Down There Care

Amenorrhea: Case of The Missing Period

By Vyshnavi Pottepalli Gabi Powell Jillian LoPiano, MD

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Period gone MIA? Your first thought might be, “🥲👋 Not mad to see her go,” because who wouldn’t want a break from those pesky period pains?! But a cycle gone completely AWOL can be concerning. This is known as ✨amenorrhea✨, a fancy word for a missed period. There are two types of amenorrhea:

Primary amenorrhea: not getting a period by the age of 16
Secondary amenorrhea: when a menstruator, who usually menstruates, does not get a period for 3 cycles or more

Today we’re going to focus on the latter type. Secondary amenorrhea can be treated like a mystery waiting to be solved. So let’s start from the beginning and go through a process of elimination to find the root cause!

 STEP one 

Test for pregnancy

Betties, the *most common* cause of secondary amenorrhea is pregnancy. So, if you are a sexually-active Betty and miss a period, take a test! The pregnancy tests found at pharmacies or drug stores detect a particular pregnancy hormone in urine at low levels and verrry early, making them super accurate.

Tested negative? A missed cycle might be due to another factor at play like stress, illness, or life changes. These can cause a short-term hiccup in the cycle, but will usually sort themselves out and are not typically cause for concern. However, if you can rule out pregnancy + miss more than three cycles, it is very much time to hit up your GYN provider and invite them into the investigation. On to step two of this mystery!

 STEP two 

Time for a GYN workup

Your GYN provider will assess the situation by asking you some questions:

How long has it been since your last period?

What was your menstrual cycle like before this?

Have you had any recent illnesses?

Do you have a family history of amenorrhea?

What medications, drugs, or herbal remedies are you taking?

What is your diet like?

What are your exercise habits?

Do you have any medical conditions or physical abnormalities, such as a single kidney or a heart condition?

This Q&A might reveal a simple explanation. For example, amenorrhea can be caused by various forms of contraceptives such as an IUD or Nexplanon, and even the pill patch and the ring. The hormone progesterone in each of these devices thins the lining of the uterus to the point that bleeding may not occur. If this is the reason for your amenorrhea, it is totally fine and not a real concern. In fact, these devices are used to treat Betties who experience heavy bleeding! But sometimes, amenorrhea cases can be a real headscratcher.


 STEP three 

Explore other conditions

At this stage of the investigation we can eliminate:

Hormones from contraceptives

So…now what?

Your provider will take a deeper look into several medical conditions that can cause missing periods such as:

Polycystic Ovarian Syndrome (PCOS)
Thyroid dysfunction
Eating disorders
Pituitary gland masses
Uterine scarring
Other medications

Each of these conditions has its own criteria for diagnosis, and your provider will use your unique symptoms as a guide for the best way to proceed. Once the underlying cause is discovered, proper treatment for that condition can begin and bring your period back around again.

Great detective work, Betties!

Our bodies can often feel like a mystery. That’s why tracking your cycle + learning your “normal” are important practices to pick up the clues when something is off.


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