether you have a family history of amenorrhea 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. This could be done using pen, paper, and a calendar, or for those who prefer to use electronic methods, there are a number of tech-based tools  that can also be used.

If you’re worried that your missed period could be due to something more serious or you’ve noticed a pattern with your missed periods, it may be helpful to discuss it with a health care provider. Once they have a better idea of your pattern and symptoms, they might help determine the cause of the missing periods and be able to recommend a variety of strategies to regulate your menstrual cycle. These could include starting on contraceptive pills, maintaining a healthy body weight, or adopting positive coping mechanisms for stress. If you aren't doing so already, consider incorporating some of the following into your routine — regular moderate physical activity, meditation, tai-chi, yoga, aromatherapy, balanced eating habits, getting enough sleep, and reaching out for support during stressful times. Practicing some or all of these strategies may help with stress management and maintain balance in your life.

While it can be frustrating to keep waiting for Aunt Flo to arrive, understanding the reasons behind the delay may be helpful in predicting future visits. 

Alice!

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