If you’ve missed your period, your first thought may be that you’re pregnant. But pregnancy isn’t the only cause of a missed period. If you’ve confirmed that you’re not pregnant, it can be helpful to consider what else may be causing a missed period.
It’s normal for your period to come about once per month. The average menstrual cycle (time between periods) lasts anywhere from 21 to 35 days. The main symptom of a period is blood flowing from your vagina, and it’s also common to experience lower abdominal cramps, mood swings, headaches, fatigue, and sore breasts.
Having menstrual cycles longer than 35 days can be normal from time to time. When you’ve had a monthly period for several years and then skip it for three or more months, this is called secondary amenorrhea, another word for a missed period.
The main symptom of a missed period is simply not having your period when you expect to get it. You may have additional symptoms depending on what’s causing your missed period.
For example, if you’re pregnant, you may experience fatigue, sore breasts, and nausea at the time you are expecting your period. If hormonal-related conditions, such as menopause, breastfeeding, or PCOS, are causing your missed period, you may have some period-like symptoms, such as mood swings, spotting, or cramps, but no period.
Several factors can cause you to miss a period or stop having your period for some time. Aside from pregnancy, common causes include puberty, menopause, breastfeeding, PCOS, stress, and rapid weight loss.
Many people will miss their period or have a late period at some point in their lives, and it’s usually not an ongoing problem. It’s important to work with your healthcare provider to determine the cause of a missed period and address any underlying health concerns.
Pregnancy
The most common cause of a missed period is pregnancy. Although some people bleed a little in early pregnancy, most people miss their period entirely when they are pregnant. Other symptoms of early pregnancy include feeling very tired, sore breasts, and nausea.
You can’t know if you are pregnant for sure unless you get a positive pregnancy test. You can take an at-home pregnancy test as soon as you’ve missed your period. If your test is negative but you still think you may be pregnant, wait a day or two and take another test, or contact a healthcare provider.
Adjusting to Puberty
When you get your first period, it’s common for it to be irregular. Your period may come every 21 days, or you may go as long as 45 days between periods. Some people go even longer between periods at first. This can last for about a year or two at first. Talk to your healthcare provider if you have any questions about your cycle.
Breastfeeding
When you are breastfeeding, your body releases high levels of a hormone called prolactin. Prolactin helps you make milk for your baby, but high levels of it will stop your period from coming. It’s common to go without a period for many months during breastfeeding. Your period will naturally return as your baby gets older and you breastfeed less frequently.
Perimenopause and Menopause
Menopause is the time in midlife when you stop getting your period. The years leading up to menopause are called perimenopause. During perimenopause, your estrogen levels change and will become very low at times, causing irregular periods. You may not have your period for several months in a row. When you haven’t had a period in 12 months, you are officially in menopause.
Hypothalamic Amenorrhea
Hypothalamic amenorrhea is when you miss your period due to weight loss or other related body changes. Having a very low body weight, 10% below a normal weight for your body, can cause you to miss your period.
You may also miss your period when you exercise an excessive amount, when you’ve lost weight very quickly, or when you’ve been under very high levels of stress. People who have eating disorders like anorexia or bulimia may also miss their periods.
Polycystic Ovary Syndrome (PCOS)
PCOS is a condition where your hormones are imbalanced. Symptoms include irregular periods, unwanted hair growth on your face, trouble getting pregnant, weight gain, and insulin resistance. It’s common to miss your period, or go a long time between periods, when you have PCOS.
Other Less Common Causes
Several other health conditions may cause you to miss your period. These include:
- Primary ovarian insufficiency (POI), where your ovaries stop working before the age of 40
- Thyroid problems
- Taking certain types of hormonal birth control
- Conditions affecting the pituitary glands, which can disrupt hormone production
- Chronic health problems, like kidney failure or inflammatory bowel disease (IBD)
If you miss your period and are sexually active, you should take a pregnancy test within a week after your expected period. If the pregnancy test is negative but you think you may be pregnant, visit a healthcare provider.
If you’ve missed your period for three months in a row and you don’t know why, visit a healthcare provider to determine the root cause. Your provider may ask about your symptoms, how long you haven’t had a period, and your medical history. They may also ask about your diet, sexual activity, medications you’re taking, stress levels, and exercise habits.
At times, blood tests may be necessary to check your hormone levels. Your provider may also need to perform an ultrasound, which is an imaging test that uses sound waves to produce images of your uterus (womb) and surrounding organs.
Treatments for missed periods depend on the cause. After making a diagnosis, your healthcare provider can recommend the appropriate treatment and next steps.
Some possible treatments for missed periods include:
- Changes in diet and activity level
- Hormone therapy for primary ovarian insufficiency
- Thyroid medication for thyroid issues
- Mental health treatment for eating disorders
- Medications for PCOS, which may include medications to help you ovulate, treat issues with your metabolism, or block androgens (male hormones)
It’s not always possible to prevent missed periods, as not all causes of a missed period are preventable. If your missed period is caused by a nutritional deficiency, excessive exercise, stress, or an eating disorder, managing these can prevent you from continuing to miss your period.
Your healthcare provider can suggest dietary and lifestyle changes to help you gain weight, correct nutritional deficiencies, and bring your body back to a balanced state.
Most people don’t have complications when they miss a period. However, if you miss your period for a long period of time and you aren’t pregnant, breastfeeding, or in menopause, certain health concerns can arise.
Experiencing several months or years with low estrogen levels, a main hormone of menstruation, can cause conditions like bone mineral density loss and osteoporosis (weak bones). You may also experience vaginal dryness and sexual issues. At times, people who miss their periods for a long time may have unusual thickening of the lining of their uterus.
If you don’t have your period for several months, it’s unlikely that you will be able to become pregnant, and you may experience fertility issues. Fertility problems may resolve once you reestablish normal menstruation, depending on the original cause of the missed periods.
It can be normal to miss your period from time to time. But if you usually have regular periods, you aren’t pregnant, and you’ve missed your period for three months, visit a healthcare provider to determine the cause.
Some common causes of missed periods outside of pregnancy are PCOS, menopause, breastfeeding, low body weight, and adjusting to your period during puberty. A healthcare provider can recommend treatment to restore your period, depending on the underlying cause.
