Your time of the month has come and gone with no signs of a visit from good old Aunt Flo. If you’ve already ruled out pregnancy, you’re probably wondering what the deal is. Before you have a full-blown freak-out, know that plenty of girls experience missed periods—scientifically known as amenorrhea—for a variety of reasons. The most important thing is to figure out what the cause is behind your missed menstruation and to get your body back on track as soon as possible. We talked to Dr. Traci Brooks, Director of Adolescent Health Services at Cambridge Health Alliance, to get the scoop. Here are some of the most common reasons why collegiettes tend to miss their periods.
1. Increased Stress
If you have been going through a stressful few weeks (maybe you just started a new job or internship) and your period seems to have disappeared, it could be due to a temporary bout of increased stress. A collegiette at Hiram College knows all too well how stress can affect the regularity of menstruation. She explains, “I get on a roll with taking a lot of classes and planning the future that it wears me out sometimes. I’ve been doing full semesters year-round to finish my B.A. and I have trouble relaxing, so my period will be delayed occasionally. It makes me nervous when that happens, especially if I just spent some ‘quality time’ with a guy, so I’ve started keeping track of my periods. I think my body has gotten used to my crazy schedule, so my periods are fairly regular now.”
Dr. Brooks explains, “Stress hormones, like cortisol, are overproduced, and this keeps the brain from producing the necessary hormones, making it so ovulation and the subsequent production of estrogens and progesterones do not occur.” Basically, without the appropriate hormones, no menstruation will occur.
Once stress levels are back to normal, menstruation usually will return relatively quickly, either delayed by a couple of weeks or an entire cycle. Dr. Brooks has seen many cases where patients report getting their menses back as soon as the main stressor is lessened. And don’t let the stress of not getting your period stress you out even more! Check out these 10 ways to reduce stress so you can stay calm.
2. Excessive Weight Loss
Losing too much weight for your body type can cause you to miss your period. How much is too much weight? Dr. Brooks explains, “Weight loss of more than 10% of ideal body weight can cause amenorrhea.” So if your ideal body weight is 130 pounds, losing 13 pounds could put you at risk for missing your period.
A person’s ideal body weight depends on a multitude of factors including age, height, skeletal structure, and metabolic rate. It sounds complicated because it is. However, using one’s body mass index (BMI) is a great way to determine one’s ideal body weight. BMI is calculated by weight in kilos divided by height in meters. An ideal BMI ranges between 18.5 and 24. Dr. Brooks suggests another rough estimate for ideal body weight, which consists of measuring your height and using 100 pounds for the first five feet, then adding an additional five pounds for each additional inch. Using this method, a 5’3” woman would have an ideal body weight of 115 pounds.
Dr. Brooks also warns that women tend to be nutritionally deficient if they are losing too much weight. She explains, “When a woman is at a nutritional deficit, she generally has a low fat intake, which can lead to decreased body fat mass, resulting in amenorrhea.” According to the Center for Young Women’s Health at the Boston Children’s Hospital, this is generally why individuals with anorexia nervosa, bulimia, or other disordered eating tend to have amenorrhea.
It truly depends on the individual when it comes to menses returning. The best way to determine your unique situation is to seek a doctor’s opinion. However, Dr. Brooks does emphasize that women are more likely to lose menses with quicker weight loss than weight loss that takes place over a longer period of time.
3. Excessive Weight Gain
In the same way that excessive weight loss causes amenorrhea, so can excessive weight gain. Dr. Brooks explains, “Too much weight gain can cause excess estrogen storage in fatty tissues which then gets partially converted by the body to androgens which can cause thinning of the uterine lining and decreased ovulation.” Additional side effects of excessive weight gain include acne, increased facial and body hair, high blood pressure, and diabetes.
The easiest way to bring back your menstrual cycle is to simply lose any excess weight, so that you reach your ideal weight. Meeting with a nutritionist or dietician would be ideal to ensure that you are going about the weight loss in as healthy a way as possible. These 10 tips for healthy weight loss can also help you get going in the right direction.
