It’s supposed to be that time of month, but for some reason you’re not getting your period. We explore the possible reasons why you may have lost your period and what you can do to bring it back.
What Does a Typical Period Look Like?
In the great words of Fraulein Maria, let’s start at the very beginning. A very good place to start. SCIENCE HOUR. Menstruation is cycle that is usually 28-30 days. During a normal menstrual cycle your hormones are working around the clock. Gonadotropin-releasing hormone (GnRH) is released from the hypothalamus (a gland in the brain) and it works on the pituitary (another gland in the brain) to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones then act on the ovaries, which produces estrogen and progesterone, which work on the uterus to carry out the menstrual cycle. This process is regulated by something called the hypothalamic-pituitary-ovarian axis. At the end cycle, the uterine lining sheds off, leading to menstruation, aka… AUNT FLO.
What is Amenorrhea?
For most women, getting our period is a normal occurrence that is likely taken for granted (and also, kinda dreadded). For approximately 3-4% of women, however, the monthly crimson wave just never appears. This is what we know of as Amenorrhea, or the absence of a period during reproductive years (approx. 12-49 years old). There are two types of amenorrhea: primary and secondary. Primary amenorrhea is when a woman doesn’t receive her period by the age of 16, while secondary amenorrhea is when a woman misses her period for three months or more after she had already started menstruation.
For the purpose of this article, we’re going to look at some of the reasons why you might be experiencing secondary amenorrhea and what you can do to get your period back.
Why You Lost Your Period
Periods are largely regulated by hormones. So, if there’s a hormone issue, it’s expected you’ll see changes in your period or miss your period altogether. This can be referred to as hypothalamic amenorrhea. Meaning, the hypothalamus stops releasing hormones responsible for starting the menstrual cycle which in turn leads to missed periods.
Obviously if you’re pregnant, breastfeeding or in menopause, you’ll miss out on your monthly visitor, but what if you’re not in that category and you’re still not getting your period? There isn’t a simple answer to this question, which is why we’ve put together a bunch of reasons why you might not be getting your period.
Both weight loss and weight gain can lead to missed periods or period loss. Research indicates that a BMI less than 19 (classified as underweight) and BMI over 25 (classified as overweight) can impact ovarian function and increases the risk of infertility.
How can weight gain lead to period loss and irregularity?
Weight gain causes an increase in fat cells in our body. Fat cells release many molecules such as adipokines that interact in the body to cause insulin resistance, inflammation, high blood pressure, increased cardiovascular risk and oocyte (female egg) maturation.
How can weight loss lead to period loss and irregularly?
Excessive and/or sudden weight loss below where your body wants to be due to restricting calories can reduce or stop the production of those hormones needed for ovulation. Weight loss due to undernutrition is characterized by low insulin levels in the body, and since insulin regulates the hormones that lead to menstruation, low insulin levels = no period.
Extreme Over Exercising and period loss
Intense physical activity places stress on your body which in turn can affect the hormones responsible for our periods. Getting technical here, exercise can decrease GnRH, leading to low levels of FSH, LS and estrogen. The result is a change in menstruation. Amenorrhea is very common among active women. In fact, female athletes are three times more likely to develop amenorrhea than nonathletes. If you are a heavy exerciser and you lose your period, it may be advised to reduce exercise intensity and to see a doctor to find out if there’s something else at play.
Medications can either intentionally cause women to lose their period (like taking birth control) or period loss could be a side effect. However, other medications such as some antidepressants and blood pressure medications can increase hormone (prolactin) levels that involuntarily stop ovulation and periods. Speak to your doctor if this side effect is not intentional or desired.
On a diet? Most diets result in weight loss, because it involves restricting a heck of a lot of calories, which may get you a smaller number on the scale, but it’s definitely not sustainable and can have a grave impact on your reproductive health. This is often best evidenced by losing your period. Women suffering from an eating disorder like anorexia nervosa tend to be at a higher risk of developing amenorrhea. If you are cutting your calories and unintentionally losing your period, it’s likely that your body is not getting enough nutrition to sustain some of its basic functions (like reproduction).
Post-pill amenorrhea is the failure to resume menstruation within 6 months of discontinuing any form of oral contraceptive (such as birth control, IUD). Research suggests that 2.2% of women experience no periods after discontinuing oral contraceptives (this is likely partially what happened to me- you can read all about my experience here). The loss of your period even after stopping the pill is caused by low amounts of two hormones (gonadotropic and ovarian hormones) and mild to moderate elevations of prolactin. Treatment is not usually required unless pregnancy is desired, as it is expected that periods will start again spontaneously. In my case, I didn’t wait long enough (6 months, apparently) to see if my period did return before seeking reproductive technology.
