No Period, No Problem?



For many of us, that time of the month is filled with moods, monster breakouts, and mounds of chocolate. We dread its arrival and plan our white pants-wearing days around it. However, if you ever have, or are now missing periods, this “period piece” is timely. Your period (while off hormonal contraception) is sort of like the sixth vital sign. It provides a lot of information about the health of your reproductive system, which is so important when you are TTC.

The arrival of a girl’s first period is sort of a big deal. In many cultures, for many centuries, it has marked the transition from girlhood to womanhood. Historically, it indicated the promise of life, new beginnings, and the start of something. While today the pomp and circumstance around getting your period are much more hush hush, it is still a very intimate moment shared by families.

Amenorrhea, medically speaking, is the lack of a period.

And, despite the unpleasant cramps and cravings, menses does mark the culmination of puberty and the commencement of the reproductive years. When will this process begin? The answer, while seemingly simple, is really somewhat complicated.

Puberty, Genetics and Fertility 

Many things play a role regarding when you go through puberty. Your ethnicity, family history, genetics, weight, living environment (urban versus suburban), fitness level, and stress level. In fact, even the century that you live in plays a role in the timing of this event. In the past 60 years, we have seen a decrease in the age at which girls get their periods. While the arrival of a period is usually abrupt, the process that brought this to you actually took years. A period marks the end of the process of puberty and genetics play a role in both puberty and fertility. 

Puberty encompasses many physical changes (breast development, pubic/underarm hair) as well as cognitive and psychosocial changes (sorry, Mom, for all those wild emotional tirades!). While all these things seem to occur at once, there is actually an orderly transition to this process.

A quick health class lesson, for those of you who may have forgotten…for most girls, puberty begins with the development of breasts at around 10 years (range 8–12). On average, from start to finish, the process takes between 1 and 4 years.

Although that first period marks the beginning of a brave new world, one period does not write the entire story. Your first period does not mean the system is ready to run on autopilot, rather it suggests that it has been primed. Now, while it is quite common for periods in the first two years to be irregular (many cycles during this time period occur without ovulation), after this point, they should start to follow some order. This pattern is not only good for wardrobe planning but also for demonstrating the system has matured!

Regular periods offer a visual that the following systems are a go:

  1.    About two weeks before the period, ovulation (egg release) has occurred (ovaries: check!)
  2.    A uterus with an open path for the blood to exist is present (uterus: check!)
  3.    The signal from the brain to the ovaries has been activated (hypothalamus/pituitary: check!)

What is Amenorrhea?

Medically speaking, the lack of a period is called amenorrhea (for all you Latin buffs, a-in Latin means without, and menorrhea is menses). When a girl has not gotten her period by age 14 without evidence of breast development or by 16 with evidence of breast development, this is called primary amenorrhea (primary because there has never been a period). Secondary amenorrhea is when a female has had a period(s) and then they stop for whatever reason. While some processes can cause both, the causes of the two are usually different.

Primary amenorrhea cases require more detective work and are much less common. They are more likely to be genetic in origin, a sign of poor ovarian development, or a uterine-vaginal blockage (septum)…basically, the rarities of medicine.

Secondary amenorrhea is something that Gynecologists deal with almost on a daily basis.

Secondary amenorrhea is something that Gynecologists deal with almost on a daily basis. (Trivia question: what is the most common cause of secondary amenorrhea? Answer: pregnancy!) But aside from pregnancy, other common causes are polycystic ovarian syndrome (PCOS), thyroid disease, over-exercise, and stress. Although a few months off from Ibuprofen and tampons feels good, you shouldn’t let this go on for very long without contacting your GYN.

Even though the arrival of Aunt Flo just in time for that beach party is no one’s idea of pleasant, it isn’t all negative. Getting regular periods, while sometimes a pain, can be a plus. It shows us that the system is functioning. While there is absolutely no problem with going on some form of hormonal contraception (pill, patch, ring, IUD) and keeping your periods at bay, this is VERY different than not getting period while off hormonal contraception, and is not alarming either.

Period and Trying to Conceive

Think of the reproductive system as an orchestra. The conductor is the brain, and the ovaries, the uterus, and the fallopian tubes are the instruments. So if the periods abruptly stop or never start, the conductor called off sick, or one of the instrument players have gone on strike, it is our job as GYNs to find out who is sleeping on the job and try to fix it! Although it might be easier to play over the group who’s gone, the music won’t sound or come out right. Periods mean something, and if they stop, someone needs to hear about it.

 

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