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You missed your period?

[00:00:00] Oh team. I've been a little silent for the last couple days cuz I'm on call and it seems very full moony because I guess it was a full moon last week. Anyway, I decided we're gonna talk about amen today. Amen. Which means lack of a period. Latin four A means without men means month, and then Rhea means flowing. 

I make that face cuz things like diarrhea. Flowy poop. Luca means flowy, drippy white discharge when you're pregnant. So in our cons, in our situation, we're gonna talk about Amen. Lack of a period, and we're gonna talk about it in. Um, venue of being pregnant or not pregnant. So being pregnant first because it's a briefer discussion. 

You're getting your period, you miss your period. The first thing you should do if you're sexually active, whether or not you're on birth control, whether or not you're taking the pill, whether or not you're on the patch, whether or not you're on the ring, whether or not you have an i u d, whether or not you've had a tubal legation or you're a tubal ion, or your husband or partner has had a vasectomy, [00:01:00] please do a pregnancy test because literally not one form of birth control is a hundred. 

unless you've had a hysterectomy. So the only form of birth control that is a hundred percent accurate is abstinence. Okay? If you're having sex and you're on birth control and you have a uter, , please do a pregnancy test. So if you call our office and say, I missed my period, the first thing we're gonna say is, okay, could you do a pregnancy test? 

And I swear patients are always like, I'm not pregnant, I promise. And the answer is, yeah, we believe that. You think you're not pregnant and you're probably not pregnant, but it's an easy, easy thing to rule out. So it's the first thing you should rule out. Now, let's assume you are pregnant, and if you planned on being pregnant is what we're gonna discuss here. 

So you missed your period. That means you're. three to five weeks from your last period, because a typical cycle will be about three to five weeks apart, and you call your doctor's office because the first thing to do is call them and say, Hey, found out I'm pregnant. I need to make my first appointment. 

Typically, the first appointment will be at about eight weeks. Assuming you have no issues, you'll go in. They'll [00:02:00] do the whole new appointment, which we've discussed in the past. I can address it again at another day. Let's say you miss your period, you have a positive pregnancy test, by the way. You'll end up doing probably like five tests cuz you won't believe the first one. 

Then you'll like put it in a Ziploc bag under your sink somewhere, thinking that one day you'll throw it out, but then you'll find it like five years later. We've all done this. If you haven't, you'll know what I mean When you get pregnant and then you're like, should I throw it out, Sharon out? I have like old P sticks. 

Hang on, pot pregnant, and somehow we all. I think until much later when we just purge everything. So you found out you're pregnant. If you have bleeding or spotting, or if you have pain on one side or the other, then I would suggest calling your doctor. It's rare that that means something bad, but in theory it could mean an ectopic. 

Ectopic in Latin top means place, EC means outside of. So the place that we want the pregnancy to grow is the uterus. If it's outside of the the regular place, it would be in the tube typically, and that can be concerning and dangerous. So if you're spot. or bleeding or having pain on one side or the other, [00:03:00] you should call your doctor. 

That's really it for you missed your period and you're pregnant. Now let's talk about you missed your period and you're not pregnant. Either because you've tested negative for your pregnancy test or you're not sexually active, so what could it be? Well, the truth is you shouldn't even consider worrying or thinking about it until by definition you've had three months of a missed period in someone who otherwise was having regular periods, because that's our definition of amenorrhea. 

According to the American College of ob, G n, acog, I can't actually say that I think people would wait, and I don't know that I would advocate for that, but I also feel good saying to patients by. We're not really worried until it's three months of missed period, because that's the definition, and up until three months many things can occur that we can't measure. 

For example, if a patient calls and says, I missed my period and I'm not pregnant, should I be worried? The answer is no. You shouldn't be worried. Often it's something kind of nebulous, like more stress in your life. If you traveled where your time zone was thrown off, that can actually just throw off your hormones and ways we can't. 

Or if you gained or [00:04:00] lost weight. Those are three obvious easy things that we can't measure, that when patients say, oh God, you know what? Yeah, I've been under a lot of stress, or I lost weight, or I gained weight, or I traveled across the world. All things that could throw off your period. Not wrong to wait it out a cycle or two and see if your period comes back. 

On the flip side, if it's longer than three months, or if a patient is particularly anxious or if she has other symptoms, then we should do a workup. So the three standard blood tests that you'd have done, if you go to your doctor and you miss your period, besides a pregnancy test, they would look for your thyroid dysfunction. 

Your thyroid is that gland right here that gives you a bunch of hormones that really moderate a ton of things in your. So if your thyroid is off, either hyper meaning too much, or hypo meaning too low, that can throw off your period, and that can stop your period. It can actually also throw it off and make you bleed too much. 

So it can be either, that's one. The second is they will check your prolactin level. Prolactin is the hormone that comes from the little gland in your brain, the pituitary gland, and it secretes that hormone and it actually makes you lactate, meaning produce. . So it's [00:05:00] what is me? It's the hormone that's mediated during lactation if you had a baby. 

