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Period Just Stopped
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An_250404 posted:
I am 44 years old and since the age of 11 my period has been the only thing I could pretty much count on never being late unless I was pregnant. They were usually heavy and painful but got better after my two kids. However the last couple of years they started to get a litte more heavier but always regular. All of the sudden it just stopped. Not a gradual decent, no spotting, nothing. It just hasn't shown up. It has now been over three weeks. This is unheard for me. I have had some bloating and full feeling and constipation and some unexpected cramping but nothing that I would say serious. The only change I have noticed in the last nine months is my stomach doesn't seem to tolerate most foods. I decided to have my annual since I was due anyway. My GYN was out for medical reasons so I agreed to be examined by the Doctor's PA. She ordered a vaginal ultrasound as well as an ultrasound of my thyroid. The vaginal ultrasound showed thickening of the uterus lining and a fibroid in the lining. She didn't feel this was the cause of the period not starting because normally this would cause some sort of bleeding. She has recommended that it be surgically removed followed by D&C. In addition, she ordered blood work to see if it is hormonal but stated she doesn't think I am going through menopause because I do not really show any other symtoms but if the blood work comes back abnormal they will start me on some hormonal treatment to see if that makes a difference. The pap smear came back normal but I am still waiting on the blood work. I have tried to look up information on lack of period but find nothing. I can't find anything that talks about your period just stopping without any spotting or gradual decline. Could this be a sign of menopause and there isn't any concern. Or should I be seeking other answers. I have no history of cervical or ovarian cancer in my family. The only cancer in my family is both grandfathers had Hodgkins Lymphoma. Which I would assume have no concern with what I am experiencing. I am ok with it being menopause, I am a strong believer in being my own advocate because both my children have medical concerns that had we not pushed the doctors would have never been found or found too late and now they are monitored regularly for their issues. Thank you for any information or direction or even putting me being able to put me at ease if you are able to provide that based on the information I have given.
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Jane Harrison Hohner, RN, RNP responded:
Dear An: I agree that neither the fibroid, nor the overly thickened lining, are likely causes of your missed flow. If a 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. You apparently have enough estrogen because the ultrasound revealed a thickening of your uterine lining.

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(s).

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.

There can be MANY causes for not ovulating: low thyroid, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with parents or spouse or kids, finances), increased body weight, anorexia, rotating shifts at work, etc. In your specific case an ovarian cyst is less likely as it would have been noted on ultrasound. However by our 40's (due to "aging eggs") missed ovulations become more common--with the most frequent missed ovulations happening during perimenopause (ie age 47-51).

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.

It sounds like your GYN care has been very thorough with blood work, imaging, and a possible follow up based upon your ultrasound. When you go back for your follow up visit you can ask specifically about missed ovulations. They will be able to give you the most "for sure" answer.

Yours,
Jane


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