Missed Periods? It Could Mean Pregnancy, Age Transition, Or A Medical Issue

The regularity of a woman's menstrual cycle is important to her well-being. If her period comes too early, she is caught off-guard; if her period comes too late, she is anxious. Missing a period altogether can make her feel very worried, and so, understanding the reason for a missed period for a month is essential.

A normal menstrual cycle varies between 21 days and 35 days; that is the time that can pass between two periods within the normal range, though the median cycle is 28 days between two periods.

If a woman's periods are delayed beyond 35 days, then it's a late period; if it's delayed beyond 40 days, then a medical consultation is advisable; and if a period is missed altogether for an entire cycle, then the cause needs to be identified.

Like anything else to do with an irregular menstrual cycle (from the start of one period to the start of the next), missed periods can have causes ranging from internal (pregnancy, age, weight, hormones, disease) to external (contraceptive devices inserted in the body, oral pills). Some facts associated with irregular periods, including missed periods, are:

• According to a study in South Korea, 14.2% of women in the age bracket of 19-54 years suffer from irregular menstruation.
• Almost 50% of Indian women suffer from menstrual irregularities.
• Missed or delayed periods may point to underlying health problems such as anemia, polycystic ovary syndrome (PCOS), or gynecologic cancers.
• Globally, almost 10% of women in the reproductive age - bracket, suffer from PCOS.
• Almost 50% of women suffering from PCOS, can get affected by Type-2 diabetes, which is also another culprit behind menstrual irregularities.

What causes irregular menstruation?

1. Pregnancy

This is the most obvious reason behind a missed period. If you miss your periods for two consecutive cycles, coupled with symptoms such as tenderness of breasts, acidity, mood swings, and unexplained fatigue, it's advisable to take a home pregnancy test and/or see a doctor for confirmation.

2. Contraceptives

Just as pregnancy causes a woman to miss her period, actively preventing pregnancy can also cause a missed period. Each menstrual cycle starts with the shedding of the unfertilized egg and thickened uterus lining from the previous cycle, when the body had prepared for pregnancy, and this shedding is visible as menstrual blood.

When the natural cycle of ovulation - the release of an egg from the ovary into the fallopian tube (connecting each ovary with the uterus) - is disrupted by contraceptives, it can cause a missed period. Sometimes, women use birth control pills to stop periods for important life events or to take a break from heavy menstrual bleeding.

Birth control pills, also known as contraceptive pills, are of three types, and this is how they prevent ovulation and egg fertilization:

• The most commonly used pill is a 'combination pill' that contains a certain dosage of the female hormones estrogen and progesterone (rather, progestin) to stop the ovaries from releasing an egg. These also make changes to the uterus and cervix to reduce the chances of pregnancy.
• There's another pill that contains only progesterone (progestin), and it keeps the sperm from reaching the egg by thickening the cervical mucus.
• There's the emergency contraceptive pill (commonly called "the morning-after pill), which is used only when a woman is not on any other birth control method. This pill works with or without hormones to prevent an unplanned pregnancy.

Going 7-10 days without periods, if you're taking the pills regularly in stipulated doses, does not mean you're pregnant. Indeed, if you haven't missed a single pill and are showing no symptoms of pregnancy, then even a missed period for a month cannot mean pregnancy.

However, if you forget to take 1 or more pills, or if you've gone 2 months without periods, it's imperative to medically ascertain a pregnancy.

Aside from oral pills, hormonal contraceptive implants, intrauterine devices, or contraceptive injections prevent a woman's body from ovulating in the usual way. That may lead to very light bleeding, spotting, or even missed periods.

One may also experience delayed or missed periods for several months after stopping the contraception. The body takes its time to get back to its normal hormone level and start ovulating as usual.

3. Age

Young girls aged 12-13 years, who've just started menstruating, may experience irregular menstruation, with a missed period or two. Their bodies are yet to adjust to the overhaul in the hormonal system that brings about menstruation.

Typical teenage problems like stress and weight gain also compound the issue, but that's not dangerous. These irregular periods can continue for even 2 years after a girl starts menstruating.

Similarly, when a woman enters the perimenopause phase (in her late 40s or early 50s, before menopause), her ovulation pattern can deviate from the usual, as the hormone levels begin to change. She may not get her periods in the usual cycle of 21-35 days; the gaps between periods may decrease or increase.

