If you’ve ever missed a menstrual period you understand the wave of emotions that can happen: fear (am I pregnant?), joy (am I pregnant?), confusion (when was my last one?), trepidation (is it coming on my vacation instead?) or relief (free pass this month). Missing a cycle can be a signal of other issues and it warrants digging a bit deeper if it happens more than once in a while!
Amenorrhea is the proper name given to a cycle that is missing for a certain length of time. Primary amenorrhea is when a young woman does not get her cycle before age 15, especially if she hasn’t developed other sexual characteristics such as breasts. In this article we focus on secondary amenorrhea, defined by the American College of Obstetricians and Gynecologists as when a woman loses her cycle for more than six months. There are three general causes of secondary amenorrhea: hormonal disturbance, physical damage preventing endometrium growth, or obstruction of the outflow path of the menstrual blood. Let’s focus on hormonal disturbances.
The most obvious reason a woman can lose her cycle is pregnancy, so we always check with a pregnancy test—yup, even if you haven’t been with a male partner. It can feel a bit silly especially since we know if we’ve been with a male partner, but it’s standard of care to check. Once that hurdle is cleared it’s time to dig in…is this PCOS, premature ovarian failure (I hate this term— they don’t fail) or something else? A quick differential is to check the thyroid, prolactin levels (a hormone that makes us lactate but can be due to a growth in the brain too), and to ask about food intake (anorexia?) and exercise (overexercising, lean athlete?).
If a woman has excessive hair growth (not the fun kind on the scalp), acne and a long history of infrequent or irregular cycles it may suggest PCOS—Polycystic Ovarian Syndrome. PCOS is a huge subject to tackle so let’s circle back to that in the future. The good news is there are many ways to treat PCOS and regulate a cycle, especially important for women who want to become pregnant.
A condition that does not get enough attention is premature ovarian failure (hereby called insufficiency, not failure!). Premature ovarian insufficiency (POI) is an endocrine deficiency, characterized by the premature depletion of ovarian follicles and decline in ovarian function before age 40. This is different from peri-menopause because POI creates a greater risk to a woman while she ages, and has potentially life-changing physical and emotional consequences. Many factors can contribute to the development of spontaneous POI including a woman’s tubes being tied or having one ovary removed, smoking and low body weight. Family history with mothers and aunts can also show a genetic connection.
Other POI risk factors can be autoimmune conditions such as Hashimoto’s or Addison’s disease. We see greater numbers of women being diagnosed with thyroid and adrenal issues at younger ages and the impact on the ovaries is definitely correlated. When women start to experience POI they may feel very menopausal: hot flashes, night sweats, vaginal dryness, anxiety, fatigue. These symptoms may come and go depending on the health and hormones being made by the ovaries each month. Estrogen deficiency is a common cause of these hormonal changes and symptoms.
Many women would be thrilled to finish their periods earlier in life! What a dream! However, the early ending of these important hormones can put women at a greater risk of heart disease, osteoporosis and type II diabetes. Lab tests are extremely important to figure out what hormonal changes are occurring and what a safe treatment would be. Measuring a woman’s FSH level is one of the first things to do. This hormone originates in the pituitary gland and is essentially a message to the ovary to get ovulating! If FSH levels rise higher than normal, it’s a sign of an ovary tuning out the message and not responding. FSH levels will continue to go up and the ovaries will continue to ignore the noise, prematurely finishing the ovulation job. This hormone test is incredibly important for any woman to have if her cycle is MIA.
Understanding why a period is missing is essential information, and supporting hormones through a woman’s life is essential in prevention. Consider a deep look at nutrients that support ovulation, such as vitamin B6, essential fatty acids like evening primrose oil to support the lipid layers surrounding the ovaries, and a diet full of antioxidants and deeply pigmented coloured foods. Ovarian health is often ignored until amenorrhea or infertility become a concern, but there is so much we can do to prevent issues earlier in our menstrual lives. Ask for information, investigate what is happening with your trusted team, and be educated about your body and your monthly cycle that shows us so much about your body and general health!
