Analysis

What to do if there is a long delay in menstruation. Lack of menstruation. Cancellation of oral contraceptives

The most common reason for a missed period is pregnancy. To check whether conception has occurred, it is enough to purchase a test system at the pharmacy to detect increased levels of human chorionic gonadotropin in the urine. In some cases, even a repeat pregnancy test is negative. This is because a delay in the menstrual cycle can occur due to other reasons. Some of them are harmless and do not cause negative effects on the body - menstruation is restored on its own. Others are associated with diseases of the reproductive and other systems, which require a diagnostic examination and the prescription of adequate therapy. It is important for every woman of reproductive age to know the reasons for the delay of the menstrual cycle in order to promptly notice unwanted disturbances in the body and seek advice from a doctor.

In order to understand why menstruation is delayed, it is necessary to consider the physiology of the menstrual cycle - a cyclical process in the body of women of reproductive age (16-50 years). The menstrual cycle is triggered by the cerebral cortex, which regulates the production of hormones from the pituitary gland and hypothalamus. These hormones control the function of the ovaries, uterus and other endocrine glands.

The normal duration of the menstrual cycle is 21-35 days, more often 28 days and is considered from the first day of cyclic bleeding from the vagina. In the first half of the cycle, an egg matures in one, or less often in both, ovaries, surrounded by a follicle. During the period of ovulation, a mature egg is released into the abdominal cavity and sent to the fallopian tubes. In place of the burst follicle, a corpus luteum remains, which produces the pregnancy hormone and supports the vital activity of the egg.

In the second half of the cycle, under the influence of the hormone, the mucous layer of the uterus thickens. This is a preparatory stage for implantation of the fertilized egg in the event of fertilization of the egg. If conception does not occur, the egg dies, the corpus luteum stops secreting the pregnancy hormone, the endometrium of the uterus is rejected, blood vessels are destroyed, and menstruation begins. The first day of menstruation is the first day of a new menstrual cycle, during which all stages are repeated again.

A delay in menstruation indicates the likelihood of pregnancy in women of reproductive age who are sexually active. However, there are many reasons for a delayed menstrual cycle that are not related to conception. Organic, functional and physiological abnormalities in the reproductive and other systems of the body can cause disruption of the cyclicity of menstruation and even stopping the menstrual cycle for a long time.

Reasons for missed periods other than pregnancy:

A delay in the menstrual cycle by 3-5 days 1-2 times a year is considered a physiological norm. If your period does not come on time regularly and is delayed for more than 5 days, you must contact a gynecologist to undergo a diagnostic examination and prescribe adequate therapy.

Ovarian dysfunction

Ovarian dysfunction is a medical diagnosis that a specialist makes in case of an irregular menstrual cycle in a woman. Thus, the gynecologist identifies the pathology of the menstrual cycle and prescribes diagnostics to determine the cause of the current situation. To do this, the specialist conducts a survey of complaints, collects an anamnesis of the disease and life, examines the mammary glands and on the gynecological chair, takes smears for vaginal flora and the presence of sexually transmitted infections. If necessary, the doctor gives directions for laboratory and instrumental research methods, consultation with related specialists. Identifying the cause of ovarian dysfunction is an important link for treatment and subsequent recovery of a woman.

Non-gynecological causes of missed periods

Menstrual irregularities are caused by diseases of organs and systems not related to the sexual sphere. A woman’s body is an integral system in which all links are interconnected.

Non-gynecological reasons:

severe emotional shock, chronic stress;
physical stress;
change of climatic zones;
weight loss, obesity;
poisoning of the body (bad habits and working conditions);
pathology of the endocrine system (hyperthyroidism, hypothyroidism);
acute and chronic diseases of internal organs (kidneys, liver, heart, lungs);
functional and organic disorders of the brain;
long-term use of medications.

Below we will consider in detail the most common non-gynecological causes of delayed menstruation.

Body weight problems

Adipose tissue in a woman’s body is involved in regulating the functions of the reproductive system. Fat cells can accumulate estrogen, which affects the cyclicity of menstruation. Weight loss leads to the cessation of menstruation for a long period of time. A good example is considered to be women professional athletes who have an insufficient amount of fatty tissue, which leads to the cessation of menstruation and the impossibility of conceiving a child. Another example is women suffering from anorexia (lack of appetite, refusal to eat, exhaustion of the body). Menstruation stops at a weight of 40-45 kg.

Excess body weight, leading to obesity, also causes menstrual irregularities. A large layer of fatty tissue accumulates excess amounts of estrogen, which inhibits the onset of cyclic menstrual bleeding. We are not talking about a few extra kilograms, but about the pathology of the endocrine system with a weight of more than 100 kg.