During perimenopause, a woman may experience anovulation, when the ovary does not put an egg in the fallopian tube; that means a missed period or several missed periods.

Menopause comes differently for different people — the transition may be smooth or disturbed — but when a woman in the perimenopause age bracket starts experiencing longer and longer stretches between periods, then she should know that menopause is very close. This isn't alarming unless there's any severe physical problem accompanying the missed periods. Hot flashes are common and natural during this phase.

The same thing can happen to a woman who is in her early 40s and undergoes premature menopause.

4. Extreme exercise, low calories, and stress

The pursuit of fitness is great, but unsupervised extreme workouts are not. Excessive exercise can not only damage your heart and musculoskeletal frame in the long run, but it can also stop your ovulation and menstruation by causing a hormonal disbalance in the pituitary and thyroid glands.

Skipping meals or eating too little at every meal, or eating disorders like anorexia and bulimia can all cause amenorrhea, i.e., absence of menstrual bleeding for 1 or more cycles, due to the lack of calories required by the body for proper ovulation and menstruation. If this condition persists for long, it can have serious implications for the female reproductive system in the form of vaginal atrophy and infertility.

Sustained and high levels of stress are another reason for missed periods. Stress leads to the release of the hormone cortisol, which interrupts the hypothalamic-pituitary-ovarian (HPO) axis. The Hypothalamus, a part of our brain, releases chemicals that stimulate the pituitary gland, which in turn stimulates the ovaries into releasing estrogen and progesterone. Any disruption here can cause delayed or missed periods.

5. Obesity

A body mass index (BMI) over 30 indicates that a woman is obese. In a classic chicken-and-egg situation, the obese body produces way too much estrogen, and that extra estrogen again leads to weight gain, especially around the waist and hips — the vicious cycle continues.

As estrogen is one of the key hormones in the menstrual process, obesity and estrogen over-production disrupt the menstrual cycle and cause missed periods, delayed periods, or excessively heavy periods.

5. Health problems

A woman who is in the age bracket of having regular periods should pay attention to any missed periods. This is often a red flag for polycystic ovary syndrome (PCOS), a fairly common condition seen in women of reproductive age. In this condition, cysts in the ovary and a higher-than-usual level of the hormone androgen throw the reproductive system off-balance, leading to delayed periods and missed periods.

Overactive and underactive thyroid glands — hyperthyroidism and hypothyroidism — can also upset a woman's metabolism and affect her ovulation and menstruation.

Diabetes is another health issue that upsets the balance of estrogen and progesterone, thus leading to delayed or missed periods. Women having PCOS are at a higher risk of developing diabetes.

Infections arising from STDs (sexually transmitted diseases) like chlamydia and gonorrhea can lead to Pelvic Inflammatory Disease (PID), which in turn causes spotting or missed periods.

Uterine or endometrial cancers, especially in perimenopausal women, are symptomized by light or irregular menstrual bleeding.

6. Breastfeeding

A lactating mother can experience lactational amenorrhea for at least 6 months after the delivery of the baby. The hormone prolactin, helps a new mother produce milk. , also stops ovulating, thus inhibiting menstruation.

In some cases, depending on the frequency of breastfeeding and the new mother's biorhythm, lactational amenorrhea can last for 1 year.

What to do in case of missed periods?

First of all, do not panic. Periods can be missed due to one or many factors, and depending on your age and life stage, it is considered normal to have up to 3 months of missed periods.

However, after the second month of a missed period, it is advisable to determine or rule out a pregnancy. If no pregnancy is detected, see if:

• you've been losing weight suddenly;
• you've been gaining weight suddenly;
• you're below 45 and yet having hot flushes;
• you were on contraceptives but haven't had periods even 6 months after stopping them;
• you're getting abdominal or pelvic cramps;
• your stress levels have increased a lot lately;
• you've been under rigorous physical stress or a demanding exercise regime.

In case of any of the above, a doctor will prescribe urine tests, blood tests, or an ultrasound to determine the cause of your missed periods and shall suggest rectification measures.

Missed periods do not require any treatment per se. In most cases, the doctor will recommend measures to raise or lower the estrogen levels to regulate ovulation. These can range from increasing calorie intake to wearing estrogen patches.

Bigger health problems like diabetes, ovarian cancer, or PID will require the full range of treatment.

Read our health conditions blogs to know about menstrual health and for ways to improve menstrual health.