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By:  Dr. Emanuel Gracias, Obstetrician and Gynaecologist at Gracias Maternity Hospital.

Missed a period? Hold your horses! Don’t let your apprehension run amok!  From expecting the worst to suspecting the unversed, a lot of menstruators are marred with questions dispersed. Is it okay to miss periods? Or is there a deeper underlying worry? Dr. Emanuel Gracias addresses the quandary-

Missing a period has somehow become surely synonymous with the assumption of the possibility of pregnancy. Well, to put things in perspective, missing your period doesn’t always imply the obvious- it doesn’t always mean that you’re pregnant. Moreover, it does not necessarily  imply a  ‘dysfunction’ in the reproductive functions. Missed or delayed periods may also occur due to reasons not associated with an underlying ailment. It could be attributed to lifestyle factors that simply alter the hormonal balance, thereby affecting the menstrual cycle.

Known as amenorrhoea, the absence of menstrual periods can be classified into two categories- primary and secondary. Primary amenorrhoea is the absence of menses till the age of 15 years, a condition in which menstrual periods haven’t yet begun. Secondary amenorrhoea is characterised by the absence of periods for three consecutive cycles in one who was previously menstruating. Both these conditions are addressed as different matters of concern. While the former strikes tension in teenagers’ parents for possible anatomic abnormality, the latter harps the worry of patients who suspect a possible reproductive complication.

The concern of ‘missed periods’ finds relevance in the domain of secondary amenorrhoea. Missing a period for a single cycle shouldn’t be a cause of concern. In fact, irregularities in menstruation are an expected phenomenon. However, when this pattern of absence occurs for a period of three months or more, a visit to your OB-GYN is core. Ruling out the case of pregnancy will enable the doctors to explore other possible avenues concerning amenorrhoea.

More often than not, the absence of periods for three or more consecutive cycles does not necessarily imply something serious. It could simply occur due to lifestyle factors like diet, exercise, and stress, among other things.  One of the most significant causes of such periodic absence of periods is the phenomenon of drastic change in body weight. When there is either a 10% loss or a 10% rise in body weight within a short period of time, the BMI (Body Mass Index) generally undergoes a rapid change. The hormonal balance goes haywire, causing the period to arrive late or be missed for several months in a row. 

By the same token of weight loss, adolescence and teenage eating disorders like anorexia nervosa are crucial causes of missed periods. Fixating on a certain body type, having a distorted body image, and being preoccupied with losing weight leads many young adults to shed a tremendous amount of kilos, making this demographic a victim of such menstrual uncertainty.

Another lifestyle factor that induces secondary amenorrhoea is exercise and bodily strain. While working out is essential to maintaining one’s well-being, it can also wind you up in a whirl of worry. A strenuous exercise regimen is what often throws off the equilibrium in the menstrual cycle. Intense workout sessions for several hours a day results in a generous calorie burn, leaving the body with less energy than it needs to keep its systems seamlessly running. This consequently causes a chaotic hormonal imbalance that leads to missed or late periods.

While it may seem anatomically harmless, the scourge of stress does sneakily skew the menstrual timelines. Remember, stress activates your body’s fight or flight response. The hormones that are produced as a result of this mode suppress certain bodily functions that aren’t generally essential in escaping the perceived threat. One such repressed function is that of ovulation. The lack of ovulation can cause periods to be missed.

Not all the causational factors are lifestyle oriented. Sometimes, it is indicative of underlying chronic conditions. Polycystic ovary syndrome (PCOS) might just about be one such condition. The imbalance of reproductive hormones interferes with the process of ovulation, thereby causing periods to arrive at inconsistent times or disappear for months together.  Besides PCOS, even thyroid issues are known to cause missed periods. Perimenopause (the phase leading up to menopause) and early menopause are also possible causes.

Whatever be the cause, if you’ve missed your period for three or more consecutive cycles, pay a visit to your doctor. An evaluation is conducted to determine and diagnose the reason- is it the diet? The stress? The burnout from workout? PCOS?

Treating the cause is deemed more important than immediately ending the hiatus of your period. Identifying the cause and treating it serves a greater purpose than just bringing back the period to its regular pattern. So if it’s a sudden weight gain that’s causing it, doctors will encourage you to gradually shed those extra kilos until your bodily equilibrium is restored. If it’s an eating disorder like anorexia nervosa, counselling and therapy can go a long way in improving one’s body image. Restoring your self-esteem can do wonders with restoring your menstrual regime. Similarly, if it’s PCOS that’s causing the inconsistency, treating it first will ensure that your period is eventually regulated. 

An efficacious treatment option that most fruitfully mends the menstrual irregularity is the oral contraceptive pill. Also one of the treatments prescribed for PCOS, these pills bring hormone levels to the normal range, regularising periods, decreasing menstrual cramps, clearing acne, and lowering the risk of cancers such as ovarian and uterus cancer. The patient is put on the pill for 21 days, bringing back a menstrual cycle of clockwork promptness. It is important to bear in mind that while such pills are widely available over the counter, using them without a prior prescription from your doctor can backfire, roping in a host of unsolicited complications.

While such medication can instantaneously bring your period back on track, that is not the ultimate objective. ‘Why?’- this interrogative element is to be inspected first. Addressing this element puts before us several options- from simple lifestyle modifications to comprehensive treatment options. Treating the cause will undoubtedly bring the period to regularity naturally. The period can wait, but tackling the  ‘why’ cannot be late. 

What causes missed or delayed periods?

  • Sudden weight gain or weight loss
  • Strenuous exercise routine
  • Intense stress
  • Polycystic ovary syndrome (PCOS)
  • Thyroid issues
  • Perimenopause and early menopause

(Dr. Emanuel Gracias is an Obstetrician and Gynaecologist at Gracias Maternity Hospital in Goa.)