Stress and physical activity

Severe emotional shock or chronic stress causes inhibition of the cerebral cortex, which, in turn, slows down the production of regulatory hormones of the pituitary gland and hypothalamus. This leads to disruption of the menstrual cycle and delay of menstruation. The same situation occurs with constant excessive physical activity - hard work or sports training. Regular physical overexertion is perceived by a woman’s body as a stressful situation that is not favorable for procreation. Therefore, the menstrual cycle stops until better times come.

Climate change

In the modern world, people travel a lot and can get to another country in a few hours. When quickly moving between countries and continents with different climates, the acclimatization process is disrupted. The body does not have time to adapt to new environmental conditions, which is perceived as a life-threatening situation. The brain inhibits the functioning of the sex glands and stops the menstrual cycle. A delay in menstruation due to a sharp change in climatic zones is a physiological process. Menstruation appears after the acclimatization process.

Heredity

A hereditary factor may influence irregular menstrual cycles. If in the female line (grandmother, mother, sister) there were episodes of delayed menstruation for no apparent reason, then the woman has a high probability of inheriting a physiological feature in the deviation of the cyclicity of menstruation.

Intoxication of the body

Poisoning of a woman’s body leads to disruption of the functioning of all organs and systems, including the reproductive system. The cerebral cortex perceives intoxication as a dangerous factor for the normal intrauterine system and suspends the menstrual cycle. Poisoning can be acute and chronic, domestic and professional. Intoxication of the body is caused by alcohol, drug, nicotine addiction, work in production with harmful working conditions, and living in environmentally unfavorable areas.

Taking medications

The need for long-term use of medications of certain pharmacological groups causes menstrual irregularities. In the case of short courses of therapy, a delay in menstruation occurs due to an incorrectly selected daily dosage.

Medicines that can cause a delay in menstruation:

anabolics;
antidepressants;
antituberculosis drugs;
diuretics;
contraceptives.

Prescription of contraceptives often causes menstrual irregularities after discontinuation of the drugs. While taking hormonal pills that protect against unwanted pregnancy, the menstrual cycle is regulated artificially by chemicals. Under such conditions, the controlling work of the cerebral cortex, pituitary gland and hypothalamus on the function of the uterus and ovaries temporarily fades away. After discontinuation of contraceptives, time is needed to restore physiological processes in the cerebral cortex. Menstruation usually acquires regular cyclicity within 1-2 months.);

venereal diseases;

period of puberty (the formation of cyclical menstruation within 6-12 months);

spontaneous and medical abortion, artificial birth;

postpartum period;

corpus luteum cyst;

taking hormonal contraceptives.

A separate group includes menopause and endocrine disease - polycystic ovary syndrome.

Climax

Menopause (menopause) is the extinction of the sex glands in a woman and the cessation of the childbearing period. After the onset of menopause, the menstrual cycle stops. Functional changes occur in a woman’s body, which primarily affect the genital area.

Menopause is divided into 3 periods:

premenopause - begins at age 45, regular periods can be combined with an irregular menstrual cycle;
menopause - begins at the age of 50, periods of a normal menstrual cycle and absence of menstruation for several months are observed;
postmenopause – begins at age 55, characterized by the cessation of the menstrual cycle.

During menopause, hormonal changes occur and insufficient amounts of female sex hormones are synthesized to maintain the menstrual cycle and reproductive function.

Polycystic ovary syndrome (PCOS)

PCOS is an endocrine disease that is accompanied by insulin resistance and increased production of androgens (male sex hormones) in a woman’s body. As a result, numerous cysts form in the ovaries, which leads to disruption of their function. In addition to delay or cessation of the menstrual cycle, excessive hair growth of the skin according to the male type, obesity, and infertility are characteristic. Taking sex hormones normalizes the functioning of the ovaries and restores the cyclicity of menstruation.

If your period is delayed for more than 5 days and the pregnancy test is negative, you must contact a gynecologist to identify the cause of menstrual irregularities and prescribe adequate treatment. Timely qualified assistance prevents the development of complications, including infertility.

The normal functioning of the female body involves monthly discharge - menstruation. This indicates that the woman is healthy and capable of conceiving and bearing a baby. It happens that there is no menstruation. Why don't I get my period even if pregnancy is ruled out? There are many reasons.

Features of a woman's body

The onset of puberty occurs during adolescence. The formation of menstrual function in girls is characterized by irregular periods for a year or two. After this time, menstruation stabilizes and is present throughout a woman’s life until menopause.

The absence of menstruation is typical during pregnancy. Over the course of 9 months, there is normally no discharge at all.

The regularity of menstruation is influenced by many factors - from the individual characteristics of the body to external influences. Frequent delays are a reason to consult a doctor.

