WOMEN are pretty used to the ebb and flow of their monthly cycle.
In fact, for a big chunk of their lives, each month is dictated by hormones driving menstruation, preparing the body for pregnancy, and then subsequently shedding the thick lining of the uterus (the bleed) when an egg isn’t fertilised.
When a period goes awry – and we’re certain that we’ve not fallen pregnant – it can be a little daunting.
Most women will start their periods around the age of 12 (although they can start as early as nine or as late as 16) and this monthly cycle typically goes on until 51, the average age a woman hits menopause.
Rachel Butcher, Head of Nutrition at Third Space, says each cycle is made up of four phases.
Phase one is day one to five, your period, where the hormones oestrogen and progesterone are at their lowest.
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Phase two, days six to 14, span from the end of your period to ovulation, the point at which an egg is released.
Oestrogen levels are rising to a peak and progesterone levels are still low.
Rachel adds: “Phase three, days 15 to 23, span from ovulation.
“Oestrogen levels initially drop, then oestrogen and progesterone start to rise and remain high.
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“Phase four is days 24 to 28 and oestrogen and progesterone levels decline to their lowest point.
“A ‘normal’ menstrual cycle can range anywhere from 21 to 40 days, so it’s important to get to know your cycle and work out what is ‘normal’ for you.”
Pregnancy is the first obvious reason behind a late period.
“If your period is more than seven days late and you’ve had unprotected sex, then it is worth ruling this one out,” says Jodie Relf, PCOS Dietitian and spokesperson for MyOva.
But there’s also a number of other potential reasons behind late or missing periods…
1. You’re exercising too much
Christopher Barker, head of nutrition and coach at The Female Curve, says overtraining is more a combination of too much exercise in combination with under-fuelling.
She says: “We have seen an increase in this given the recent trend of more and more women trying their hand at intense HIIT workouts and CrossFit along with the continued pressure to have a slim figure.”
He advises women to avoid training without food or going on diets which exclude carbohydrates.
Chris adds: “Also progesterone is catabolic in nature – it breaks down muscle – so if you are over exercising and under-fuelling around training, it’s likely you could be losing muscle mass in the long run, also leading to bone loss.”
2. You're underweight
Chris says: “Being underweight can cause a condition called hypothalamic amenorrhea.
“This is where your menstrual cycle stops the hypothalamus, a gland in the brain that regulates body processes, slows or stops releasing gonadotropin-releasing hormone (GnRH), the hormone that starts the menstrual cycle.”
People with eating disorders like anorexia may find their periods cease.
3. You’re overly stressed
Emotional stress, caused by work, anxiety, or depression, and physical stress, caused by surgery, illness and bacterial infections, to name a few, can potentially lead to a lack of periods.
There’s science behind it, according to Jodie: “When we experience large volumes of stress, the hypothalamic-pituitary adrenal (HPA) axis is activated and has an inhibitory effect on the female reproductive system.
“It impacts the amount of GnRH, luteinizing hormone, oestrogen and progesterone that is secreted and these hormones play an essential role in ovulation and the triggering of menstruation.”
When we experience irregularities in our cycle due to things like stress or insufficient calories, it can take one or two cycles for things to balance out again.
Jodie says: “If your cycles are irregular for two or more cycles, it’s worth letting your GP know to establish whether further testing is required.”
4. You have polycystic ovarian syndrome (PCOS)
Jodie explains: “Predominantly an ovulatory disorder, many of those with PCOS will experience anovulatory cycles (a menstrual cycle without the release of an egg) or irregular ovulation which manifests as either absent or irregular periods.”
Those with PCOS often have higher testosterone levels.
She says: “When testosterone levels are high the ovaries don’t function as they should.”
A missing period isn’t the only potential symptom of PCO.
“Other symptoms include excess facial hair, increased abdominal weight gain, oily skin and acne and thinning hair or balding.”
Concerned? Book an appointment with your GP.
5. You’re not eating enough
Jodie says: “When we create large calorie deficits then our body will look for ways to conserve energy.”
Similar to the overtraining principle, when we don’t eat enough, our body downregulates systems that are not essential for survival such as reproduction.
She adds: “A significant lack of calories, due to restricting intake or excess exercise, is also a real stress on the body which then triggers the stress response and impacts menstruation.”
6. You have an overactive or underactive thyroid
“If your thyroid is not functioning as it should then you can experience menstrual irregularities,” explains Jodie.
Our thyroid is a tiny gland which sits at the base of the neck.
Jodie says: “The thyroid produces hormones that are involved in menstruation, therefore an imbalance of these hormones will cause absent or irregular cycles.
“For both an under and over active thyroid this will need to be managed by a GP or specialist.
“There's very little that can be done from a lifestyle perspective alone.”
7. You’re entering perimenopause
Chris says: “One reason for a change in cycle length which is often overlooked can be as you start to enter your perimenopause and transition through to menopause.”
However, he says if you’re under 40, your lack of periods is probably not menopause as only one in 100 women undergo premature menopause or primary ovarian insufficiency.
“If you want to have a rough idea of when that might be for the most part this is genetically programmed.
“So, ask your mother, aunts, older sisters when their periods stopped as this will be a good guideline for when yours may stop.”
Chris adds that you cannot delay menopause with the pill or any natural treatment.
It’s worth visiting your GP if you’re unsure as to whether you’ve entered perimenopause.
On the pill?
Rachel says the oral contraceptive pill is often prescribed to ‘regulate’ the menstrual cycle, however, “the withdrawal bleed experienced on an oral contraceptive pill is not the same as your period”.
She adds: “This is because your body isn’t actually receiving exogenous hormones, so while it sheds some uterine lining, it isn’t the same as having a real period.
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“It can often in fact, cover up issues with amenorrhea (loss of periods) or low energy availability.
“If it works for you and your body, you may want to consider switching to an IUD.”
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