Why is your period missing?

Have you been told that your period isn’t important? I sure did! In fact, I was encouraged to skip it so I did so for the entire summer and whenever it felt inconvenient. I had no idea periods were actually so important for my health. Check out my past blog post about why you should care about having a period.

Fyi, a period bleed is actually not a true period but instead a withdrawal bleed from the synthetic hormones. So while you are on hormonal contraception, you may be bleeding but this is not a real period.

So why may you be missing your period? PCOS, Functional Hypothalamic Amenorrhea, Hyperprolactinemia, thyroid disease, certain medications, non-PCOs insulin resistance, obesity, celiac disease… can all be reasons as to why you are not getting a period.

And of course remember if you just came off the pill or it’s been a few months since stopping, it can take time for the body to re-establish a menstrual cycle.

PCOS

Many women with PCOS do not get a period or they have irregular bleeds every 35 days or more. These are anovulatory bleeds meaning they aren’t ovulating. So we want to be asking the right questions, such as why are you not ovulating? Common causes include insulin resistance, inflammation, and chronic stress.

In PCOS, the LH:FSH ratio is usually out of balance which will prevent a woman from ovulating. PCOs women typically have chronically high LH levels and low FSH levels which prevent ovulation from happening. High LH can promote high androgen production resulting in anovulation, hirsutism, acne, and hair loss.

What I commonly see in PCOS women is accepting their diagnosis as the reason why they aren’t ovulating or getting regular periods, but this is a mistake. Just because you have PCOS doesn’t mean you can’t ovulate or get a regular period, PCOS in itself is not enough of a reason. We want to know what is going on under the surface and then correct it.

Functional Hypothalamic Amenorrhea

Also known as stress-induced anovulation, FHA is one of the most common causes of secondary amenorrhea (meaning you have had a period before but now you don’t). It usually comes from undereating, over-exercising, chronic high stress, or chronic disease. This is a common phenomenon in female athletes, bodybuilders, and dieters.

Women with FHA will have to manage their stress properly, reduce their exercise intensity, and increase their caloric intake. This can be difficult for many women to grasp but it is critical in order to heal.

I rarely actually meet a new client who is eating enough as we are constantly bombarded with messages to eat less to lose weight but this can actually backfire on our weight loss efforts!

We have to remember that the female body, though powerful, is delicate and will respond to environmental triggers that may threaten the safety of a baby. Any sort of stress will impact the female cycle and if chronic this can impact fertility.

Thyroid Disease

As the thyroid has a significant role in energy production in the body, a low functioning thyroid can reduce energy made from the ovaries which is needed to successfully ovulate every month. Low thyroid can also worsen insulin resistance, making our cells more resistant to the hormone insulin, which can lead to anovulation.

Any thyroid dysfunction, whether too high or too low can disrupt the release of hormones from the brain such as LH and FSH as well as prolactin. With hypothyroidism the brain may release too much TRH which can trigger prolactin release. Too high prolactin is a cause of irregular periods or absent periods. Prolactin is the hormone released during breastfeeding and has an ovulation inhibiting effect by suppressing LH and FSH.

Be sure to get your thyroid tested properly. This means a full panel and comparing to optimal ranges not just the normal ranges. Grab my free guide for more info on bloodwork for PCOS and hormones.

Hyperprolactinemia

As discussed high prolactin can suppress ovulation. This means your blood levels of prolactin are higher than normal. If you are not breastfeeding or pregnant, high prolactin can be caused by certain medications, post-pill, pituitary tumors, thyroid disease….

Insulin resistance

High insulin is seen in many women with PCOS, in fact up to 70% of them. Hyperinsulinemia can cause an increase of androgens to be produced by the ovaries which inhibits ovulation. It can also stimulate too much LH which can also stop ovulation from happening.

Obesity

Excess weight can dysregulate hormones which can lead to menstrual irregularities and amenorrhea. Adipose tissue is actually considered to be an endocrine organ because it releases hormones such as leptin, estrogen, adiponectin, and resistin. Though there are many more!

Having these hormones in balance is key in regulating metabolic function.

This hormonal imbalance picture alongside a low grade chronic inflammatory state, which is heightened by excess fat cells, worsens insulin resistance, making weight loss even more complicated. Obesity is also linked to higher androgen production which can inhibit normal menstrual function.

Inflammation

The effects of inflammation have been mentioned above. Inflammation can come from many factors and can worsen the PCOS phenotype as well as stimulate excess androgens from the ovaries and the adrenals, inhibit ovulation, and affect hormone receptors. When it comes to calming down inflammation I always start by addressing the gut.

Stress

Stress can suppress hormone production that is necessary for ovulation to happen. If this is acute this can result in delayed ovulation. We’ve all experienced this when we have been super stressed during one particular cycle and our period came late. However with chronic long term stress due to anything from dieting to over-exercising to trauma, cycles may stop altogether. This happens because stress can affect the production of gonadotrophin-releasing hormone (GnRH) in the brain, interfering with ovulation and regular menstruation.

This is commonly seen in FHA cases.

Remember the female body is sensitive and its only concern is reproduction. So if your body feels like it is unsafe to have a baby right now, it’s going to shut down that possibility!

Post Pill

Synthetic hormones suppress ovulation and shut down the communication between the brain and the ovaries. When you stop taking HBC it can take many months to restore regular ovulation and menstruation. This can take longer if you started hormonal contraception early on because your body never learned how to establish normal hormonal function. Learn more about the effects of the pill on PCOS and hormones here.

If you’re having trouble re-establishing a healthy cycle and want to start to rebalance your hormones with PCOS with the help of a holistic nutritionist who addresses the root causes of your symptoms, check out my services or book a free discovery call here.

This is not an exhaustive list as to why you may not be getting a regular cycle. This information is provided for educational purposes and should not be construed as medical advice. Please consult with your healthcare practitioners before undertaking any changes in your diet or adding supplements. 

This post contains affiliate links. For more information visit my disclosures page.

Studies & sources

https://www.sciencedirect.com/science/article/pii/S1521693414002223?via%3Dihub

https://www.fertstert.org/article/S0015-0282(16)43468-0/pdf

https://cen.acs.org/biological-chemistry/biochemistry/Hormones-reveal-secret-life-fat/96/i40

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333037/

https://www.sciencedirect.com/science/article/abs/pii/104327609190018I?via%3Dihub

https://www.medicalnewstoday.com/articles/322643#thyroid