- Hello doctor, is it normal for a person to miss their period? Why and what causes this? – Clara
Dear Clara,
The absence of mensuration in women is called amenorrhoea. If the woman is not on any family planning method to prevent conception, she is expected to miss her periods due to fertilisation.
Amenorrhoea
- Primary amenorrhoea is when girls fail to menstruate by 16 years of age.
- Secondary amenorrhoea is absence of menstruation for more than six months in a normal female of reproductive age that is not due to pregnancy, lactation or the menopause.
Causes
- Anatomical including genital tract abnormalities; scaring of the inside of the uterus (asherman’s syndrome), vagina and uterus underdevelopement or absence (mullerian agenesis), extra tissue in the vagina stretching across the middle of the vagina to separating the upper and lower vagina (transverse vaginal septum) and blocking the vaginal opening (imperforate hymen).
- Ovarian disorders like poly-cystic ovarian syndrome, premature ovarian failure (POF) before age 40 usually unexplained, but may be due to chemotherapy, radiotherapy, autoimmune disease or chromosomal disorders.
- Excessive exercise, weight loss and stress can switch off stimulation of the pituitary gland involved in ovulation.
- Brain tumors which block hormones that trigger ovulation like dopamine.
- Head injuries.
- Systemic disorders including, tuberculosis and sarcoidosis resulting in an infiltrative process in the brain region responsible for ovulation.
- Drugs: progestogens which block hormone that trigger ovulation.
Investigations
Your doctor will sum up their findings from the history and examination to guide the choice and order of investigations, ranging from a pregnancy test, blood for hormones (like leutininzing hormone, follicle stimulating hormone, and testosterone), to radiographic test like ultrasound scan and CT scan /MRI, to rule out uterine abnormalities and brain tumors respectively.
