Health Library Missed or Irregular PeriodsFrom Healthwise

Most women have between 11 and 13 menstrual periods each year. You may be different: You may have more or fewer. Missed or irregular periods must be looked at in terms of what is normal for you.

Periods are often irregular during the first few years after menstruation starts. It may take several years for the hormones that control menstruation to reach a balance.

Menstrual periods also may be very irregular at the other end of the menstrual years. Many women realize that they are approaching perimenopause and menopause when their otherwise regular periods become irregular. Menopause occurs when it has been 12 months since you have had a menstrual period.

Pregnancy is the most common cause of a missed period. If you might be pregnant, treat yourself as if you are pregnant until you know for sure. Use a home pregnancy test as the first step to finding out whether you are pregnant.

If you are not pregnant, other causes of missed or irregular periods include:

• Excessive weight loss or gain. Although low body weight is a common cause of missed or irregular periods, obesity also can cause menstrual problems.
• Eating disorders, such as anorexia or bulimia. For more information, see the topic Anorexia Nervosa or Bulimia Nervosa.
• Increased exercise. Missed periods are common in endurance athletes.
• Emotional stress.
• Illness.
• Travel.
• Medicines such as hormonal birth control methods, which may cause lighter, less frequent, more frequent, or skipped periods or no periods at all.
• Hormone problems. This may cause a change in the levels of the hormones that the body needs to support menstruation.
• Illegal drug use.
• Problems with the pelvic organs, such as imperforate hymen, polycystic ovary syndrome, or Asherman's syndrome.
• Breast-feeding. Many women do not resume regular periods until they have completed breast-feeding.

Remember, you can still become pregnant even though you are not menstruating. Practice birth control if you do not wish to become pregnant.

Premature ovarian failure is when you stop menstruating before age 40. Surgery, chemotherapy, and radiation therapy to the abdomen or pelvis may cause premature ovarian failure.

Other diseases such as irritable bowel syndrome, tuberculosis, liver disease, and diabetes can cause missed or irregular periods, although this is rare. However, if any of these diseases are present, you will usually have other symptoms besides menstrual irregularities.

If you've skipped a period, try to relax. Restoring your life to emotional and physical balance can help. Many women miss periods now and then. Unless you are pregnant, chances are your cycle will return to normal next month.

Review the Check Your Symptoms section to determine if and when you need to see your health professional.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first:

• Abnormal vaginal bleeding: Go to the topic Abnormal Vaginal Bleeding.
• Lower abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.

	Yes	Do you think you might be pregnant?
When to See a Doctor See significance of pregnancy if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If the result of a home pregnancy test is positive, practice the following good health habits until you see your health professional: Eat a balanced diet. Do not smoke. Do not use alcohol or drugs. Avoid caffeine, or limit your intake to about 1 cup of coffee or tea each day. Do not clean a cat litter box, to avoid the risk of toxoplasmosis. Avoid people who are ill. Take a vitamin supplement that contains folic acid or a prenatal vitamin. Call your health professional today if you answer "Yes" to the following question. Yes Is your home pregnancy test positive and you are concerned about being pregnant? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you done a home pregnancy test and the result was positive? Yes Have you done a home pregnancy test and the result was negative, but you have not started your period and have symptoms of pregnancy? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you missed a period?
When to See a Doctor See significance of missing a period if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Have you had a tubal ligation? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you missed two periods, and there is no obvious cause? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that your missed or irregular periods could be caused by a medicine?
When to See a Doctor See significance of a medicine if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think that your missed or irregular periods may be caused by a medicine? Note: If your answer is Yes: Call the health professional who prescribed the medicine to determine whether this is an expected side effect of this medicine. An appointment may not be needed. If you are taking a medicine not prescribed by a health professional, stop taking it. Call your health professional if you feel you need to keep taking the medicine or if you need help to control your symptoms after you stop the medicine. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you an endurance athlete, and you have not started your periods or your periods are extremely irregular?
When to See a Doctor See significance of endurance training if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Are you age 16 or older, and you have not had a period for 3 months? Yes Are you age 15 or older, and you have never had a menstrual period? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you age 15 or older, and you have never had a menstrual period?
When to See a Doctor See significance of never having a period if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you not started having menstrual periods? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you using a hormonal birth control method, and your periods are different than you expected?
When to See a Doctor See significance of using hormonal birth control methods if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Note: Your health professional may be able to give you advice over the telephone regarding this problem. Yes Have you missed 1 or more periods, but you have not skipped any of your birth control pills? Yes Have your periods been different than what your health professional told you to expect? Yes Have you continued to miss periods or have very light periods and you have followed the instructions given by the health professional who prescribed the birth control pills? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

