Dear Alice,

What is the usual treatment for missed periods? I haven't had my period for half a year (ever since I stopped taking the pill). I have also lost some weight. What are the health effects of missed periods?

Periodless

Dear Periodless,

It's great that you're noticing when your body and its functions have changed — that's the first step at which exploration and possible solutions can be pursued. Amenorrhea ("a" means without and "menorrhea" means menstrual flow) is the medical term for not having your period for an extended amount of time. When you go off the pill, it can take a while for your body to re-adjust to its natural hormone production schedule. Missed periods could be to a number of causes ranging from pregnancy, changes in physical activity or eating habits, to medical causes (more on this in a bit). Missed periods could affect a person’s ability to become pregnant and affect bone density. Treatments can vary, being selected based on the cause of amenorrhea. Since you have missed over three consecutive periods, it could be wise to make an appointment with a health care provider. They can help determine the causes of your missed periods and any necessary treatment.

One of the most common reasons that people with a uterus stop menstruating is pregnancy. If you’ve already ruled that out, some other common reasons for missing periods include weight loss, hormonal changes, strenuous physical activity, mental or emotional stress, and eating disorders such as anorexia. Amenorrhea may also be due to larger causes, including:

  • Problems with the hypothalamus: The hypothalamus (in the center of the brain) controls the production of the reproductive hormones that regulate the menstrual cycle. Problems with your hypothalamus can make your periods stop for months at a time.
  • Thyroid malfunction: Overactive or underactive thyroid functioning can cause menstrual irregularities, including amenorrhea.
  • A tumor in the pituitary gland: This can also result in abnormal hormone production, and, ultimately, halt menstruation.
  • Polycystic ovary syndrome (PCOS): PCOS causes high, stable hormone levels rather than the fluctuating hormone levels that accompany normal menstrual cycles, which can also impact the frequency of periods.
  • Structural problems: Uterine scarring, structural abnormalities, or missing reproductive organs can also cause amenorrhea.

Amenorrhea can have a negative impact on reproductive, endocrine, and muscular-skeletal systems. Without ovulation (and menstruation), pregnancy isn’t possible. With this, one complication of missing periods may be infertility. In addition, if the cause of amenorrhea is due to low estrogen levels, there may be a loss of bone density (this is particularly relevant for competitive athletes in physically demanding sports). Regardless of diet and physical activity programs, it’s possible for athletes to have significant reductions in bone mass when their periods are stopped.

Treatment for missed periods is typically specific to the underlying cause. In some cases, that may include contraceptive pills, hormone therapies, or other medications. In meeting with a health care provider, it’ll be helpful to share a thorough history of your activities, diet, and workload. You can also describe any other symptoms you may be experiencing, even if they seem insignificant. These clues can be beneficial in figuring out your situation.

Alice!

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