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    Reasons for a late/missed period besides pregnancy?
    Anon_174962 posted:
    I'm 21 years old and have somewhat regular periods, usually 38-40 days apart. I have only missed my period once and that was due to exreme stress. My last period started on August 26. I was due for one in the first week of October and it has yet to come. I haven't had sex in this period of time, so pregnancy is out of the question. I have no symptoms of PMS or pregnancy, I feel completely normal. However, my last period was absolutely miserable. Very heavy bleeding, vomiting, migraines, fatigue, everything you could imagine. Is it possible that I'm late/missing this one because the last one was so unusual, or could it be something else?
    Jane Harrison Hohner, RN, RNP responded:
    Dear Anon: As you may have read, the most common reason for a menstrual pattern like you have described is not having an ovulation every month. 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. The good news is that you have enough estrogen to make a lining that does usually shed.

    In a normal cycle, progesterone production increases following ovulation and release of an egg.. 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. Alternatively, the built up lining can begin to shed on its own creating erratic bleeding patterns which are usually "too-light" or super heavy and prolonged.

    There can be many causes for not ovulating: low thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (as you have already noted), increased body weight, anorexia, rotating shifts at work, etc.

    It is unlikely that your last, miserable period "caused" this current missed flow. However, that super heavy flow may have also been a result of an ovulation disturbance. The vomiting and flu like symptoms MIGHT have been due to increased prostaglandins from the heavier flow. Conversely, a migraine itself can provoke vomiting and fatigue.

    If you have been several months without a period (eg by Thanksgiving), a gynecologist can 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.

    Hopefully your own, natural cycle will reset itself---as it did before. If it does not, or you develop pelvic pain (eg ovarian cyst), see your GYN or local family planning clinic.


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