By Dr. Sunita Varma
A normal menstrual period usually occurs every 28 days but this can vary from 21 to 35 days. Regularity of periods is dependent on a finely tuned orchestra of multiple hormones produced by the pituitary gland in the brain and the ovary. These hormones cause your ovaries to release an egg every month resulting in regular menstrual periods. Longer cycles or missed periods can be due to a variety of reasons:
1) Extremes of your reproductive life – the first few years of puberty and before menopause – are times when you may skip cycles. This is normal, as long as your period isn’t prolonged, very heavy or totally erratic, in which case some treatment may be required. Premature menopause occurring before the age of 40 years may necessitate hormone replacement therapy.
2) Pregnancy is the most common reason if you are sexually active. A pregnancy test would be mandatory before any further tests are done.
3) Polycystic ovarian disease (PCOD) occurs when the ovaries develop multiple harmless follicles and regular ovulation doesn’t take place. This happens due to a hormonal imbalance and may be associated with weight gain, facial hair, scalp hair loss and acne in addition to missed periods. Regular exercise, dietary modification and weight loss would help control this condition. Sometimes hormonal treatment may need to be given. If you have PCOD and are planning to conceive, medications to help you ovulate may be needed.
4) Excessive exercise (as seen in professional athletes) may lead to stoppage of ovulation as you lose too much body fat. Moderating the amount of exercise with the help of a sports medicine specialist usually helps.
5) Sudden weight loss or stress can also be a reason for prolonged cycles as your body stops making hormones required for ovulation. In such cases, eating disorders like anorexia should be ruled out first. Coping strategies like cognitive behavioral therapy, yoga and meditation may help in such cases.
6) Obesity can lead to missed periods, as the fat tissue in your body produces too much of a hormone called estrogen. This leads to stoppage of ovulation and prolonged menstrual cycles. Excessive weight is often associated with PCOD and its resultant side effects. Dietary modification and regular exercise is the obvious treatment. In women who have a very high body mass index and do not respond to these measures, bariatric surgery may also be advised because these women are at high risk of metabolic disorders like hypertension, diabetes, and heart disease.
7) Use of certain contraceptives can lead to irregular or absent periods. These include the progesterone only pill, contraceptive injections, and the hormonal intrauterine contraceptive device. This is normal and requires no treatment as it occurs due to thinning of the uterine lining.
8) Some drugs like antidepressants and domperidone (an anti-nausea medication commonly found in antacids) can lead to increase in your milk hormone (prolactin) levels causing periods to stop. You may see some nipple discharge from the breasts, which is harmless. Sometimes a tumor in the pituitary gland can also have a similar effect, and you may experience headaches or vision disturbances. Treatment is with medication or surgery, depending on the size of the tumor.
9) Thyroid disease, uncontrolled diabetes or heart disease can also be a cause of missed periods and must be ruled out.
See your gynecologist if you are not pregnant, and have
1) missed more than 3 periods in a row,
2) frequent headaches or visual disturbances,
3) excessive weight gain or loss,
4) development of facial hair or excessive acne.
(The author is the Director- Obstetrics & Gynaecology, Fortis Hospital Shalimar Bagh. Views expressed are personal and do not reflect the official position or policy of FinancialExpress.com.)
