Reasons for your missed period: when to see a doctor

Lots of women make a note in their calendar each month to track their periods, but what can it mean when you miss a period? Amenorrhoea is the term used to describe when a woman stops having regular periods. This can affect women of any age up until the menopause. Dr Maria Papadopoulou, a leading obstetrician and gynaecologist, discusses the causes of amenorrhoea and its relation to infertility and pregnancy.

What are the top causes of amenorrhoea?

The most common cause of amenorrhoea, of course, is the menopause. But, what is menopause? It is the end of the reproductive period. It happens in women between the ages 47-54, but we can have a premenopausal stage that can include amenorrhoea or we can have premature menopause that occurs in some women aged 30-32 years old.

• Pregnancy:

The second most common cause of amenorrhoea is pregnancy itself. When a woman’s period stops and is in the fertile stage, she needs to do a pregnancy test to see if she is pregnant or not.

• Ovarian cysts:

The third common cause of amenorrhoea are ovarian cysts. Sometimes, even with no symptoms, you might visit your gynaecologist to do a scan and if you do not have a period, the underlying cause for this is a cyst, shown on a scan. Ovarian cysts can be from 2cm and can grow up to 10cm in size. This kind of cyst can secrete hormones, causing a hormonal imbalance, resulting in amenorrhoea.

• Thyroid disorders:

Amenorrhoea may also result from hormonal imbalances related to thyroid disorders. Hypothyroidism, for example, can cause amenorrhoea, and actually, amenorrhoea is the first symptom that a patient has that makes them decide to see a doctor.

• Stress:

Lastly, stress can cause amenorrhoea – if a woman’s stress levels are very intense, this can cause amenorrhoea in all ages.

Of course, there are many other reasons why amenorrhoea occurs and it is important that lab tests and scans are performed to find the exact cause to give the right treatment.

Can amenorrhoea lead to infertility?

The answer to that question is: definitely.

Why? Because when a woman is suffering from amenorrhoea, their hormones are not working properly, so she will not ovulate during her cycle. If a woman has amenorrhoea for over two months, this means that there is no ovulation in this time period. If there is no ovulation, women cannot conceive.

It is very important that if a woman has amenorrhoea in their fertile years who wants to have a family that she seeks medical advice so that treatment can be given which could allow her to conceive in the future. If no treatment is sought, there is the possibility that she would not be able to have a family in the future due to longer-term infertility.

If there is amenorrhoea, we need to consider it very seriously and see why it is happening, when it started and what treatment we can give to help regulate the menstrual cycle.

Why does amenorrhoea occur during pregnancy?

Amenorrhoea is a natural stage of pregnancy because of what happens during conceiving. Ovulation occurs during the middle of the menstrual cycle of a woman. After conception, the foetus grows inside the uterus.

But, what actually happens in the ovaries? At the site of ovulation, we have the creation of a small cyst that we call a corpus luteum. This cyst secretes hormones that, in case there is a pregnancy, safeguards it. The corpus luteum actually produces high amounts of oestrogen and progesterone to help the pregnancy secure itself and after that, the placenta looks after the developing baby.

The high amount of oestrogen and progesterone produced from that specific cyst in the ovary, means there is no longer the up and down of hormones, which then gives rise to amenorrhoea. This is how nature secures a pregnancy for the first day to the first few weeks of a pregnancy.

If your period has stopped or become irregular, make an appointment with an expert to be assessed and, if necessary, treated.