Women's Health Community

Dear bogienbac: A little background first; if that's OK. If the pregnancy test is negative then the next most common cause of a missed period is not having ovulated that cycle. In a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month. This is why menopausal women with low estrogen levels should not be having a bleed.

In a normal cycle, progesterone production increases following ovulation. Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining—your period.

So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus—your missed period.

If you have been several months without a period, a gynecologist may give you some progesterone in a pill form (eg Provera 10 mg for 5 days). Within 48-72 hours after stopping the progesterone your "progesterone blood level" will fall, triggering the release of the lining that has been building up. Many women report that these periods are very heavy-- as though several months of lining are shed.

Causes for not ovulating are multifold: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with parents or partner, finances), increased body weight, anorexia, rotating shifts at work, etc. Being perimenopausal will also limit ovulations.

There is a second, less common cause for not having a period. In some women the estrogen levels become very low. The levels are so low that no uterine lining is available to be shed. When these women are given the progesterone pills to take, no flow occurs after the medication is finished. This tells the GYN that the woman is not making enough estrogen to produce a thickened uterine lining.

In your specific case, it sounds like the blood tests for thyroid and pituitary problems (eg TSH & prolactin levels) were normal. Also that your menopause (FSH) level was normal (not elevated). In perimenopause the FSH level can swing widely. So there is no obvious reason for your absent flows. Did your GYN give you some Provera or Prometrium (both FDA approved types of progesterone--synthetic or natural). If the medication caused a bleed you still have enough estrogen to make a lining and the problem is lack of ovulations. No bleed equals low estrogen.

Oral or IV steroids can interfere with ovulations; they do not suppress estrogen levels. Advair has irregular menstrual periods listed as an infrequent side effect periods. With very low levels of incidence it is hard to know if reported menstrual problems were caused by the inhaled steroids --or were coincidental. Apparently in your ten years of use you had no period problems until 10 months ago. Thus Advair seems a less likely culprit.

Bottom line, your own GYN can give you the most "for sure" answer. If the "progesterone withdrawal bleed" test has not been done it might give you more information. You can also consider a second opinion with a reproductive endocrinologist.

Yours,
Jane