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Delayed Period

Introduction

Menstruation refers to monthly bleeding experienced by most women. It usually lasts for 3-7 days and signifies the shedding of the uterine lining. Most women have regular menstrual blood flow or periods every 21-35 days. Many factors can contribute to a disruption of the menstrual cycle and it is not uncommon for periods to be early or delayed. However if the delay is longer than usual, it is advisable to determine the underlying cause. In cases where the delay is longer than 3 months, the condition is termed Amenorrhea. In cases, where periods are seen at intervals greater than 35 days, it is termed Oligomenorrhea.

Cause

Pregnancy: Delayed periods are the most obvious sign of pregnancy. Periods occur after ovulation and in the event that the egg is not fertilized. If pregnancy does occur, the uterine lining is not shed and there is no period.

Breastfeeding: Irregular ovulation during breastfeeding can lead to delayed periods.

Hormone imbalance: The menstrual cycle is regulated by hormones estrogen and progesterone secreted by the ovaries. Therefore disorders or conditions, which result in hormonal imbalance, can lead to delayed periods. These include:Hypo and Hyperthyroidism (underactive and overactive thyroid gland respectively)Pituitary adenoma (benign tumor of the pituitary gland) can cause adrenal insufficiency resulting in the production ofinsufficient hormones by adrenal glands.High levels of androgens and cortisones suppress ovulation and delay periods.                                   Polycystic ovarian syndrome (PCOS) leads to the development of small cysts on the ovaries resulting in excessive androgen release by the ovaries and therefore delayed/irregular periods.                           Premature ovarian failure: Women who are affected by this condition often experience irregular or infrequent periods for many years.

Perimenopause: includes the years preceding menopause, which are characterized by irregular/delayed periods.

Asherman syndrome: is characterized by severe scarring or adhesions in the uterus lining and causes obstruction of menstrual flow.

Heredity: In the case of a delay in menarche (when menstruation begins for the first time), studies have found that in addition to environmental factors, hereditary factors play a key role. The age when the mother, older sister and grandmother got their first period will determine when a girl gets hers. Therefore a long delay is not necessarily indicative of a disorder.

 

Risk Factors:

Women suffering from obesity, drastic weight loss or eating disorders such as anorexia and bulimia nervosa (a condition where a person has regular episodes of overeating and feels a loss of control) can experience delayed periods due to anovulation ( a condition in which the ovaries do not release an egg).

Excessive exercising or any other strenuousphysical activity can also lead to delayed periods.

Travel can also disrupt regular periods due to jetlag, which affects the body’s internal clock. Besides this, it is not uncommon for travel to be stressful, bring changes in diet and physical activity, which by themselves have been shown to delay periods.

Women experiencing severe stress, depression and anxiety are also at risk for delayed periods due to insufficient levels of follicle stimulating hormone (FSH) secreted from the pituitary gland. FSH would normally stimulate ovulation.

Use of medication such as contraceptive pills, steroids, anti-depressants and anti cancer drugs also contributes to delayed periods. Illegal drug use can also disrupt the menstrual cycle.

Diagnosis

A physician will at first obtain information about the patient’s regular menstrual cycle and history to determine if a delay is substantial and a cause for concern.Information about the use of birth control pills and/or other medication, medical history, travel, diet and exerciseis neededfor accurate diagnosis. A physical exam is done to identify other symptoms, which may help in diagnosing the underlying cause of a delayedperiod.Pregnancy willneed to be ruled out as a cause for delayed period. A thorough clinical examination with blood tests to check hormone levels and function,will need to be done to identify potential endocrinal issues.                                                                                                                                                                               A pelvic exam can identify enlarged ovaries, as seen in PCOS. Blood tests and ultrasound are used to confirm diagnosis.

Treatment

In case of puberty and menopause, no treatment is necessary unless the condition is problematic. In cases where delayed periods are symptoms of other conditions or disorders, the treatment is provided accordingly after identifying the underlying cause. For instance, in the event of hormonal imbalance, hormone therapy may be required to bring levels back to normal.While birth controls pills may themselves be the cause of delayed periods in some women, they are also found to be helpful in regulating menstruation in others, especially women suffering from PCOS.Weight gain or alternatively weight loss, may be required depending on whether the patient is over or under weight.Surgery may be required in extreme cases such as Asherman syndrome.

 

Prevention

Tracking of one’s menstrual cycle will help determine uncharacteristic delays more accurately.

Regular gynecological consultations including pelvic exams will help ensure that problems affecting reproductive organs are identified immediately.

A balanced diet and healthy lifestyle is helpful in preventing disruptions to the menstrual cycle.

Restricting smoking and alcohol intake may help regulate the menstrual cycle better as they can affect the way the liver processes the hormones involved in menstruation.

Avoiding stress, emotional as well as physical, can go a long way in maintaining a regular menstrual cycle.