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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Bleeding marks the start of your monthly menstrual cycle. If you’re like a lot of people, it might not be your favorite part of the month, but when it doesn’t show up on time or at all, it can be a brand new source of stress.
Of course, every month is not the same, and depending on what’s happening in your life, menstruation can be irregular. Sometimes your flow is heavier or lighter. Periods can drag out over seven days––or be short and to the point.
Then there are times when it’s late or doesn’t show up at all. While some of these inconsistencies may be alarming, it’s not surprising given the external factors (like stress) that can affect your menstrual cycle.
Can stress cause an irregular period?
Getting straight to the question at hand, yes, stress is one of many things that can affect your period. That said, you might be wondering how.
Stress is our body’s response to physical or emotional triggers. When we’re exposed to something stressful—be it a meeting with our boss or an intense workout—it can flip on our “fight-or-flight” response, controlled by the sympathetic nervous system. This stress response sets off a cascade of chemical reactions that allows you to respond to the stressor. While the stress response is there to help keep us safe from danger, it can also have an effect on the delicate balance of hormones in your body. Unfortunately, problems can arise when we’re continuously stressed (Chu, 2021).
One of the systems affected by chronic stress is called the hypothalamic-pituitary-ovarian (HPO) axis. It gets a little complicated, but, to put it simply, the HPO axis is what connects our brain to our reproductive systems. It also bridges the relationship between stress and our menstrual cycle (Sophie Gibson, 2020).
Ideally, the HPO axis functions like this: specific areas of your brain—specifically, the hypothalamus and pituitary gland—release hormones that control estrogen and progesterone levels, which regulate the menstrual cycle.
Things like emotional stress, weight loss, poor eating habits, and over-exercising can suppress the HPO axis. This results in lower hormone levels that can result in amenorrhea—aka, no period (Sophie Gibson, 2020).
Is not having a period bad?
Some people find monthly bleeding inconvenient, so you might wonder if not having a period is even all that bad.
Like many health concerns, it depends on the situation. Here’s an example. Suppose you’re taking an extended-cycle birth control like Seasonale or a long-term birth control injection or implant. These are designed to suppress your menstrual cycle, and that’s okay (TEVA, 2017). Other times, not menstruating can be a sign of a hormonal imbalance or other problem, so if you’re missing your period without using one of these treatments, it may be a good idea to speak with a healthcare provider.
A suppressed HPO axis that causes your period to stop is known by healthcare providers as functional hypothalamic amenorrhea (FHA). If you have FHA for a long time, persistently low estrogen levels can raise your risk for osteoporosis and heart disease (Shufelt, 2017). FHA may also affect your mood. One study found that participants who didn’t have a period were more likely to experience symptoms of depression compared to those who did get their period (Marcus, 2001).
Amenorrhea: what causes a missed period?
When is it time to see someone?
There’s no exact timeline on when you should seek medical advice about irregular or missed periods.
If your period is usually regular and always on time, you might want to talk to a healthcare provider if you haven’t had it for a few months. If your period is already irregular but has gotten worse, you can usually hold off for a few months to see if it gets better before speaking to a provider.
Before a visit to the clinic, gather any information they might find helpful, such as the date of your last period if you can remember it and when any irregularities started. Also, share any information about any medications you’ve recently started taking, changes to your diet or fluctuations in your weight, and information about your general well-being.
Your provider will likely do a physical exam and perform a blood test to find out what’s causing your irregular periods. The physical exam can involve a pelvic exam, where they use a speculum to look at your vagina and cervix, or a vaginal ultrasound, where they use a wand placed in the vaginal canal to examine your cervix, uterus, and ovaries.
They’ll likely do a pregnancy test as well unless you’re 100% certain you’re not pregnant. This process can take time and might require follow-up visits, consultations with gynecology health specialists, and additional laboratory tests before they can pinpoint the exact cause (Klein, 2019).
Other factors that can delay your period
Hormones are little messengers throughout your body that help organs talk to each other.
When it comes to your menstrual cycle, hormones like estrogen and progesterone strategically rise and fall every month to trigger ovulation, followed by menstruation. Anything that affects these hormone levels can cause a missed or late period (Thiyagarajan, 2020).
