Clinical Reference Systems: Pediatric Advisor 10.0
Menstrual Period, Late or Missed
Menstrual cycles vary in length from one woman to the next.
They may occur at at the same time each month or be
irregular. A menstrual period is considered late if it is 5
or more days overdue according to your usual pattern of
periods. A period is considered missed if there is no
menstrual flow for 6 or more weeks.
What is the cause?
- Pregnancy
This is the most common cause of missed periods in
teenage girls. If you have had sex even once in
the past several months, see your doctor for a pregnancy
test before you consider any of the other possible
causes.
- Stress
Stress is the second most common cause of late or missed
periods in teenagers. It may be emotional stress (for
example, breakup with a boyfriend or final exams) or
depression. Or it may be physical stress to the body,
such as a severe illness, a sexually transmitted
infection, rapid weight loss or gain, or strenuous
exercise. Dieting or binging and purging may interrupt
menstrual cycles. Changes in your usual routine (for
example, going on vacation) may also cause your period
to be late or missed.
- Normal development
During the first couple of years of menstruation many
teenagers have irregular periods. During this time the
body's hormones are not yet "fine-tuned," so the ovaries
may not release an egg once every month. As a result,
your cycles may be irregular, occurring as close
together as 2 weeks or as far apart as 3 months.
- Hormone imbalance
Hormone imbalance is rarely the cause of missed periods.
In teenagers, polycystic ovary syndrome is the most
common type of hormone imbalance that affects the
menstrual cycle. Polycystic ovaries may cause irregular
cycles, increased body hair, acne, and weight gain.
Sometimes when you stop taking birth control pills you
may have a temporary hormone imbalance and loss of
periods. If you are having sex, be sure to use another
reliable method of birth control because you could still
become pregnant.
Problems of the thyroid gland, pituitary gland,
adrenal glands, or ovaries can be rare causes of
irregular periods.
How do I know what the cause is?
- Pregnancy
A positive pregnancy test is the only way to be certain
of pregnancy. It is best to see your doctor for a
pregnancy test because home test kits can be confusing
and give misleading results. In addition, it's
important to have a supportive person available to
answer all your questions if you are pregnant. Breast
swelling, weight gain, and nausea are additional signs
of pregnancy. You may wish to have a parent (or other
adult you trust) go with you.
- Stress
Some stress is a normal part of daily life. Only you
can know if you are under too much stress. Read the
paragraph about stress under "What is the cause?"
Consider whether any of these events have happened
lately in your life.
- Normal development
If your doctor finds nothing abnormal during your
physical exam and you've been having periods for 2 years
or less, your irregular periods may be part of your
normal development. Remember, if you have had sex, go
to your doctor's office for a pregnancy test when your
period is late for you, even if you normally have
irregular cycles. Also, if you are having sex, read the
information on birth control or discuss it with your
health care provider.
See Birth Control Methods
- Hormone imbalance
If you have missed several periods without an
explanation, your doctor can check your ovaries and look
for any signs of hormone imbalance. Blood tests can be
done to measure hormone levels.
When will my period return to normal?
- Pregnancy
It is important to identify pregnancy early so that you
can discuss the options available to you and start
prenatal care. Early prenatal care helps ensure a
healthy baby. Call your doctor if you have any
bleeding during your pregnancy. You will not have a
normal period until after the baby is born.
- Stress
Your periods should return when the activities or
situations that are stressing you are eliminated or
changed.
- Normal development
Most girls' menstrual cycles become fairly regular as
their hormone levels become mature and synchronized. A
few women will continue to have irregular cycles as
their normal pattern.
- Hormone imbalance
Most often a hormone imbalance can be treated after
your doctor discovers the cause.
How can I take care of myself?
- Keep a calendar of when your periods occur and how long
they last. This information can help your doctor
make a correct diagnosis. Take it to your
appointment.
- Eat healthy foods and keep your weight steady. If you
are overweight, a balanced diet and regular exercise
will help you lose weight slowly (no more than 2 pounds
a week). If you are underweight, eat more.
- If you follow a strenuous exercise program, consider
cutting back until your periods come back.
- If you have sex, always use birth control. Talk to your
doctor about the available methods.
- If you think you might be pregnant, get a pregnancy test
whenever your period is 5 or more days late. Don't
wait. Confidential testing and counseling are available
in most doctors' offices and clinics. Take your
first morning urine specimen with you for the test.
Keep it refrigerated until you take it in.
Call Your Physician During Office Hours If:
- You think you might be pregnant.
- You have had sex and your period is at least 5 days late.
- Your period does not return within 6 weeks.
- You need help with gaining or losing weight.
- You need help for binging/purging or excessive dieting.
- You need help for stress or depression.
- You have an abnormal vaginal discharge or abdominal
pains.
- You develop excessive facial or body hair, significant
acne, trouble with your eyesight, persistent headaches, a
deepening of your voice, a coarsening of your skin, hot
or cold sensations when no one else feels them, or other
symptoms that concern you.
- Your period does not return within 6 months after
stopping birth control pills and you aren't pregnant.
- You have other questions or concerns.
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Written by Kathleen A. Mammel, M.D., Director, Adolescent
Pediatrics, William Beaumont Hospital, Royal Oak, Michigan.
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Copyright 1999 Clinical Reference Systems
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