Again, there is no exact formula as to when your period will return so the best thing to do is to seek your doctor’s professional opinion based on your particular situation.
Polycystic ovary syndrome (known as PCOS) is an endocrine disorder that usually manifests itself once a woman begins menstruating. Like the name suggests, PCOS is characterized by small cysts in the ovaries and occurs due to an imbalance in the female sex hormones. Women living with PCOS typically have irregular menstrual cycles, excess hair growth or acne, and are often overweight. PCOS is one of the most common endocrine disorders in women and according to a study by Dr. Robert Barbieri and Dr. David Ehrmann, accounts for approximately 20 percent of cases of missed periods. In most of these cases, women experience oligomenorrhea, where they get their period infrequently, usually 4-6 times a year.
If you think you might have PCOS, there are three signs to look for. The first criterion is known as hyperandrogenism, which manifests itself as acne or excessive hair growth. The second criterion is missing your period and the third criterion is polycystic ovaries, which can only be discovered through an ultrasound. If you suspect you may have PCOS, see a gynecologist to get checked out.
An excessive increase in exercise typically has a similar effect on your menstrual cycle as excessive weight loss. This is because over-exercising usually is one of the causes behind weight loss of more than 10% of an individual’s ideal body weight. Dr. Brooks labels the effects of increased exercise and excessive weight loss as the “female athletic triad,” which consists of disordered eating, amenorrhea, and osteoporosis/osteopenia.
There are certain kinds of exercise that increase the risk of not getting your period. Women who participate in long distance running, ballet, gymnastics, and figure skating tend to experience what is known as athletic amenorrhea. Dr. Brooks explains, “Exercises that really emphasize body type and small size are known to cause amenorrhea. Crew has also been known to be a problem, but really any exercise that gets a woman’s body mass down more than 10% is an issue.”
If you are a college athlete, a marathoner, or just like getting your sweat on, there are things you can do to help regulate your period. Dr. Brooks suggests maximizing calcium and vitamin D intake. She also advises, “Athletes should be followed by a physician routinely as well as have a bone density scan and consequent program created for them.”
6. Chronic Illness
Women with certain chronic illnesses are more likely to experience irregular or missed menstrual periods due to low weight or a flare in illness. Dr. Brooks shares that diseases such as Crohn’s disease, diabetes, ulcerative colitis, lupus, cystic fibrosis, sickle disease, and certain types of cancer are likely to affect a woman’s menstrual cycle.
Harper from The College of William & Mary experienced amenorrhea while having mono. She recalls, “Back in high school I had a bout of mono and for like 3-4 months afterward I didn't have a period. The doctors were drawing a lot of blood out of me for testing since the mono had affected my liver. I'm also borderline anemic and had a lot of infections that summer due to my weakened immune system. It was a really huge mess.”
So, if your period is usually regular but then you come down with something like mono and it disappears, it may just be a matter of waiting until your immune system is back on track to know if the sickness is the culprit. However, if you have a chronic illness that’s causing you to miss your period frequently, then talk to your doctor or a gyno about ways to regulate it.
If you have irregular periods or just out of the blue stopped getting it and are unsure of the cause, definitely make an appointment to see your doctor. In fact, even if you think you know the cause, make an appointment because you could be experiencing other serious side effects like decreased bone density. Your regular doctor and your gynecologist are both trusted options, so Dr. Brooks suggests choosing whichever doctor you feel like you have a more established relationship with. According to Dr. Brooks, the long-term effects of amenorrhea include osteopenia (decreased bone density), osteoporosis (thinned bone) and stress fractures from having low estrogen levels. If amenorrhea goes untreated for too long, infertility might arise as a serious problem, so it is best to take care of the issue before it worsens.
Once the cause is identified, treatment is generally simple. According to the Boston Children’s Hospital, the type of treatment depends upon the cause. Some common forms of treatment include changing exercise patterns, seeing a nutritionist, talking with a counselor about stress, or hormone treatments involving progesterone, estrogen, or birth control pills.
No matter what your situation turns out to be, know that there are other collegiettes experiencing the same thing and with treatment, your period can return back to normal.