There are a variety of reasons why you may be missing or having irregular periods. Pregnancy and breastfeeding are the obvious ones, but coming off of the birth-control pill, PCOS and hypothalamic amenorrhea are other causes.
Firstly, while some women may not be concerned about their lack of menstruation, it can actually be quite concerning if it persists. A regular menstrual cycle usually indicates healthy ovulation and therefore a good amount of estrogen and progesterone in the body. A lack of a period means a lack of ovulation and generally indicates low levels of these hormones. Both hormones are incredibly important for the health and optimal functioning of our body.
Beyond fertility, we know that estrogen is important for cardiovascular health, bone strength, as well as mood and mental health. Studies show that long-term lack of estrogen (called hypoestrogenemia) can lead to increased cardiovascular events, osteoporosis and depression (1). These are all conditions that increase post-menopause, but can also be seen in pre-menopausal women who have long-term anovulation (aka a lack of menstruation).
One of the other causes of missed or irregular periods is hypothalamic amenorrhea. ‘Amenorrhea’ is defined as 3 months without a menstrual cycle, or 6 months of irregular cycles. ‘Hypothalamic amenorrhea’ is a condition where there is an issue with the signaling between the hypothalamus and pituitary glands in the brain and the adrenal glands and ovaries in the body. Extreme stress on the body is believed to be at the root of this breakdown in communication. Stress can be psychological, but also physical in the form of undereating and over-exercising. One study showed that those with functional hypothalamic amenorrhea were more likely to have dysfunction attitudes like perfectionisms and be more likely to be overly concerned with the judgements from others (2). Given the amount of stress and pressure that young women and really all women are under these days, it’s another reason why it is so important to take an honest look at how stress is affecting our health. Hypothalamic amenorrhea is a complex condition, and best treated from a variety of angles including nutrition, lifestyle practices, and stress management. According to the Endocrine Society Clinical Practice Guidelines, treatment with oral contraceptive pills is not indicated in this condition, as it does not treat the cause. (3)
Even though some women may think that not having a period is convenient, I promise you that a healthy menstrual cycle is necessary for optimal health. If you are experiencing irregularities with your cycle, I encourage you to work with a health care practitioner to dive deeper into what is going on with your body. I offer free 15-minute consultations so you can see whether Naturopathic Medicine is right for you.
1. Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017 May;35(3):256–62.
2. Marcus MD, Loucks TL, Berga SL. Psychological correlates of functional hypothalamic amenorrhea. Fertil Steril. 2001 Aug;76(2):310–6.
3. Gordon CM, Ackerman KE, Berga SL, Kaplan JR, Mastorakos G, Misra M, et al. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017 01;102(5):1413–39.