By Dr. Sunita Varma
A normal menstrual period usually occurs every 28 days, but this can range from 21 to 35 days. Period regularity depends 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 each month, which results in regular menstrual periods. Longer cycles or missed periods can be due to a variety of reasons:
1) The extremes of your reproductive life, the early years of puberty and before menopause, are times when you can skip cycles. This is normal, as long as your period is not prolonged, very heavy or totally erratic, in which case some treatment may be necessary. Premature menopause that occurs before the age of 40 may require hormone replacement therapy.
2) Pregnancy is the most common reason if you are sexually active. A pregnancy test would be mandatory before further testing.
3) Polycystic ovary disease (PCOD) occurs when the ovaries develop multiple harmless follicles and regular ovulation does not occur. This happens due to a hormonal imbalance and can be associated with weight gain, facial hair, scalp hair loss and acne, as well as missed periods. Regular exercise, diet modification, and weight loss would help control this condition. Sometimes it may be necessary to administer hormonal treatment. If you have PCOD and are planning to conceive, you may need medication to help you ovulate.
4) Excessive exercise (as seen in professional athletes) can cause ovulation to stop as too much body fat is lost. Moderating the amount of exercise with the help of a sports medicine specialist often helps.
5) Sudden weight loss or stress can also be a reason for prolonged cycles, as your body stops producing the hormones needed for ovulation. In such cases, eating disorders like anorexia should be ruled out first. Coping strategies such as cognitive behavioral therapy, yoga, and meditation can help in these 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 the interruption of ovulation and prolonged menstrual cycles. Excessive weight is often associated with PCOD and its resulting side effects. Diet 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 recommended because these women are at high risk for metabolic disorders such as hypertension, diabetes, and heart disease.
7) The use of certain contraceptives can cause irregular or absent periods. These include the progesterone-only pill, birth control injections, and the hormonal intrauterine contraceptive device. This is normal and does not require treatment as it occurs due to the thinning of the lining of the uterus.
8) Some medications such as antidepressants and domperidone (an anti-nausea medication commonly found in antacids) can cause increased levels of the milk hormone (prolactin) and cause periods to stop. You may see some nipple discharge from your 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 drugs 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 should 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 of Obstetrics and Gynaecology, Fortis Hospital Shalimar Bagh. The opinions expressed are personal and do not reflect the official position or policy of FinancialExpress.com).