Dear Doctor,

I recently missed my period and thought I was pregnant. I took a pregnancy test and it came out negative. I took another a few days later and the result was the same. I’m about two weeks late and I don’t know why. This has never happened before. What do you think the problem is, or is it normal?

Rita

 Dear Rita,

What is your age, how many periods have you missed and was the cycle regular before? Answers to these questions can help decide the underlying cause for missed periods.

Technically speaking, secondary amenorrhea (missing periods after one had regular cycles before) is said to occur when one misses three or more consecutive cycles. Menstrual cycle occurs due to balance of the hormones, estrogen and progesterone.

Around ovulation time, the uterus gets prepared to receive a fertilized ovum and estrogen levels become high.

Blood vessels proliferate in inner lining of uterus and it becomes very vascular and soft. When fertilization does not occur, estrogen levels decline, causing menstrual bleeding. 

Generally, with a woman of reproductive age, pregnancy is the most common cause for missed periods but there are other causes as well.

A woman may have irregular cycles around menopause when periods tend to become irregular and even some cycles may be missed. When a baby is breastfed, periods do not occur in that duration due to high levels of prolactin.

One can have amenorrhea due to life style factors like stress, sudden weight gain or weight loss and use of alcohol. Hormonal disorders as that of the hypothalamus, pituitary, thyroid or adrenal glands can lead to amenorrhea. It can be due to ovarian dysfunction like polycystic ovarian syndrome.

Hormonal contraceptives, particularly those containing progesterone can cause irregular menses or even amenorrhea. Periods can be missed due to high levels of testosterone. Athletes are said to have irregular menses due to the heavy physical training they undergo.

Some antipsychotic drugs disrupt the normal hormonal cycle resulting into missed periods among sinister conditions, ovarian or brain tumors cause amenorrhea as one of the manifestations.

To correct the problem, it is advised to have a healthy life style. Avoid stress and learn to be relaxed totally. This can be achieved by yoga/meditational or other techniques.

Avoid alcohol. Take a healthy, balanced diet. This should include fresh green vegetables, fruits, whole grains, nuts, fish and healthy milk products. Regular physical exercise is a must along with a balanced diet to maintain a normal body weight. Such a life style keeps the body healthy and also maintains hormonal equilibrium. 

If on progesterone implants or mixed pill for contraception, consider use of alternate form of contraception. This can be either use of condoms or intrauterine contraceptive device. If in spite of life style measures, menses are not resumed, it is suggested to do tests for hormone levels. Any disorder detected can be treated.

Dr Rachna is a specialist in internal medicine at Ruhengeri Hospital