Missed Period, But Not Pregnant? Here’s What Might Be Going On

Originally Published April 20, 2020 on Wellness | By Erica Sweeney

When you miss a period, your first instinct is likely to take a pregnancy test. If that test turns out negative, a number of things could be going on. While it’s not always a cause for alarm, a missed period, or amenorrhea, can actually signal a health problem, such as stress, polycystic ovary syndrome, hypothyroidism, an eating disorder or another health condition.

An estimated 14 to 25 percent of women of childbearing age experience menstrual irregularities. If this is you, take heart in the fact that you’re not alone—even celebrities struggle with irregular or missed periods. In an interview with The Times last year, Game of Thrones star Sophie Turner shared that she lost her period for a year as a teenager after extreme dieting.

So what exactly is a missed period and what causes it? We asked women’s health experts to explain.

What’s a missed period?

A period, or menstruation, involves the shedding of the uterine lining. Blood and tissue from the uterus flow from the cervix to the vagina and out of the body, according to The Cleveland Clinic.

“Normal” menstruation occurs about every 21 to 35 days, says Jane van Dis, OB-GYN and medical director at Maven. If you don’t have a period after 35 days, it’s considered “missed.” Before you try to get to get to the root cause, know that every so often, a period can simply be delayed. It can also be physiologically normal for a woman to skip an entire period at some point, often in her teens or after age 40.

But if your period is persistently missed, and you miss more than two or three cycles, van Dis says it’s time to call your doctor or OB-GYN.

What can cause a missed period?

First things first: Pregnancy is the most common reason that you’ll miss a period—but if you’ve definitively ruled out pregnancy as the cause, there are a number of other reasons you could skip a cycle. The two most common reasons are polycystic ovary syndrome (PCOS) and thyroid disease, van Dis says.

PCOS is a hormonal imbalance that affects ovulation and metabolism, and can increase the risk of diabetes, heart disease and uterine cancer. Hypothyroidism, or an underactive thyroid, also increases the risk of heart disease. Tests for these conditions are relatively simple, van Dis says, and “the information can be life-saving.”

Pituitary tumors, anorexia, side effects from medication, perimenopause, sexually transmitted infections (STIs) and major illnesses can also cause someone to miss a period, says Sherry Ross, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California.

Drug or alcohol abuse, excessive exercise, weight gain or loss and stress are also contributors. “Your menstrual cycle is an amazing barometer of your overall health and wellness,” Ross says.

What does it mean if you missed your period?

While you can try to get to the bottom of what your missed period means on your own, if you don’t have a period for three months, van Dis says a visit to your OB-GYN is a must.

Along with a missed period, Ross says to visit your doctor if you have other symptoms, including:

  • Heart palpitations
  • Feeling excessively hot or cold, insomnia
  • Unexplained weight loss or gain
  • Hair loss
  • Breast tenderness
  • Fatigue
  • Pelvic pain
  • Vaginal malodorous discharge
  • Uterine cramping
  • Lack of appetite
  • Male pattern hair growth
  • Heavy bleeding with big grape to apricot blood clots

Your doctor will likely perform a pregnancy test, pelvic exam and do blood tests to determine the reason behind your missed period. The types tests you will most likely undergo include thyroid, blood glucose, ovarian and testosterone panel, pelvic ultrasound and STIs.

Once you get a diagnosis, a doctor can give you a treatment plan. But what if you’re missing periods, you’re not pregnant and a medical condition has been ruled out? Focusing on eating a healthy diet, getting plenty of rest and exercising for at least 30 minutes a day could help, van Dis says.

It’s true that excessive exercise, like how an athlete might work out, could cause missed periods. But regular exercise will not, Ross explains, and it’s good for you. “There are outside influences such as severe stress, traveling outside the U.S. and extreme weight loss or gain that can affect this delicate hormonal balance that brings on a period, but going to the gym is not one of them,” she says.

Reducing stress can also help your missed periods. Studies show that stress has a major impact on women’s health. It can affect ovulation, period regularity and fertility.

“It is well-known that stress and stressors directly affect our health, whether we want to admit it or not,” Ross says. “Stress not only affects our body physically but also affects our emotions and behaviors. Extreme stress such as a loss of a loved one or a divorce can cause hormonal imbalance leading to irregular periods.”

Considering trying intermittent fasting? Read up on how it could affect your period.

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