When periods stop… or don’t start

For most women, “that time of the month” or the days leading up to it are not their favorite. But menstruation is a sign of our ability as a species to reproduce, which is why the absence of a monthly period (“amenorrhea”) in girls and women from about 16 to 45 years old who are not pregnant is a health problem. There are two types of amenorrhea: if a girl has not started her first period by the age of 16, it’s called “primary amenorrhea”. “Secondary amenorrhea” is more common, affecting up to 7% of females, and occurs when the period has already started but then stops for 6 months or longer.

Why would menstruation not start?

The onset of a girl’s monthly period is typically between 10 and 15 years old. But if her period has not started by the age of 13 and other signs of puberty such as breast development are also absent, it’s recommended that she pay a visit to her doctor and not wait until she is 16[i]. About 1% of girls experience this.

After a girl’s period starts, it can take up to the age of 18 for her menstrual cycle to establish itself[ii]. This means that irregular periods during the teen-age years are not unusual, and can include occasional skipped periods as well as uneven intervals between them as the evolving hormonal system becomes more balanced.

Parents (and medical providers) occasionally need to confirm that a girl’s period did not actually start, since she might be unaware of this if the flow is very light.

There are a few different reasons why a girl’s period may not start. Almost 30% of cases are caused by genetic abnormalities such as Turner’s syndrome, where one of the sex chromosomes is missing. Other explanations include hormonal conditions such as Cushing syndrome, which results in excess production of cortisol (the “stress hormone”). Finally, tumors on the pituitary gland (part of the hormone regulation system) or other locations can cause lack of onset of the first period.

Identifying the cause usually requires full bloodwork including a hormone and thyroid panels and urinalysis, and may also involve imaging of the pelvis using ultrasound or MRI. Genetic and hormonal problems are typically treated in conventional medicine through surgery or drug therapies.

When all these explanations have been ruled out (including pregnancy), a couple of other reasons could be considered. One is excessive exercise, which can be seen in girls who have been high-performance athletes from a young age. In these cases, parents can be assisted by health care providers to evaluate whether the risks to their daughters’ health are worth the rewards of competitive athletics.

If there is no evidence of excess exercise, then an eating disorder such as bulimia might be suspected, where a girl secretly engages in binge-eating and self-induced vomiting. Bulimia is an emotional disorder that can be contributed to by family problems, societal pressures to be thin and a distorted body image (thinking she is fat when she is not). Counseling is the main intervention recommended in these cases.

When periods stop

There isn’t agreement on the point at which absence of periods (secondary amenorrhea) requires a medical evaluation. Some suggest 6 months, but if the period does not spontaneously resume within 3 months, it’s probably a good idea to get checked out[iii].  

There are multiple causes of secondary amenorrhea, some are the same as those that cause primary amenorrhea such as genetic abnormalities and tumors. Similarly, excessive exercise and eating disorders can cause periods to stop.

Several hormonal conditions can result in secondary amenorrhea, including Cushing syndrome.  Polycystic ovarian syndrome (PCOS) is a hormonal condition where there is an overproduction of male hormones in girls and women resulting in unwanted body hair, acne, weight gain, diabetes, hair loss and irregular periods, frequently without ovulation [see separate blog: “4 letters we don’t want to hear: PCOS”]. Another is hypothyroidism, involving underfunction of the thyroid, which is relatively common in women and affects the menstrual cycle [see separate blog: “Hypothyroidism: the bigger picture”]. 

A traumatic head injury can actually result in stopped periods, since both the hypothalamus and pituitary gland that control hormone regulation are located in the brain.

Finally, some prescription medications can interfere with menstrual cycles and cause periods to stop, especially oral contraceptives and other hormone-based drug therapies.

As with primary amenorrhea and depending on the cause, treatment for stopped periods is typically surgery or drug therapies.

A natural approach to resolving amenorrhea

For those who prefer to avoid the risks of surgery and/or the side effects of hormonal therapy, natural therapies can be used as an adjunct alongside, before, or after conventional medical treatment.[iv] Of course, the goal would be to start or re-start the period.

If the cause of the amenorrhea involves hormone production or regulation, some basic steps can be taken that support the endocrine system. This could include:  consumption of healthy fats, avoidance of “endocrine disruptors” (chemicals in food, cleaning, plastics and many other products that interfere with hormone functioning) and daily exposure to sunlight (which the body uses to produce several hormones). For some, especially young or teenage girls, a vegan diet can make it difficult for the developing body to establish a regular menstrual cycle if there are insufficient healthy fats.

With the exception of genetic causes and tumors, most of the other underlying reasons for amenorrhea, including hormonal and emotional conditions, can be addressed with homeopathic medicines, which are federally recognized in the US.

We would first have an extended conversation that includes a detailed analysis of all relevant symptoms and history, as well as a review of any medical assessments from your doctor or naturopath including blood tests and other diagnostic tests.

After, we would likely begin with a single homeopathic medicine and, from there, we might add low-potency remedies that target various components of the endocrine system such as the uterus, ovaries, hypothalamus or pituitary gland. It may take several months for menstruation to start or re-establish itself, so some patience is required as well.

To learn more about how I could help with delayed onset or stopped periods call me for a free 15-minute consultation or schedule one on the online scheduler.

[i] WebMD (2019) “Amenorrhea”, Medscape, https://emedicine.medscape.com/article/252928

[ii] American College of Obstetricians and Gynecologists (2019) “Your first period”,  https://www.acog.org/womens-health/faqs/your-first-period

[iii] Klein, D, S Paradise R Reeder (2019) “Amenorrhea: A Systematic Approach to Diagnosis and Management” American Family Physician 100(1):39-48 https://www.aafp.org/afp/2019/0701/p39.html

[iv] Thanks are due to Karen Allen CCH, homeopath and teacher, whose expertise was relied on for this section.