Why don't I get my period?

The countdown of the menstrual cycle begins on the first day of menstruation. Normally, it lasts 28 days (plus or minus 5-7 days, everything is individual here). Thus, there is no cause for concern if its duration is from 21 to 35 days. And yet, the more serious factor is not the duration of the cycle, but its regularity.

So what is the menstrual cycle? In its first half, preparation for or maturation of the egg occurs. Progesterone is produced, which is necessary for the fertilization of the female cell and its penetration into the uterine mucosa. If conception has occurred, then the absence of menstruation is the norm, which will last until delivery or the end of breastfeeding.

If fertilization does not occur, the amount of progesterone decreases, the uterine mucosa is gradually torn away from the uterine walls and comes out. This is menstruation.

The reasons why menstruation does not come for a long time should be determined by a doctor.

The main reasons for the absence of menstruation

Pregnancy

The most common reason for the absence of menstruation in women of reproductive age is still pregnancy. The resulting conception leads to the fact that the body’s functioning is restructured, and the hormonal background changes. Everything is set up for pregnancy, so there is no menstruation.

The symptom of all such diseases is not only amenorrhea. You should pay attention to pain in the lower abdomen that is uncharacteristic of the normal condition, and discharge between periods. If they are present, a visit to the doctor is necessary.

The beginning of menopause

The onset of menopause occurs after 40 years of age. Although there is a concept of early menopause (after 30-35 years). This period is characterized by the decline of reproductive function. Ovulations become irregular, hormonal levels are rearranged, the cycle changes - and these are also the reasons why periods do not go on time.

Abortion

Abortion is performed by mechanical curettage of the uterine cavity. There may be excessive tissue removal, resulting in post-procedure recovery time that may take longer than during a normal menstrual cycle. Therefore, menstruation may begin 40 or more days after the abortion.

Prevention measures

Necessary:

lead a healthy lifestyle and eliminate all bad habits;
when playing sports, avoid overload;
eat right: the diet should be balanced, the products should contain the necessary amount of vitamins and nutrients;
not to starve;
take medications only as prescribed by a doctor;
visit a gynecologist twice a year, even in the absence of any visible abnormalities.

It is worth remembering that a regular menstrual cycle, no delays, and careful attention to your body are the key to women’s health.

Video about the reasons for the delay

When consulting women, an obstetrician-gynecologist often encounters the complaint of “delayed menstruation.” In this case, the patient has concerns and natural questions: “Is everything okay? What if I’m pregnant? Does this happen to others? Am I healthy?” Let's talk about the reasons for this condition, which can be different.

A little physiology

The menstrual cycle is the monthly changes in the female body that occur under the influence of sex hormones. The main sign of a normal cycle (its duration is 21-35 days) is considered to be regular bloody discharge from the genitals, the normal duration of which is 3-7 days. Normal blood loss during menstruation does not exceed 50-100 ml.

Menstrual function is regulated through the joint activity of a complex complex of nervous and humoral structures (cerebral cortex; hypothalamus and pituitary gland - endocrine glands located in the brain), as well as genital organs (ovaries, uterus). Since all levels of this system are interconnected, a delay in the next menstruation may be associated with a disruption in the functioning of any of the listed links. Therefore, the cause of delayed menstruation can be a “breakdown” at any level of regulation of the menstrual cycle.

Causes of delayed menstruation

Delayed periods may be caused by various gynecological diseases, such as the uterus (salpingoophoritis), uterus (benign tumor of the uterus) and others. However, it should be noted that with these diseases bleeding from the uterus is more often observed.

Periodic delays in menstruation are characteristic of a disease such as polycystic ovary syndrome (PCOS). This concept combines a number of pathological processes in which the production of hormones is disrupted. In this case, ovulation (the release of an egg from the ovary) does not occur in the body and infertility occurs.

PCOS is observed when the function of various organs is impaired: the hypothalamus, pituitary gland, adrenal glands, and the ovaries themselves. Therefore, the disease can manifest itself differently depending on the causes of its occurrence, and the use of any one diagnostic sign or method is not enough to establish a diagnosis.

With polycystic ovary syndrome, the most common problems are menstrual irregularities (more often - delays from several days to several months), excessive growth of body hair, an increase in the size of the ovaries (but not always), and in half of the patients - obesity. When measured (in the rectum), it remains approximately constant throughout the cycle, and does not increase in the second half, as is normal. In the most severe (primary) form of the disease, these signs appear already in adolescence after the onset of menstruation.

