What should I do if I haven't had my periods for almost four months now?
If you haven't had your periods for almost four months, there are several steps and considerations you should take to determine the cause and appropriate course of action:
Rule Out Pregnancy
The first step is to rule out pregnancy, even if you are using birth control or believe it is unlikely. Take a home pregnancy test or consult your healthcare provider for a pregnancy test in their office35.
Medical Evaluation
If the pregnancy test is negative, it is important to see your healthcare provider for an evaluation. Here are some key points to consider:
Medical History and Examination
Your healthcare provider will take a detailed medical history and perform a physical examination to identify any underlying causes. This includes questions about your menstrual history, sexual activity, diet, exercise habits, stress levels, and any medications you are taking13.
Common Causes
Secondary amenorrhea can be caused by a variety of factors, including:
- Functional Hypothalamic Amenorrhea: Often due to significant stress, frequent vigorous exercise, or eating disorders1.
- Polycystic Ovary Syndrome (PCOS): Characterized by hyperandrogenism and ovulatory dysfunction12.
- Hyperprolactinemia: Elevated prolactin levels can suppress the hypothalamic-pituitary-ovarian (HPO) axis1.
- Thyroid Disorders: Both hyperthyroidism and hypothyroidism can affect menstrual cycles12.
- Primary Ovarian Insufficiency: Premature depletion or dysfunction of ovarian follicles1.
- Intrauterine Adhesions (Asherman Syndrome): Often caused by vigorous curettage or other uterine procedures1.
Laboratory Tests
Your healthcare provider may order various tests to determine the cause, such as:
- Hormone level tests (e.g., FSH, LH, prolactin, thyroid hormones)
- Blood sugar tests to rule out diabetes
- Other tests depending on the suspected cause13.
When to Seek Medical Attention
You should seek medical attention if you experience any of the following:
- Consistently irregular periods
- Severe pain associated with periods
- Heavy bleeding or bleeding between periods
- Recent weight loss or gain
- Excessive exercise suspected as a cause
- Other new symptoms that could indicate an underlying condition25.
By following these steps, you can help identify the cause of your missed periods and receive appropriate treatment or management.