Ever missed your period 2-3 times in a row and then panicked? When our monthly guest stops visiting, sure it will cause some concern—and rightly so!

Periods are a glorious part of womanhood; and we have a love/hate relationship with it. Missing periods may seem convenient at the time, as you don’t have to deal with those struggles, like cramps, cravings, bloating and mood swings. It is usually common to miss a period once or twice. And in most cases, it is not a serious issue. But if your periods stop suddenly or unexpectedly for two to three months in a row, it can be a warning sign that something is amiss.

Absence or infrequent menstruation in a woman of reproductive age is medically termed as amenorrhea. It does not mean that the woman is infertile; instead it often signifies a health problem or condition that needs attention. There are two types of amenorrhea.

1. Primary amenorrhea is when a girl has not menstruated by the age of 15 or do not show any signs of puberty.
2. Secondary amenorrhea is the absence of menstruation for three months in a female who had regular menstrual cycles previously; or absence of menstruation for six months with previously history of irregular cycles.

Studies showed that approximately three to four percent of women will experience amenorrhea during their lifetime.

Before the idea of having amenorrhea stresses you out, understand that this condition can be cured easily with good care and medications, if needed. The management of amenorrhea usually depends on its underlying cause.

So, what are the causes of absent menstruation?

The primary and secondary amenorrhea can occur for numerous reasons.

The main causes of primary amenorrhea include family history, genetics, and some lifestyle factors like eating disorder, extreme exercise pattern, obesity, etc.

According to the American Society for Reproductive Medicine, pregnancy can be the cause of secondary amenorrhea. Other possible causes include:

• Polycystic ovary syndrome (PCOS)
• Severe anxiety or emotional distress
• Obesity
• Participating in strenuous athletic training
• Use of contraceptive pills
• Breast feeding
• Rapid weight loss
• Early menopause

Other causes include:

• Brain (pituitary) tumors
• Drugs for cancer treatment
• Drugs to treat schizophrenia or psychosis
• Overactive thyroid gland
• Reduced function of the ovaries
• Uncontrolled diabetes
• Abnormal production of certain hormones, such as testosterone, cortisone

How to tackle amenorrhea?

Obesity is one of the major causes for absent menstruation; too much exercise or too little food can also cause amenorrhea. These factors can be easily addressed by changing your lifestyle. Lifestyle modification involves altering long-term habits, typically eating habits, physical activity, and maintaining a balance in work, recreation, and rest.

1. Dietary approaches

A healthy diet helps to lose the excess weight and reduces the risks due to obesity. Attaining and maintaining a healthy weight will often help to balance the appropriate hormone levels and restore the menstrual cycle. An ideal dietary management should focus on substituting the unhealthy foods that are high in calories and low in nutrients with the healthy ones.

Practice the following tips to maintain a healthy weight:

• Avoid crash or fad diets and try to choose diets that are medically proven.
• Always practice mindful eating.
• Eat in smaller portions.
• Eat only when you are hungry.
• Drink plenty of water to stay hydrated.
• Follow a regular meal pattern.

2. Physical activity

Getting substantial exercise is as important as avoiding excess calories in food to maintain hormone levels in your body. But high intensity exercise can stress the body and alter the hormonal balance. A mild change or adjustment in your physical activity levels will help restart your menstrual cycle. For beginners, it is always recommended to gradually increase the amount of exercise day-by-day so that you can build your strength and endurance over time.

If you are a very active person, it is advisable to switch to a more moderate program and less intense workouts. You can also ask your coach or trainer about how to train in a way that helps maintain your health and regulate your menstrual cycles.

3. Stress management

Stress can affect your menstrual cycle by temporarily interfering with the part of the brain that controls the hormones and regulates your menstrual cycle.

Effectively managing stress can help your periods return to normal.

Here are some quick tips to managing stress:

• Surround yourself with positive people and positive energy.
• Practice meditation/yoga.
• Nurture yourself by enjoying your passions.
• Go for a walk.
• Get enough sleep.
• Spend time with your family and friends.
• Sweat out any tension with a good workout.

Additionally, keeping a track of your menstrual cycles would help you to notice any changes that occur. Note the date when your period starts, how long it lasts, and any problems you experience.

The above-mentioned methods may or may not help you manage amenorrhea. Thus, it is better to consult a doctor for detailed diagnosis and proper treatment options.

When to see a doctor?

Consult your gynecologist if you have missed at least three menstrual periods in a row, or if you have never had a menstrual period and you are 15-year-old or older.

What to expect at a doctor’s appointment?

For primary amenorrhea, the doctor will review your health history and will do a general physical examination, followed by a thorough pelvic exam.

For secondary amenorrhea, the doctor will begin the diagnosis with a pregnancy test as this can be the primary cause of amenorrhea. If pregnancy is ruled out, tests such as hormone tests, a pelvic exam or other tests may be performed to identify the underlying cause.

Absence or infrequent menstruation caused by hormonal problems or other health conditions can be treated with medications. If the lifestyle factors such as stress, exercise or diet are the cause of the amenorrhea, it can be corrected by proper lifestyle modifications.

Reference:

1. Absent menstrual periods. https://medlineplus.gov/ency/article/001219.htm. Accessed on: 14-09-2020.
2. Stopped or missed periods. https://www.nhs.uk/conditions/stopped-or-missed-periods/ . Accessed on: 14-09-2020.
3. Rebar R. Evaluation of Amenorrhea, Anovulation, and Abnormal Bleeding. [Updated 2018 Jan 15]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
4. The American congress of obstetricians and gynecologists. http://www.acog.org. Accessed on: 14-09-2020.
5. Women’s health—department of health and human services. http://www.womenshealth.gov. Accessed on: 14-09-2020.
6. Missed periods. https://patient.info/womens-health/periods-and-period-problems/missed-periods . Accessed on: 14-09-2020.
7. Amenorrhea. https://www.mayoclinic.org/diseases-conditions/amenorrhea/ . Accessed on: 14-09-2020.
8. What causes amenorrhea?. https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/causes . Accessed on: 14-09-2020.