Missed periods and you’re not pregnant

Q: I am 34 years old and I have not had my periods for the past four months. Last month, I noticed some ‘spotting’ but nothing since then. Initially, I thought I was pregnant and had several pregnancy tests done (both using over-the-counter kits and even went to hospital twice for blood tests) – all results were negative. What could be wrong? My partner and I want to start a family and this is really stressing me.

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Menstrual patterns change throughout a woman’s life. It is not unusual for a woman to occasionally have a period that comes a few days earlier or later than expected.
In fact, missing a single period is often not a great cause for concern. However, missing more than three consecutive periods warrants a closer look.

Possible culprits:

Stress and illness

Physical, mental and emotional stress can cause you to miss your periods. Stress has been known to disrupt the function of the part of the brain that helps regulate reproductive hormones leading to abnormalities in ones’ menstrual cycle. Recent illness constitutes a form of physical stress and can also disrupt your menstrual cycle. The illness could be in the form of an infection or a poorly controlled long term health problem like diabetes or lupus. Surgery can also have the same effect.

Dieting

If you drastically change your feeding habits in an attempt to rapidly lose weight, you could inadvertently disrupt your menstrual cycle. Very low calorie diets with a poor balance of nutrients will cause your body to go into ‘starvation mode’ and you will develop menstrual irregularities.

The other extreme is also true —if you rapidly gain a lot of weight, your menstrual pattern could also change.

Too much exercise

Exercise is good for you but if you embark on a rigorous programme, you are likely to notice changes in your menses. In the first few months, they either become lighter, irregular or may temporarily not occur.

Contraception

If you were recently (or currently) using hormonal contraception, it can alter your menstrual pattern. Hormonal injections are notorious for stopping periods (interestingly, it is part of the reason why that mode of contraception is very popular). Once you stop using hormonal contraceptives, their effects may take a few weeks (even longer) to clear.

Polycystic Ovarian Syndrome (PCOS)

In PCOS, the ovaries contain lots of cysts but they are not regularly releasing eggs (ovulating) as they should. It is associated with hormonal imbalance (the body produces too much testosterone) which can also cause you to develop excessive facial and body hair, acne and weight gain. PCOS can run in families.

Thyroid issues

The thyroid gland usually helps regulate your body’s metabolism. An over-active thyroid produces excess thyroid hormones, which can cause your periods to become irregular or stop altogether. Thyroid over-activity can also cause hair loss, inability to tolerate warm weather/temperatures (you feel extremely hot and sweaty), mood swings and hand tremors.

Uterine issues

If you had a recent surgical procedure performed on your uterus, it could heal with excessive scarring (known as adhesions) leading to problems with menstruation.

Although there is always some degree of scarring after surgery, extreme cases of excessive adhesions are rare. It can occur after ‘cleaning out’ your womb after a miscarriage, or after fibroid surgery or a Caesarean section.

Medication, herbs

Antidepressants, chemotherapy drugs and some herbal medication have been known to cause menses to cease.

Although herbal medication are ‘natural’, they also have side effects and they can affect your reproductive cycle. In Kenya, the herbal therapy industry is unregulated and often you cannot truly verify the ingredients used to make the medication.

Primary ovarian insufficiency

Most women go into menopause between the ages of 50-55 years. If menopause begins before the age of 40, it’s considered to be early (premature) menopause.

This is thought to occur if your ovaries stop producing eggs and reproductive hormones earlier than expected. Once this occurs, your menses stop.

Brain tumours

Tumours in the section of the brain known as the pituitary gland can cause a change in menstrual patterns.