Most women experience a noticeable change in their menstrual cycle at some point in their lives. Fluctuations of hormones, the ominous “change of life,” and of course, pregnancy, are the most common culprits.
Even still, many women claim that a missed or late period is simply due to stress, and believe it or not, this is often true; typical stressors can actually cause Aunt Flo to skip her visit or show up very late to the party. Clinically, this condition is known as hypothalamic amenorrhea.
“Stresses may include physical stress for athletes, emotional stress, severe chronic diseases, and nutritional issues or eating disorders,” says Dr. Sharon Lahiri, an endocrinologist at the Henry Ford Hospital in Detroit. “This disorder is associated with low estrogen levels.”
For women, the chemical reproductive system is a complicated, nuanced machine. The hypothalamus, located close to the temporal lobe of the brain, is largely responsible for linking the central nervous system to the endocrine system. It relies on the pituitary gland, a mighty little mechanism that communicates with the hypothalamus. The pituitary gland produces two hormones that are “in charge” of a woman’s reproductive health. These are FSH (Follicle Stimulating Hormone) and LH (Luteinising Hormone). These two hormones cause the monthly development of a follicle and the release of an egg.
The process is known as the hypothalamic-pituitary-gonadal axis. If there’s an imbalance of female sex hormones, estrogen or progestin, this will disrupt the pituitary gland’s production of FSH and LH, and interrupt the fine-tuned process.
“A synchrony exists between the brain and the ovary that allows the egg to develop normally and the uterus to be receptive to the fertilized egg for implantation,” explains Dr. Jane Frederick who practices at one of the Huntington Reproductive Centers in California.
Often, if there’s a low level of estrogen level, then the pituitary gland produces more FSH and LH, which is the common reason for absence or erratic periods.
Hormonal imbalance is often seen in young — and stressed out — women. There’s a long list of culprits that cause hormones to go awry, which includes everything from significant weight loss or gain, too much exercise, too many carbs, caffeine, and booze. Mood disorders, depression, a break-up, financial problems — there’s a litany of woes in our modern world that may cause a woman to purchase fewer tampons every month.
One missed or late period isn’t something to stress over, but if erratic or absent menses persist for several months it’s important to see a doctor — both for the future of your reproductive health and your sanity.
Dr. Robert Goldfarb, a gynecologist at Henry Ford recommends that a woman be evaluated if menses occur more frequently than every 21 days, less frequently than every 45 days, or last greater than one week.
“Endocrinologists will evaluate for abnormalities in the reproductive axis that may occur anywhere from the central nervous system to the ovary,” says Dr. Goldfarb. “We also look for other disorders such as thyroid or adrenal problems that could be causing the cycle irregularities.”
What’s the longest you’ve ever gone without getting your period (excluding pregnancy)?