Why your period stopped (secondary amenorrhoea)

If your period stopped, there is a reason – it is never normal – except if you’re pregnant or postmenopausal – for your period to stop or be irregular. 

Absence of your period for six months or more is called amenorrhoea, but there are two different kinds:

  • Primary amenorrhoea – when your periods don’t start before you are 17 years old
  • Secondary amenorrhoea – where your periods have started but then your period stopped

Here we cover what might have gone wrong if your period stopped. Never had a period? See our primary amenorrhoea article.

Possible reasons why your period has stopped

My period stopped – am I pregnant, lactating, or have I reached perimenopause?

Without stating the obvious, the most common reason why women stop having their periods is pregnancy, and while breastfeeding afterwards, due to high prolactin levels blocking other hormones. You need to rule out pregnancy before you proceed to other diagnostic tests.

Even if you don’t think it’s possible, if you’ve had a penis or semen anywhere near your vagina in the past couple of months, do a test anyway. This is a process of elimination.

Home pregnancy tests are cheap and easy, and if you go to the doctor, this is the first thing they are going to do. If you are nearing menopause, your periods will taper off and then stop altogether.

If you are between 40 and 60 years of age, you can go and get some basic tests to see where you’re at hormonally, and to rule out anything serious.

My period stopped – am I doing too much exercise?

This can cause amenorrhoea by reducing the level of circulating oestrogens – that is, the oestrogen in your blood is excreted too quickly to have an impact on your tissues.

Furthermore, if you are on a heavily restricted diet (calories and/or nutrients) while doing endurance exercises, you can disrupt the hypothalamic-pituitary-ovarian (HPO) axis resulting in hormonal – and period – disruptions.

A lot of vigorous exercise also increases your cortisol levels, a stress hormone, which interferes with your normal body function in lots of ways, including hormones. When this stops your periods, it’s known a hypothalamic amenorrhoea.

My period stopped – do I have too much testosterone?

Androgens like testosterone are masculinising hormones. Women have healthy androgens too, but in smaller amounts than men, so having elevated androgen levels can cause your periods to stop.

If your lack of periods is caused by high levels of androgens, you may also experience other symptoms such as excessive hair growth on the face, oily skin, acne or loss of hair on the scalp.

Read more about androgen excess here. 

My period stopped – is it because I went off the pill?

If you have recently gone off the pill, wait it out for three months, and it should work itself out on its own. If it doesn’t, see a practitioner for advice.

My period stopped – is it because I am using Implanon, the Depo Provera injection, an hormonal IUDs or use the mini pill?

Hormonal contraceptives can also stop your period due to the hormonal interactions, with these longer-acting hormonal contraceptives being famous for blocking periods for months at a time. In fact, that’s why some women like them.

My period stopped – is it because I’m on a special diet?

When a woman’s body weight goes below the recommended body mass index (BMI) it may cause disruption to the body’s normal menstrual cycle and ovulation.

When body fat goes below 25 per cent, amenorrhoea usually occurs. The minimum body fat thing is why fertility is traditionally associated with voluptuous women, meanwhile, stick-insect models are not known for their fertility.

Skinny models are probably not getting their periods – it’s just impossible without the minimum body fat requirements. This is also why low weight teenage girls get their periods late.

Low or no carb diets can also cause interruptions to your hormones, because your body thinks you are starving. This is especially true if you go on the diet abruptly. Low or no carb diets are just not healthy for your body, so keep it low to moderate, and have at least some carbs every day.

If you’re trying to lose weight, have your carbs in the morning so you don’t take the sugars to bed with you. Low or no carb diets interfere with your HPO and HPA axes. Extreme diets can shock your system, so just ease into it.

My period stopped – is it because I’m stressed?

Don’t underestimate the power of stress hormones to disrupt your business. Adrenaline and cortisol have an impact on all body systems, and can disrupt the HPO and HPA axes (hypothalamic-pituitary-ovarian and hypothalamic-pituitary-adrenal axis).

See hypothalamic amenorrhoea for more information.

My period stopped – do I have premature ovarian failure?

Premature ovarian failure is a condition where ovary functions stop before the age of 40. The cause is unknown but it may arise from an autoimmune malfunction or can be triggered by chemo or radiotherapy.

In ovarian failure, follicle stimulating hormone (FSH) and luteinising hormone (LH) are usually raised. An FSH level of ≥20 IU/l in someone under 40 would indicate an ovary problem. Read more about premature ovarian failure.

My period stopped – do I have cysts on my ovaries?

Having cysts on your ovaries is actually pretty normal, but they usually come and go without you noticing. There is a situation whereby you may have many cysts on your ovaries, or a big cyst, that is blocking your normal hormonal cascade from happening, which would trigger your period eventually.

Polycystic ovaries (PCO – different from polycystic ovarian syndrome, PCOS) involves the presence of multiple immature ovarian follicles that are called cysts, but aren’t really.

Having PCO usually causes failure to ovulate and in turn infertility. It may or may not result in a loss of periods, depending on the state of the hormonal cascade that causes bleeding and ovulation.

One in four women are found to have polycystic ovaries on ultrasound, and is considered normal, as it isn’t a disease or illness. It’s when it interferes with normal ovulation and causes infertility it is a problem.

Read more about ovarian cysts. 

My period stopped – do I have polycystic ovarian syndrome (PCOS)?

