Missed or absent periods describe the occurrence when, after a woman has established a regular pattern of menstruation, it stops for 3 months or longer. An absent period can also occur when a woman has not started menstruation by age 16. Irregular periods occur at intervals longer than 38 days or if the duration varies from month to month.
Irregularity of menses occurs in about 13.7% of women, representing a significant source of distress for many.
Amenorrhea (absence of menses) can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina. It is often classified as either primary (absence of menarche by age 15) or secondary (absence of menses for more than three months in girls or women who previously had regular menstrual cycles or six months in girls or women who had irregular menses).
What Are the Dangers of Irregular Periods and Missing Periods?
Maintaining steady, regular, and relatively pain-free menstrual periods every month is a good sign that your hormones are working properly and that you have an intact reproductive system. Getting off track, at the very least, may lead to painful symptoms associated with premenstrual syndrome or PMS.
PMS can be fraught with mood swings, irritability, insomnia, sweating, and agonizing pain at its worst.
Cardiovascular mortality is surprisingly associated with irregular periods, particularly if polycystic ovary syndrome or obesity co-exist.
Amenorrhea is associated with a high risk of wrist and hip fractures with eventual osteoporosis. Although generally not considered life-threatening unless anorexia nervosa co-exists, the presence of anorexia nervosa warrants immediate nutritional support, sometimes with tube feeding and total parenteral nutrition, to correct nutritional imbalances responsible for the systemic shutdown of the reproductive system.
The nutritional imbalances found in women with menstrual irregularity may also lead to low estrogen levels; changes in mineral, glucose, and fat metabolism; and affect overall health down the road.
Reasons for Missed or Irregular Periods
Aside from pregnancy and breastfeeding, common causes of missed or irregular periods include:
1. Stress. We all get stressed, but people handle stress in different ways. Some handle it well and have good coping skills. Others are just dealing with so much stress that their body bears the stress quite literally, affecting the brain and the hypothalamus-pituitary-adrenal (HPA) axis. This can lead to hypothalamic amenorrhea (HA). In HA, your levels of luteinizing and follicle-stimulating hormone fall below normal, and you aren’t able to shed your uterine lining leading to a missed period. Too much cortisol and adrenaline during HA also contribute to this problem.
2. Poor diet. A high intake of sugar, processed foods, pesticides, hydrogenated fats, toxins, and polluted water can lead to a whole host of endocrine-disrupting abnormalities. This type of diet can lead to adrenal fatigue, which raises cortisol levels and causes alterations in thyroid function thus affecting the HPA axis.
3. Polycystic Ovary Syndrome (PCOS). Polycystic ovary syndrome accounts for over 87% of irregular menses cases. The treatment for PCOS is generally a contraceptive pill to normalize hormones and metformin to increase insulin sensitivity and support weight loss if overweight. Even a 5-10% weight loss can improve the symptoms of PCOS including the irregular menses. Exercise is another critical lifestyle treatment for PCOS.
4. Extreme weight loss or unusually low body weight. When your body mass index falls below 18 or 19, the body is unable to keep up with normal hormone production. This is due to nutrient deficiency or a low body fat level.
5. Strenuous physical exercise or activity. While moderate activity is essential to optimal healthspan, like anything else, too much of a good thing can be harmful. Excessive exercising can lead to a very low level of body fat, anemia, and may put pressure on your HPA axis. Again, cortisol comes into play being released in response to the exertion of overtraining. Sex hormones become depleted. Among women bodybuilders, for example, up to 81 percent experienced amenorrhea at some point despite eating a nutritionally adequate diet!
6. Thyroid disorders. Yes, thyroid dysfunction can affect reproductive hormones and can cause irregular or missed menses. Again, changes in estrogen and cortisol appear to be the main culprits along with the obvious changes in thyroid hormones.
7. Stopping the birth control pill. While most women’s bodies will adjust within a few months of stopping their birth control pill, it may take months or even years to regain normalcy again.
8. Food allergies and sensitivities. Because allergies affect the gut-brain axis and can also cause nutritional deficiencies, missed periods are often seen co-existing with food allergies. The chronic stress of dealing with food allergies can affect the adrenal glands with subsequent effects on cortisol production and the ability to produce the sex hormones needed for a healthy cycle.
Normalizing Your Cycles
- If you have PCOS, follow lifestyle guidelines for treatment and take your medication.
- Find better ways to manage your stress. Better yet, reduce it as much as possible.
- Get restful sleep.
- Eat a balanced diet with probiotics for gut health.
- Consider using adaptogenic herbs such as ashwagandha or holy basil.
- Exercise at least 150 minutes per week but don’t overtrain.
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