Missed periods

Missed a period? You're not necessarily pregnant.

Amenorrhea

Amenorrhea is the medical term for not having periods. There are two types of amenorrhea:

• Primary Amenorrhea is exceptionally rare - it's not having started periods by the age of 16. This can be caused by: abnormalities in the cervix, uterus or vagina (such as a narrow cervix, double uterus or transverse vaginal septum); late onset of puberty; and pregnancy.

• Secondary Amenorrhea is much more common and there are loads of reasons for it. Missing your period isn't officially amenorrhea until you've missed it for three months in a row, but the causes of missing one period and missing more than one are generally the same.

Common causes of missing a period (or amenorrhea)

To menstruate, the uterus, cervix, vagina and ovaries, as well as the pituitary gland and hypothalamus (which are located in the brain and control the hormones which cause menstruation), must be working normally. There are lots of reasons for these to not be functioning as they usually do, some more serious than others.

• Pregnancy: is the most common cause of amenorrhea. Periods are not expected to resume until after childbirth and breast-feeding women may also find that they don't have periods.

• Recently started periods: For about a year after your first period it's not uncommon for your cycle to be very erratic or even to miss your period for several months.

• Lifestyle:
  1. Major changes in your life, (new job, sudden massive workload, bereavement) can create enough stress to make you to miss your period.
  2. Rapid weight gain or loss can cause amenorrhea. In particular amenorrhea is associated with malnutrition or low body fat caused by eating disorders.
  3. Too much exercise, often connected with heavy dieting, can also stop your periods. Just because you're really fit, stopping your periods isn't any healthier. Periods are a sign of your body working properly.
  4. In some cases heavy smoking can also be the cause of amenorrhea.

• Serious illness: Any illness affecting your reproductive organs or their hormones, such as a tumour in the brain (pituitary gland) as well as any serious illness. Particular ovary conditions include ovary damage, autoimmune ovary disorder and Turner's Syndrome. In addition to the actual illness, some treatments also cause amenorrhea, such as chemotherapy, radiation therapy and some medications. You should check with your GP if you're unsure about any of your medication.

• Mental health and emotional disorders: For example depression and pseudocyesis, which is a condition where a woman convinces herself that she is pregnant when she isn't. The psychological effect is so strong that her periods may actually stop.

• Hormonal conditions: For example hormonal or masculinisation disorders. Also if you stop taking a hormonal contraceptive your period may not start again for anything between three months and a year.

More serious problems associated with amenorrhea

• STIs can cause amenorrhea. Chlamydia is particularly dangerous as it often shows no symptoms and can cause infertility if left untreated.

• Polycystic Ovary Syndrome causes eggs in the ovaries to develop into cysts. If they remain untreated they can build up and enlarge, causing a variety of problems ranging from acne and excess hair growth, to diabetes, infertility, heart disease and cancer.

• Ectopic pregnancy is when the pregnancy develops outside the womb, for example in the fallopian tube or the cervix. If it goes unnoticed serious surgery maybe required, which can cause infertility. For help and support with ectopic pregnancies go to the Ectopic Pregnancy Trust website.

• Anovulation is when the egg doesn't develop and get released properly. There are many reasons for this. Premature ovarian failure (also called premature menopause) is one example. One in 1000 15-29 year-olds and one in 100 30-39 year-olds suffer from premature ovarian failure.

What to do if you've missed your period

First of all don't panic. Even if you are pregnant there are options, and if you're not it may be nothing to worry about. It's important to keep positive because amenorrhea can usually be corrected. If you've not had a period for two months make an appointment with your GP and remember that ongoing stress often causes your period to stop for six months or more.

Amenorrhea isn't a disease, it's a symptom of other things. If your periods are irregular try to keep a record of your cycle, or at least try to remember the last one you had. It's also worth finding out whether there's a history of any similar problems in your family. To prevent amenorrhea recurring you should try to maintain a healthy weight and avoid excess alcohol, smoking and drugs. Remember that amenorrhea is often caused by lifestyle and think about how stressful your life is. Try and balance work with play and get enough rest.