But actually it can spontaneously through a small little benign, often tumor, secrete too much prolactin, and that will secrete the hormone that gives you breast milk and then suppress ovulation, meaning suppress your ovaries from popping out an egg. No ovulation means no, period. Third, they'll check something called fsh follicle stimulating hormone, and that's the one that we know moderates what happens in our ovaries and gives us ovulation through the regular mechanisms of our fsh, lh, estrogen, and progesterone hormones, all interacting to stimulate one of those little lucky eggs to pop out and ovulate. 

And again, give you a period if your FSH is elevate. . It could be a sign of perimenopause or menopause, but it's a little bit finicky. You really need to check the FSH level on day three or four of your cycle. Remember, day one is the first day you bleed. So day three or four, because that's how we can really tell at different parts of our cycle, the FSH will change. 

And so most [00:06:00] valuable would be your fsh. So those are the three standards, like you actually don't even need to do anything else according to the workup. But there are other things that we would do blood test. Depending on people's symptoms. So again, it could be your thyroid, it could be prolactin, it could be early menopause, but that's unlikely. 

If you have other symptoms like a terrible headache or milk coming out, it's more likely to be prolactin. If you said, I'm missing my period, and by the way, I'm having. Horrible night sweats and hot flashes. There's always a small chance you're going through early menopause. If you said, God, I feel like I didn't think I was pregnant, but I missed a pill, then it could be pregnancy. 

If you said, I'm really constipated and I have a little bit of hair loss, and I'm feeling like my skin is drier, it could be extreme forms of hypothyroidism. So again, the good news. , almost all these things are things that we can address and to a degree, fix. Early Menopause is a tough one, and it's not a common cause of it at all, but we can't necessarily fix it. 

But there's things that we can do still to help people get pregnant if that's what they want. Now, the truth is that the majority of [00:07:00] patients who miss their period, Don't have anything that we find, but a secondary group we see really often, which is those women who have something called polycystic ovary syndrome. 

I'm not gonna go into detail details about P C O S today cuz we have to do a whole separate post about it, but women who have polycystic ovary syndrome do not have cyst on their ovaries. They happen to have multiple fluid-filled pockets in their ovaries, which are basically all. Follicles, which are where the eggs are housed, and they're waiting to pop themselves out of the ovaries and they don't pop themselves out at appropriate times. 

So those women don't necessarily get their period regularly. or at all. Now many women have P C O S and they kind of have just subtle versions of it. I kind of described it as a spectrum, and it hasn't actually presented itself because it's been something really subtle because some women with P C O S still do get their period. 

They still do ovulate, so the spectrum is wide. . You might be one of those people who has it, but gets 32 day cycle. No one's ever thought to address it because we didn't need to address it. You might be someone who says, and this is a common theme, [00:08:00] I went off to college, I gained 20 pounds, and all of a sudden my period stopped. 

That alone is often a little bit of a trigger to me. They're like, huh, something's probably going on with your hormone levels that we can measure because weight gain. Can sometimes really be the trigger that unmasks polycystic ovary syndrome because it has to do with your insulin and sugar and FSH, and lh, and all the hormones interacting and not allowing ovulation to occur. 

A small subgroup of these patients will not have the typical symptoms because a very classic form of P C O S will ha be weight issues for many patients, and they will have excess hair in certain places like their chin. Sometimes on their nipples, they will sometimes have acne and they will sometimes miss their period. 

So that's kind of the classic patient, but we see subtle variations all the time. One interesting subgroup we see. Is the women who are very lean. So traditionally you have patients with P C O S, we think of as heavier and traditionally patients who are very lean. We think of as having something called [00:09:00] hypothalamic amenorrhea, which is a fancy way of saying the hypothalamus, another gland that's in our brain. 

Doesn't allow ovulation to happen in women who are very, very lean and have low body mass index or low body fat. Think of traditionally like gymnasts and ice skaters would typically miss their period, and it's kind of like nature's way of saying, you're a little too lean right now. Maybe this is not a good time for you to get pregnant and how a baby, because that baby will take from your stores. 

Therefore we're gonna suppress ovulation and you're not gonna get a period. So those two people, someone with P C O S not getting their period and someone with hypothalamic a amenorrhea, not getting their period will potentially have only one difference when you look at their lab tests, because sometimes there's overlap and one person can actually have aspects of both, but the estrogen levels in someone with P C O S will be normal. 

And the estrogen levels in someone with hypothalamic amenorrhea will be very. , and therefore that means the way we treat it and everything is a little bit different. Okay? So again, if you miss your. First, make sure you're not pregnant. Second, if you're [00:10:00] not pregnant, you can either wait it out a couple cycles or go see your doctor, and she will do a variety of tests that will rule out issues that she either can address and fix, or that she will just address and describe what they mean. 

And then inevitably, many patients end up just getting their period again in a couple months, even though everything's turned out normal. And so we kind of scratch our heads and say, we don't know why. It was probably. Things that we can't measure. All right? I describe that as the hormones we can't measure. 

So that's really our approach to missing your period, and it tends to be a very common thing. Many women in their lifetime will say, oh my God, I had that period of time where I didn't get my period for a couple of months. So don't despair. But like anything else, be proactive and take it seriously enough that you get tested if you need to, but don't take it so seriously that you all of a sudden Google it and jump to the conclusion that you've gone through menopause, because that's the least likely thing. 

Still possible, but not. Okay, I'm gonna go deliver some babies. Bye.