Management of missed periods

Dr Richa Sharma, Dr Amit Basnotra
We often come across in our life episodes of missing periods and that creates panic in mind of the patient especially when they are not expecting pregnancy and have a regular course of menstrual cycles.
Generally when it’s a sporadic episode we ignore it but if its recurring then its better to consult a doctor to rule out any underlying serious matter.
What does amenorrhoea speaks of ?
If your doctor says you have “amenorrhea,” it means that you aren’t getting your periods, although you’ve been through puberty, aren’t pregnant, and haven’t gone through menopause.
It’s not about having irregular periods. If you have amenorrhea, you never get your period. Although it’s not a disease, you should tell your doctor about it, because it might be a symptom of a medical condition that can be treated.
Many women have their menstrual periods once every month. That is because the normal menstrual cycle has an average length of 21 to 35 days, so women may expect to have 11-13 menstrual cycles in a year. These are just averages, and every woman may have different lengths of menstrual cycles. However, some women may become a little bit concerned when her expected menstrual period does not come on the approximate date or week they had anticipated. If it seems like the period has not come for about 40 days or longer, one may consider it a missed period (amenorrhea).
Causes – Many things could cause amenorrhea
* Natural amenorrhoea-Primary/secondary,Breast feeding,menopause
Possible causes of primary amenorrhea (when a woman never gets her first period) include:
* Failure of the ovaries
* Problems in the central nervous system (brain and spinal cord) or the pituitary gland (a gland in the brain that makes the hormones involved in menstruation)
* Problems with reproductive organs
Common causes of secondary amenorrhea (when a woman who has had normal periods stops getting them) include:
* Pregnancy
* Breastfeeding
* Stopping the use of birth control
* Menopause
* Some birth control methods, such as Depo-Provera or certain types of intrauterine devices (IUDs)
* Medications
* Hormonal Imbalance-PCOS,Pituitary/thrroid disorders,Premature ovarian failure
* Anatomical problems- Uterine scars, Congenital absence of reproductive parts, Obstruction
* Lifestyle factors- Excessive stress or extreme anxiety, Extreme weight changes, Eating disorders, Exercising rigorously or excessively
* A woman who has had her uterus or ovaries removed will also stop menstruating.
Management of a missed period
* First thing which come in mind of patient and the doctor is to rule out pregnancy.That is done by the urine test or blood test beta HCG after consultation with the doctor and may need help of other investigations and the ultrasound.If positive then its is carried out like a natural pregnancy and if negative then next line of action is taken ruling out others causes of amenorrhoea. It is always best to consult a physician especially if you have missed more than one period for two or three consecutive months. To assist the health provider in the evaluation it is also recommended that you keep track of your menstrual cycle and other symptoms you are experiencing.
* Rule out other causes- Missed periods doesn’t always mean a pregnancy.We as doctor and patient shouldn’t ignore any coincidental events or findings.
Think about common causes – If you are not considering the possibility of pregnancy, but it is your first time to have a delay in your menstrual period, think about other possible causes, such as extreme stress, exercise, or weight changes that may contribute to your problem. You may also try to think about certain medications you are taking or other symptoms you are experiencing which may be related to the hormonal changes. These are the most common causes of missed periods but not due to pregnancy.
The treatment will vary depending on the specific cause of amenorrhea, and some tests may be needed to establish a diagnosis.
(The author are senior IVF Consultant, and Senior Gastroentrologist)