Stress & Period Loss
Stress can lead to your menstrual cycle becoming longer or shorter or can cause it to stop altogether. How? Stress supresses the hypothalamic gonadotropic-releasing hormone also called GnRH. When that hormone is low, the body fails to ovulate (aka. anovulation). The more stress you are under, the more GnRH is suppressed, leading to amenorrhea. Just another really important reason to get the stress in your life under control.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women. It affects 6% of women of productive age. I’ve written about PCOS extensively here and here. One of the key signs of PCOS is period irregularities. In order to be diagnosed with PCOS there needs to be absence of ovulation, high levels of androgens (hormones important in males) and ovarian cysts. Other symptoms include no periods, frequently missed periods, heavy periods, infertility, excessive hair growth on face, chest, belly, upper thighs (called hirsutism), acne, obesity and weight gain, pelvic pain, and areas of thickened, dark and velvety skin. It is always best to consult with a doctor if you identify with some of these signs and symptoms.
HOW to Get Your Period Back
Eating a Healthy Balanced Diet
It may sound simple, but getting in a healthy balanced diet is one of the ways get your period back and maintain a healthy menstrual cycle. I’ve written about what to eat on your menstrual cycle here. Especially if you’re an active person, getting a healthy balance of carbohydrates, healthy fats and lean sources of protein not only helps your fitness performance but can protect you from other chronic diseases and even lengthen your life!
Get in your B-vitamins
Vitamin B6 supports your body’s metabolism and may be beneficial in stimulating serotonin and melatonin production. Since both of these hormones play important roles in sleep, it may help improve our reproductive health.
REACH FOR Omega-3
Don’t forget to get in those healthy fats! Omega-3s can do wonders for our health, and research suggests they may play a role in our menstrual cycle. A 2013 randomized controlled trial found that omega-3 supplementation helped patients with PCOS reduce testosterone levels and regulate menstrual cycles. The research in this area is still emerging and more studies are needed.
FOCUS ON Bone-Strengthening Foods
Women with amenorrhea are at an increased risk for low bone density, especially adolescents. For this reason, getting enough bone strengthening vitamins and minerals in your diet is very important. For bone health, it is recommended that women with amenorrhea take vitamin D (400 to 1,000 IU) and calcium (around 1200 mg). This can be through calcium rich foods (seeds, cheese, yogurt, canned fish, beans, lentils and leafy greens) and vitamin D rich foods (fatty fish, liver, cheese, egg yolks and fortified foods), alone or in combination with supplements.
Nutrition can play a significant role in our menstrual cycle, and making sure our diet includes a rich source of nutrients, vitamins and minerals is the best way to fuel our bodies.
Stress Relieving Activities
According to some interesting research, cognitive behavioral therapy (CBT) may be effective at bringing your period back. In a randomized controlled study, the group of women that participated in 16 CBT sessions experienced a return in their period after 20 weeks. It’s important to note that these CBT sessions included a combination of education on nutrition and exercise.
Too much stress in your life can be a burden on your mental health, but also your physical health. Find ways to cut out the noise in your life by going for a walk, meditating or trying therapy to help support your reproductive health.
Ditch the Diet
Even if you are eating a healthy balanced diet, you always want to make sure you’re getting enough calories and fat in your diet. It’s important to consume enough calories to support your weight to maintain a healthy menstrual cycle. A five year retrospective study of female athletes with menstrual disturbances found that increasing their dietary intake helped the return of their period. There seems to be a focus on getting enough fat and carbohydrate, since these nutrients tend to be the most under consumed macronutrients (thanks to popular diets like Keto, Paleo & Atkins).
Not only is it important to get the right nutrition in, but it’s also important to get enough in your diet to support your weight and your reproductive health.
GET MORE Sleep
There are a variety of hormones that are involved in our sleep and our circadian rhythms including melatonin, cortisol, thyroid stimulating hormone and prolactin. All of these hormones play an important role in either keeping us alert and energetic during the day or getting a good sleep at night. Not getting enough sleep can have a significant role on hormones like Thyroid Stimulating Hormone, Luteinizing Hormone, Follicle Stimulating Hormone, Estradiol and Prolactin, all of which may interfere with your reproductive health. While we need more human research, one early animal study suggested that sleep deprivation resulted in decreased egg output. In human research, one study looked at people who work irregular shift hours and found that they were more likely to experience irregular periods. This is likely because when you shift your body clock, you’re also shifting your reproductive hormones, which has an impact on your menstrual cycle.
Getting enough sleep, keeps your hormones running smoothly which can help to maintain reproductive health.
Exercise, but not too much
Since amenorrhea is very common among active women, at times it may be best to reduce your intensity at the gym. Taking a rest day can not only benefit your reproductive health, but can help with muscle recovery and protects you from injury.
Getting in your daily physical activity can do wonders for our health, however over exercising and going overboard at the gym can have a negative effect and put your reproductive health at risk.
BOTTOM LINE ON WHY YOU LOST YOUR PERIOD AND WHAT TO DO
At the end of the day, I’m a Dietitian, and my scope of practice isn’t to diagnosis why you’ve lost your period. Your first step should always be to speak to your doctor to help you rule out serious medical reasons like PCOS. But what I can recommend is that if you are underweight, dieting, over-exercising and missing your period, adding a dietitian to your healthcare team may help you create a plan to help you get that period back safely.
RD2B Hannah Wilson & Sofia Tsalamlal, RD, MHSc Nutrition Communication