There is nothing like a missed period to add more stress to your everyday life. A healthy menstrual cycle ranges from anywhere between 21 to 35 days. During menarche (your first period) and menopause, it is perfectly normal to have irregular periods. But when you miss your period for longer than one cycle, and you are certain you are not pregnant, it could point to some underlying conditions.

“Amenorrhea is the name given to missed periods”, says Dr Priyanka Sinha, Kolkata-based consultant gynaecologist at Apollo Multispeciality Hospital?. “If you were having your period regularly and it suddenly stops, the reasons could be varied, from hormonal changes to medical conditions.” The doctor tells us all about the causes of missed periods, and what you can do about them.

 

1. Polycystic Ovary Syndrome or PCOS.
“Almost 80 percent of women of reproductive age who visit my clinic have this problem, and amenorrhea is one of the symptoms,” says Dr Sinha. Polycystic Ovary Syndrome occurs because of hormonal imbalances in your body that can result in an increased level of androgen or male hormones in the body. As a result PCOS interferes with the growth and release of eggs from the ovaries. The interruption of ovulation causes irregular or missed periods.
 

Treatment: Necessary dietary and lifestyle changes can be of significant help to deal with PCOS and its symptoms. “At least thirty minutes of moderate exercise, combined with a healthy diet full of green leafy vegetables, fish and eggs, with less carbohydrates, and limited junk or processed foods can be very beneficial,” advises Dr Sinha.

 

2. Increase in the levels of the hormone prolactin.
Prolactin is a hormone secreted by the pituitary gland, which helps in regulating menstruation. During pregnancy, prolactin levels naturally increase, and it causes breasts to grow and develop, and helps in the production of milk after the baby is born. But outside of pregnancy, prolactin can increase due to a number of reasons. “Prolactin tends to suppress the hormones estrogen and progesterone, which causes changes to ovulation,” says Dr Sinha. “This can trigger an artificial menopause in your body.” If excess prolactin is behind your amenorrhea, you might have milkish discharge from your breasts, or headaches and visual disturbances as symptoms. Prolactin can increase because of the following reasons:

 

• Lack of sleep, anxiety and high levels of stress.
• Commonly available antacids which contain pantoprazole and domperidone
• Antipsychotic or antidepressant medications, or medicines that regulate high blood pressure
• In rare cases, formation of prolactinoma, a tumour at the base of the pituitary gland

 

Treatment: “Your gynaecologist will first check your prolactin levels through a serum prolactin test,” says Dr Sinha. “If it is below 1000, then you will be given medication to treat it. Once the prolactin levels are normal, your period will resume as before. But if the prolactin level is above 1000, and you are experiencing headaches you will be recommended to get an MRI or CT scan.” For factors like stress and anxiety, try practising relaxation techniques or getting professional help through therapy. For amenorrhea caused by medicines, ovarian assessment needs to be done to check whether ovaries are functioning properly. “Hormonal supplements may be given to reverse premature menopause,” says Dr Sinha.

 

3. Thyroid Issues
An overactive (hyperthyroidism) and underactive (hypothyroidism) thyroid can affect one in eight women worldwide. Your body’s metabolism and hormonal levels are regulated by the thyroid gland. Thyroid issues can cause problems with ovulation, which leads to disordered growth and shedding of the uterine lining that happens months apart. It can also cause an increase in production of prolactin, which in turn causes amenorrhea. The severity of amenorrhea will depend on the severity of the thyroid issues.
 

Treatment: “Much like excess prolactin, once the thyroid hormone is regulated through medication, you will again have normal periods,” says Dr Sinha.

 

4. Excessive weight loss due to crash diets or intense exercise.
The connection between a healthy body weight and your period is intrinsic. If there is a mismatch between the amount of energy consumed by your body in the form of food and the amount you use, then it will disrupt your reproductive functions like ovulation in order to conserve energy. Intense exercise without sufficient replenishment of calories, or diets that cut out vital food groups like carbohydrates, can trigger unhealthy weight loss that will affect your menstrual cycle, causing irregular periods.
 

Treatment: Improved diet as recommended by a licensed dietician, and decreased exercise will get your body back on track.

 

5. Changes due to birth control.
Changes in your menstrual cycle can happen when you go on or off birth control. “Injections given as contraception, such as the depo provera, given especially to breastfeeding women, can cause amenorrhea,” says Dr Sinha. Birth control pills or the intrauterine device (IUD) can also result in missed periods.
 

Treatment: When you stop taking the pills or injections, your cycle should go back to normal within 3 to 6 months.