Dear Periodless,

Amenorrhea ("a" means without and "menorrhea" means menstrual flow) is the medical term for this condition. Since you have missed over three consecutive periods, make an appointment with your health care provider. The assumption, from your letter, is that you have already made sure that you are not pregnant, which is the main reason women stop menstruating. Other common reasons include weight loss, hormonal changes, strenuous exercise, and a change in one's environment (this has also been referred to as "boarding school" syndrome), and even the eating disorder anorexia.

After going off the pill, your body may take some time to adjust to secreting its own hormones that regulate ovulation and your period. If it takes more than six months for your period to return, a visit to your health care provider is recommended. If the cause of your amenorrhea is due to low estrogen levels, vaginal dryness and a loss of bone density can result (for example, among highly competitive athletes in physically demanding sports). Athletes, regardless of their excellent diet and exercise programs, have lost significant bone mass when their periods stopped. Amenorrhea can have a negative impact on reproductive, endocrine, and muscular-skeletal systems. (For more information, see archived Alice answers to Calcium and osteoporosis, Women, calcium, and osteoporosis?, and Calcium — How much is enough?.)

Your provider will need to determine the causes of your amenorrhea if it is not due to problems with your hypothalamus. Other causes include insufficient thyroid hormone production, which causes the pituitary gland to secrete thyroid stimulating hormone (TSH). When the level of this hormone is high, the body increases prolactin production, which can cause amenorrhea as well as breast milk secretion. A tumor in the pituitary gland can also result in abnormal hormone production, and, ultimately, halt menstruation. High hormone production can also alter the menstrual cycle, resulting in a risk for uterine and/or breast cancer.

Give your women's health care provider a thorough history of your activities, diet, and workload. Let her or him know about any other symptoms you may be experiencing, even if they seem insignificant. It may be nothing, or it may be just the clue needed to determine the cause.

If you're at Columbia, make an appointment with a provider in Primary Care by calling x4-2284. Outside of Columbia, see your women's health care provider.

Alice

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