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What Could Cause Missed Period For Three Menstrual Cycles In An Unmarried, Non-sexually Active Young Female?
Question: My daughter is 23-years-old, unmarried, not sexually active, has never been pregnant. She is concerned because she has not had a period since February. She reports that her periods have been irregular for a little over a year, but this is the longest she has gone between periods. She is not having any pelvic pain and is not having any kind of discharge. She has no other health problems other than that she is overweight.
Brief Answer:
Thoughts on this
Detailed Answer:
Hello and welcome,
It is not uncommon for women, especially young women, to occasionally skip ovulations which throws off their cycle. When it has happened for 3 months in a row, and they previously used to menstruate, we give a short course of a progestin such as Provera. Then after completing about 1 week of taking this within a couple of days of finishing the progestin, there will be a withdrawal bleed in most cases. This type of amenorrhea is usually caused either by stress (physical or psychological) and there is usually enough estrogen produced so that after taking the progestin for a few days, the lining of the uterus (endometrium) is matured as if there had been ovulation, and when the progestin is finished and there is no more, the lining will slough off and there will be bleeding just like if a person has a normal cycle.
If, after a course of progestin, there is no withdrawal bleeding within a couple of days of finishing it, then that can indicate that the body is not producing enough estrogen, and that is a different situation. Then a pelvic exam is indicated as well as hormonal blood tests.
If she is significantly overweight and has a history of irregularity, this may be polycystic ovarian syndrome and possibly congenital adrenal hyperplasia. With the latter, often the woman has some acne or facial hair growth due to excessive androgens. PCOS can be diagnosed with history, pelvic ultrasound, and hormonal testing. CAH can be diagnosed with history and hormonal blood testing.
Taking a low dose daily birth control pill can help with providing regularity. Weight loss, particularly decreasing refined carbohydrates, can help with PCOS and CAH symptoms. If there are problems with excessive androgens, there are medications to help with that too.
If she has no established doctor yet, an urgent care doctor can prescribe a short course of progestin, but as she has been irregular over a year and is overweight, something long term such as a daily contraceptive pill may be needed.
I hope this information gives you a place to start.
Thoughts on this
Detailed Answer:
Hello and welcome,
It is not uncommon for women, especially young women, to occasionally skip ovulations which throws off their cycle. When it has happened for 3 months in a row, and they previously used to menstruate, we give a short course of a progestin such as Provera. Then after completing about 1 week of taking this within a couple of days of finishing the progestin, there will be a withdrawal bleed in most cases. This type of amenorrhea is usually caused either by stress (physical or psychological) and there is usually enough estrogen produced so that after taking the progestin for a few days, the lining of the uterus (endometrium) is matured as if there had been ovulation, and when the progestin is finished and there is no more, the lining will slough off and there will be bleeding just like if a person has a normal cycle.
If, after a course of progestin, there is no withdrawal bleeding within a couple of days of finishing it, then that can indicate that the body is not producing enough estrogen, and that is a different situation. Then a pelvic exam is indicated as well as hormonal blood tests.
If she is significantly overweight and has a history of irregularity, this may be polycystic ovarian syndrome and possibly congenital adrenal hyperplasia. With the latter, often the woman has some acne or facial hair growth due to excessive androgens. PCOS can be diagnosed with history, pelvic ultrasound, and hormonal testing. CAH can be diagnosed with history and hormonal blood testing.
Taking a low dose daily birth control pill can help with providing regularity. Weight loss, particularly decreasing refined carbohydrates, can help with PCOS and CAH symptoms. If there are problems with excessive androgens, there are medications to help with that too.
If she has no established doctor yet, an urgent care doctor can prescribe a short course of progestin, but as she has been irregular over a year and is overweight, something long term such as a daily contraceptive pill may be needed.
I hope this information gives you a place to start.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for the detailed response. Zoe does have acne and some facial hair growth which you have identified as possible CAH. She has lost some weight recently, mainly due to concerns about her irregularity. I think continued plans along this line will be beneficial in many ways. We hope to get her in to see a doctor in the next few days and this information will be very helpful. Thanks again.
Brief Answer:
Regarding PCOS
Detailed Answer:
Just to clarify, there can be overlap of PCOS and CAH. CAH can be one cause of PCOS, as can be other genetic factors or metabolic syndrome (insulin resistance, obesity, high lipids, high blood pressure). But I want to point out that too much androgen is a feature of PCOS too. With the history you provided, PCOS is likely.
I think establishing with a doctor is a good idea to have a look at Zoe.
I would be happy to address any future questions you may have.
Best regards,
Bonnie Berger-Durnbaugh, MD
Regarding PCOS
Detailed Answer:
Just to clarify, there can be overlap of PCOS and CAH. CAH can be one cause of PCOS, as can be other genetic factors or metabolic syndrome (insulin resistance, obesity, high lipids, high blood pressure). But I want to point out that too much androgen is a feature of PCOS too. With the history you provided, PCOS is likely.
I think establishing with a doctor is a good idea to have a look at Zoe.
I would be happy to address any future questions you may have.
Best regards,
Bonnie Berger-Durnbaugh, MD
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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