| If you unexpectedly discover that you aren't having your period, you might worry that you're pregnant or that something is wrong with your reproductive system. Not knowing why menstruation has stopped can be stressful, and waiting for it to recur may feel like a lifetime. The absence of menstruation (amenorrhea) can be cause for concern, says Sandhya Pruthi, M.D., a specialist in general internal medicine and women's health at Mayo Clinic, Rochester, Minn. "The cessation of your period can lead to anxiety for women, and there is often urgency to define the cause." The cause of amenorrhea can be as common as pregnancy or as rare as a pituitary tumor. It can be a side effect of a normal condition or a sign of an underlying problem requiring treatment.
| Your monthly reproductive cycle | | | Each month several follicles — tiny sacs that contain a single immature egg — begin to develop in your ovaries. One follicle eventually grows larger than the rest as its egg matures.
| | | Female reproductive system |  | After the ovary releases an egg, it travels through the fallopian tube ... | | << ENLARGE | | Meanwhile your ovaries secrete estrogen from the dominant follicle. Estrogen thickens the lining of your uterus (endometrium). This prepares your uterus for implantation if the egg is fertilized. Soon after, the follicle ruptures and releases the mature egg (ovulation). The egg released during ovulation enters your fallopian tube on its way to the uterus. During the egg's journey, a sperm may fertilize it. If fertilization occurs, the egg implants itself in the lining of your uterus and menstruation doesn't occur. If the egg isn't fertilized, menstrual flow begins.
 | Hormones controlled by the hypothalamus — an area at the base of your brain that acts as a control center for your body — regulate your menstrual cycle. The hypothalamus sends chemicals to the pituitary gland, a tiny gland also located at the base of your brain. The pituitary gland releases hormones that travel through your bloodstream to your ovaries, where they cause ovarian follicles to produce estrogen and progesterone. These hormones prepare your uterus for pregnancy. A complex group of hormones determines your monthly menstrual cycle. If something goes wrong at any stage of the process, menstruation can be interrupted.
| Why menstruation might stop | | | Your periods may stop because of: - Pregnancy. In women of reproductive age, pregnancy is the most common cause of amenorrhea. When a fertilized egg is implanted in the lining of your uterus, the lining remains to nourish the fetus and isn't shed by menstruation.
- Contraceptives. Some women who take birth control pills may not have periods. When oral contraceptives are stopped, it may take 3 to 6 months to resume regular ovulation and menstruation. Contraceptives that are injected or implanted, such as Depo-Provera, may also cause amenorrhea, as can newer progesterone-containing IUDs, such as Mirena.
- Breast-feeding. Mothers who breast-feed usually experience amenorrhea. Although ovulation may occur, menstruation may not. Pregnancy can result even though menstruation is absent.
- Stress. Mental stress can temporarily alter the functioning of your hypothalamus. Ovulation and menstruation may stop. Regular menstrual periods usually resume when your stress decreases.
- Medication. Certain medications can cause menstrual periods to stop. For example, oral corticosteroids, antidepressants, antipsychotics, thyroid medication and some chemotherapy drugs can cause amenorrhea.
- Illness. Chronic illness may postpone menstrual periods. As you recover, menstruation typically resumes.
- Hormonal imbalance. A common form of hormonal imbalance in women is polycystic ovary syndrome (PCOS). This condition causes relatively high and sustained levels of estrogen and androgen, a male hormone, rather than the fluctuating condition seen in the normal menstrual cycle. This results in a decrease in the pituitary hormones that lead to ovulation and menstruation. PCOS often is associated with obesity, amenorrhea or abnormal uterine bleeding.
- Malnutrition. Low body weight causes you to stop producing estrogen, halting ovulation. Women who have the eating disorders anorexia or bulimia often experience estrogen shutdown, which causes their periods to stop.
- Excessive exercise. Women who participate in sports that require rigorous training, such as ballet, long-distance running or gymnastics, may find their menstrual cycle interrupted. The hormone leptin alerts the brain to the amount of body fat that's in your body. If the percentage of body fat is too low — less than 15 percent to 17 percent — menstrual function can be affected.
- Thyroid malfunction. Thyroid disorders can cause an increase or decrease in the production of prolactin — a reproductive hormone generated by your pituitary gland. An altered prolactin level can affect your hypothalamus and disrupt your menstrual cycle.
- Pituitary tumor. A benign tumor in your pituitary gland (adenoma or prolactinoma) can cause an overproduction of prolactin. Excess prolactin can interfere with the regulation of menstruation. This type of tumor is rare and can often be treated with medication.
"Pregnancy must always be suspected," says Keith Johansen, M.D., a specialist in obstetrics and gynecology at Mayo Clinic, Rochester, Minn. If pregnancy is ruled out, Dr. Johansen suggests that a woman watch for any of the following signs and symptoms: - Lack of menstruation for 3 to 6 months or longer
- Headaches, hair loss or changes in vision
- Production of breast milk or secretions
- Periods not resuming 3 to 6 months after pregnancy-related surgery
If you experience any of these signs or symptoms, see your doctor. Changes in your period may be caused by other health problems, such as tumors or disorders of the pituitary gland. Several tests can be done to determine the cause of amenorrhea. A progestin challenge test requires 7 to 10 days of medication to trigger bleeding. The test is performed to determine whether menstruation has stopped due to a lack of estrogen. Blood testing can be done to detect thyroid or pituitary disorders. Imaging tests can reveal pituitary tumors.
Treatment of amenorrhea is based on the cause. Your doctor may suggest that you make changes in your lifestyle depending on your levels of stress, physical activity, or weight loss or gain. The lack of estrogen caused by athletic amenorrhea can be treated with estrogen replacement therapy in the form of oral contraceptives. Amenorrhea caused by thyroid or pituitary problems can be treated with medications.
| Lifestyle changes can help avoid amenorrhea | | | The best way to avoid an interruption in your menstrual cycle is to maintain a healthy lifestyle: - Make changes in your diet and exercise activity to achieve your ideal body weight.
- Practice moderation in all activities. Try to balance work, recreation and rest.
- Assess areas of stress and conflict in your life. If you can't decrease stress on your own, ask for help from family, friends and your doctor.
- Avoid excessive use of alcohol and drugs.
- Don't smoke.
Be aware of changes in your menstrual cycle and check with your doctor if you have concerns. Amenorrhea may cause anxiety, but your doctor can help determine the cause and offer ways to regulate your cycle.
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