PCOS is the most common reproductive-age condition affecting women, with nine per cent of women meeting the criteria for PCOS. PCOS involves the whole body, and has a hefty link to insulin resistance and blood-sugar dysregulation.

Insulin resistance causes the pancreas to make more insulin, with the increased insulin levels affecting the ovary. This prevents ovulation and causes a rise in androgens (testosterone and friends). The rise in androgens causes the excess hair and acne commonly associated with PCOS.

Read more about PCOS.

My period stopped – do I have a thyroid condition?

Both an under and overactive thyroid can cause imbalances in androgen-oestrogen conversion. This can lead to ovulatory failure and therefore cessation of menstrual flow.

Thyroid tests are notoriously unreliable, however low T4 with low thyroid-stimulating hormone (TSH) means your pituitary may be struggling. Low T4 causes the hypothalamus to release more thyrotropin- releasing hormone (TRH), which stimulates the release of prolactin – which stops your menstrual cycle for breastfeeding.

My period stopped – do I have Cushing’s syndrome, congenital adrenal hyperplasia or adrenal or ovarian cancer? 

These conditions all cause androgen excess and can stop periods in their tracks. Some cancers are androgen-producing which means they upset the natural balance of your cycles. CAH is with you from birth.

My period stopped – do I have cervical stenosis, Asherman’s syndrome or adhesions in my uterus?

Uterine adhesions can be a cause of amenorrhea because they interfere with the ability of the uterus to build the endometrium, the lining that is shed (your ‘period’).

Read more about cervical stenosis. 

My period stopped – do I have a pituitary gland problem?

Pituitary gland damage because of tumour or surgical means can interfere with proper hormone regulation needed for the menstrual cycle to occur.

My period stopped – do I have a hypothalamus problem?

Low levels of hormone gonadotropin suggest the hypothalamus is involved, in hypothalamic amenorrhoea. The hypothalamus gets involved when you’re stressed or with excessive exercise/weight loss, which may be concomitant with an eating disorder. Serum gonadotropin levels may present as normal, however.

Read more about hypothalamic amenorrhoea.

My period stopped – is it because of a drug or medication I am on?

Some antihypertensive and chemotherapy drugs can cause your period to stop, but so can heroin and other recreational drugs. Phenothiazines and metoclopramide raise prolactin levels (the hormone produced while breastfeeding) that causes the loss of periods.

Diagnosis of amenorrhoea

What your doctor will do if your period has stopped

Your doctor will do a routine check and history-taking. Be ready to give details and your own observations. A pregnancy test might be done if appropriate, as well as a BMI calculation.

Other diagnostics might be recommended if deemed necessary such as an investigation for follicle-stimulating hormone (FSH) and luteinising hormone (LH) and pelvic ultrasound.

Your doctor will be looking for a physical reason why you aren’t having a period, like a blockage of some kind, cancers, growths, or hormonal imbalances that are easy to identify using blood tests.

What your naturopath will do once you have had more serious causes ruled out by your GP

Charting your cycle will be a useful start, even though it seems like you aren’t having one – you are, but you just can’t see it. Your body is doing nothing except trying to ovulate and have a normal cycle, because this is your primary biological purpose in this life: to reproduce.

Charting involves observing your vaginal fluids for changes, and writing down your observations during your cycle. There are spikes in hormones that can be observed using temperature (your temperature spikes ever-so-slightly just after you ovulate, and stays up until you bleed) if necessary.

Stress is closely linked to hormonal disturbances, so your naturopath is going to discuss your emotional landscape with you to see what’s going on.

Nothing happens without a cause, so your naturopath will work with you to figure out what that might be, and correct it using whatever method is deemed appropriate: herbs, supplements, lifestyle and diet, plus whatever other therapies may help.

How to treat the underlying cause

Treatment of secondary amenorrhoea is naturally entirely dependent on the cause and vary widely between medical practitioners and naturopaths.

All treatments can be effective, so you and your practitioner will determine the right one for you. Make sure you are informed before undertaking any treatments, and if necessary, get a second opinion. There is more than one way to get your periods back.

Some examples of treatments for a loss of periods are:

  • If it is found out that your BMI is less than normal, a nutritional program may be recommended to get you a little fatter (you need the fat to have a period).
  • If the cause is excessive exercise or stress-related, an appointment with a health counsellor or psychologist might be warranted.
  • For premature ovarian failure, hormone-replacement therapy may be suitable.
  • For amenorrhoea caused by thyroid and pituitary problems, menstrual flow would most likely resume after treating the underlying thyroid or pituitary illness.

There are a lot of possible reasons why your period may have stopped, so it is important that you get help to find out why, and do it soon. If it turns out to be something bad, get it treated sooner rather than later.

Don’t underestimate the beauty of a good, solid, regular period – it means a bunch of awesome things are working properly.

References

  • Amenorrhoea; NICE CKS, June 2009
  • Maclaran K, Panay N, 2011, Premature ovarian failure. Journal of Family Planning and Reproductive Health Care. Jan;37(1):35-42
  • Barrack MT, Ackerman KE, Gibbs JC, 2013, Update on the female athlete triad. Curr Rev Musculoskelet Med. 2013 Apr 24
  • Dickerson EH, Raghunath AS, Atkin SL, 2009, Initial investigation of amenorrhoea, BMJ. 2009 Aug 4;339:b2184
  • Heiman DL, 2009, Amenorrhea. Primary Care. 2009 Mar;36(1):1-17, vii


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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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