There is no home treatment for missed or irregular periods; however, the following information may help you find the cause of your missed or irregular periods:

• Eat a balanced diet. Being underweight or overweight can cause missed and irregular periods. For more information, see the topics Healthy Eating and Healthy Weight.
• If you are an endurance athlete, you may have to cut back on your training. Be sure to talk with your health professional about hormone and calcium supplements to protect against bone loss if you are missing periods. For more information, see the topic Fitness.

If you think you might be pregnant

Do a home pregnancy test if you had sex during the previous months. If the result is positive, practice the following good health habits until you see your health professional:

• Eat a balanced diet.
• Do not smoke or use other tobacco products.
• Do not use alcohol or drugs.
• Avoid caffeine, or limit your intake to about 1 cup of coffee or tea each day.
• Do not clean a cat litter box, to avoid the risk of toxoplasmosis.
• Avoid people who are ill.
• Take a vitamin supplement that contains folic acid or a prenatal vitamin.

If the home pregnancy test is negative but you continue to have pregnancy symptoms, it is a good idea to see your health professional to confirm the results. Practice good health habits until you see your health professional.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• You have early symptoms of pregnancy, such as:
  • Missed periods.
  • Increased urination.
  • Fatigue.
  • Breast tenderness or enlargement.
  • Nausea and vomiting.
• You have missed more than three menstrual periods in a row.

Here are some steps you can take to help prevent missed or irregular periods.

• Avoid fad diets that greatly restrict calories and food variety, and avoid rapid weight loss. To maintain a healthy weight, focus on eating a variety of low-fat foods. For more information, see the topics Healthy Eating and Healthy Weight.
• Use contraception consistently, as directed by your health professional. For more information, see the topic Birth Control.
• Increase exercise gradually. For more information, see the topic Fitness.
• Learn and practice relaxation exercises to reduce and cope with stress. For more information, see the topic Stress Management.

If you participate in endurance sports, you may miss periods or stop menstruating. Eat a healthy, balanced diet and keep track of your periods. Tell your doctor about any changes in your menstrual periods.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• What was the date of your last menstrual period?
  • When was your previous period? Was it normal?
  • If you are a teen, do you have regular cycles, such as a period every 21 to 45 days?
  • If you are an adult, do you have regular cycles, such as a period every 21 to 35 days?
• How old were you when your periods began?
• Are you sexually active?
• What type of birth control are you using? How long have you been using it?
• Have you missed any birth control pills or failed to have your hormonal injection according to schedule?
• Have you done a home pregnancy test? When did you do the test? What was the result?
• Have you been under increased physical or emotional stress?
• Have you recently changed your diet or exercise habits?
• Have you recently gained or lost weight?
• What prescription and nonprescription medicines are you taking? Are you using illegal drugs?
• Do you have any health risks?

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older
• Abnormal Vaginal Bleeding
• Birth Control
• Fitness
• Healthy Eating
• Healthy Weight
• Menopause and Perimenopause
• Menstrual Cramps
• Stress Management

Author:	Jan Nissl, RN, BS	Last Updated: July 5, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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