What to know about a sudden change in menstrual cycle length
Pregnancy and breastfeeding are also common causes for amenorrhea, although it is possible for some people to get their period when breastfeeding (Nawaz, 2021). Other things that can affect your menstrual cycle include (Klein, 2019):
- Medications (antidepressants, birth control pills, opioid pain medications, chemotherapy)
- Thyroid conditions
- Polycystic ovary syndrome (PCOS), or any condition that causes cysts or growths on your ovaries
- High levels of cortisol (aka the stress hormone)
- Poor liver function
- Celiac disease and inflammatory bowel disease
Speak with your provider to understand if you may have an underlying condition that could be affecting your period and to learn more about what treatment options are available.
It’s important to find the cause of irregular periods so the underlying issue can be treated. For conditions like FHA, first-line treatment aims to restore your body’s hormonal balance by restoring HPO axis activity.
Depending on your lifestyle, a healthcare professional may recommend dietary changes and reducing your exercise load to help your body balance itself out. Many times, people have to gain weight before their period returns to normal.
10 reasons for a missed period
Your provider may also refer you to a mental health specialist for cognitive-behavioral therapy (CBT). CBT helps you learn strategies to change how you think and approach certain situations. With CBT, individuals may work on their attitudes and views regarding eating, exercising, and a healthy lifestyle to learn better strategies for handling stressful situations (Berga, 2003).
Having an irregular period can be frustrating. Still, be patient with your body as it may take time to return to its natural balance.
- Berga, S. L., Marcus, M. D., Loucks, T. L., Hlastala, S., Ringham, R., & Krohn, M. A. (2003). Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy. Fertility and Sterility, 80(4), 976–981. doi:10.1016/s0015-0282(03)01124-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14556820/
- Chu, B., Marwaha, K., Sanvictores, T., & Ayers, D. (2021). Physiology, Stress Reaction. [Updated Sep 18, 2021]. In StatPearls. StatPearls Publishing. Retrieved Sep. 10, 2021 from https://pubmed.ncbi.nlm.nih.gov/31082164/
- Gordon, C. M., Ackerman, K. E., Berga, S. L., Kaplan, J. R., Mastorakos, G., Misra, M., et al. (2017). Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(5), 1413–1439. doi:10.1210/jc.2017-00131. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28368518/
- Klein, D. A., Paradise, S. L., & Reeder, R. M. (2019). Amenorrhea: A Systematic Approach to Diagnosis and Management. American Family Physician, 100(1), 39–48. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31259490/
- Marcus, M. D., Loucks, T. L., & Berga, S. L. (2001). Psychological correlates of functional hypothalamic amenorrhea. Fertility and Sterility, 76(2), 310–316. doi: 10.1016/s0015-0282(01)01921-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11476778/
- Nawaz, G. & Rogol, A. D. (2021). Amenorrhea. [Updated Jul 25, 2021]. In StatPearls. StatPearls Publishing. Retrieved Sep. 10, 2021 from https://pubmed.ncbi.nlm.nih.gov/29489290/
- Shufelt, C. L., Torbati, T., & Dutra, E. (2017). Hypothalamic Amenorrhea and the Long-Term Health Consequences. Seminars in Reproductive Medicine, 35(3), 256–262. doi: 10.1055/s-0037-1603581. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28658709/
- Sophie Gibson, M. E., Fleming, N., Zuijdwijk, C., & Dumont, T. (2020). Where Have the Periods Gone? The Evaluation and Management of Functional Hypothalamic Amenorrhea. Journal of Clinical Research in Pediatric Endocrinology, 12(Suppl 1), 18–27. doi: 10.4274/jcrpe.galenos.2019.2019.S0178. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32041389/
- TEVA Pharmaceuticals USA, Inc. (2017) Seasonale: Highlights of Prescribing Information. North Wales, PA: Author. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021946s007lbl.pdf
- Thiyagarajan, D. K., Basit, H., & Jeanmonod, R. (2020). Physiology, Menstrual Cycle. [Updated Oct 30, 2021]. In StatPearls. StatPearls Publishing. Retrieved Sep. 10, 2021 from https://pubmed.ncbi.nlm.nih.gov/29763196/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.