To treat this condition, various hormonal drugs are prescribed, drugs are used that reduce the level of male sex hormones (the formation of which increases with this disease), regulate metabolic processes in the structures of the brain, etc. If present, it is absolutely necessary to reduce body weight. When preparing for a planned pregnancy, an important stage of treatment is to stimulate ovulation - the release of an egg from the ovary. For this purpose, medications are used, and if they are ineffective, surgical treatment methods are used. Currently, it is performed by laparoscopy: small holes are made in the anterior abdominal wall through which optical instruments for examining the abdominal cavity and surgical instruments are inserted.

Delayed menstruation may also occur after termination of pregnancy. The reason is a hormonal imbalance, as well as the fact that during instrumental curettage of the uterus, an excessive amount of tissue can be removed, including that part of the inner lining of the uterus, which normally grows during the menstrual cycle and is released in the form of menstrual blood. To restore this functional layer sometimes takes a little longer than during a normal cycle. That is, after an abortion, menstruation may occur not after 28-32 days, but after 40 days or more. This delay is not normal: the woman requires examination and treatment.

The cause of delayed menstruation may be taking oral contraceptives. While taking the drug or after its withdrawal, absence of menstruation may occur for several menstrual cycles: this is the so-called ovarian hyperinhibition syndrome.

If ovarian hyperinhibition syndrome develops, oral contraceptives are discontinued. As a rule, within 2-3 months, maximum within 6 months after the end of their use, ovarian function is spontaneously restored. If the absence of menstruation persists for a longer period, drugs that stimulate the pituitary gland (CLOMIPHENE) or drugs that stimulate the maturation of the egg and its release from the ovary (PERGONAL, CHORIONIC GONADOTROPIN) are prescribed. Until normal menstrual function is restored, it is necessary to use other methods of contraception.

Stress- long-term or strong short-term - is the cause of a malfunction of the central structures (cerebral cortex, hypothalamus) that regulate the functioning of the ovaries and uterus. An example of such disorders is the so-called wartime amenorrhea, when women stopped menstruating under conditions of stress.

Another reason for a significant delay in menstruation can be significant and rapid weight loss. So, doctors have such a concept as critical menstrual weight - this is the weight at which teenage girls, as a rule, begin to menstruate. However, we are more interested in the fact that with a strong desire to lose weight, having reached this critical menstrual weight (45-47 kg), a woman can get not only the desired result, but also a long delay in menstruation.

Most often this effect occurs when anorexia nervosa- eating disorder, characterized by refusal to eat and/or its rejection. This is accompanied by a disorder in the functioning of such regulatory systems of the body as the nervous and endocrine ones. Anorexia nervosa is characterized by a sharp decrease in the production of pituitary hormones, which also regulate the functioning of the ovaries. In this case, reproductive dysfunction should be considered as a protective reaction in conditions of nutritional deficiency and mental stress. Therefore, to restore age-related hormone secretion, it is necessary to achieve ideal body weight and eliminate mental stress.

Anorexia nervosa in 50% of cases can occur with episodes bulimia(gluttony), after which the patient shows particularly obvious signs of anxiety, remorse and depression, and successful attempts to induce vomiting.

For this reason, when preparing for pregnancy, do not try to achieve the ideal “90 - 60 - 90”. If you are planning to lose weight, treat it wisely, or better yet, consult a nutritionist.

Pregnancy- this, fortunately, is the most common and most physiological cause of delayed menstruation in women of reproductive age. In this case, a delay in menstruation may be accompanied by such signs as changes in taste and olfactory sensations, engorgement, and soreness of the mammary glands. As a rule, a pregnancy test in this case gives a positive result. Delayed menstruation also occurs during ectopic pregnancy, when the fertilized egg attaches to the fallopian tube. In this case, all subjective sensations characteristic of pregnancy may also be present.

What can the doctor do?

In case of menstrual irregularities, you should immediately consult a doctor. An examination by an obstetrician-gynecologist will help rule out conditions that require immediate surgical intervention. This could be an ectopic pregnancy, frozen pregnancy, tumor diseases, etc.

To understand the cause of menstrual irregularities, the doctor may prescribe additional examinations:

measuring basal temperature and charting its changes- these measurements, along with other methods, make it possible to judge the presence or absence of such an event as ovulation - the release of an egg from the ovary;
Ultrasound of the pelvic organs- uterus, ovaries;
blood test for hormones- with its help, the level of hormones of the pituitary gland, ovaries, and, if necessary, other endocrine glands is determined;
computed or magnetic resonance imaging- methods that can be used to obtain layer-by-layer images of brain structures to exclude pituitary tumors.

If there are concomitant endocrine diseases, the gynecologist will prescribe a consultation with other doctors - an endocrinologist, a psychotherapist, a nutritionist.

Ildar Zainullin
obstetrician-gynecologist, Ufa

Normally, the menstrual cycle lasts from 21 to 35 days. For each woman, its duration is individual, but for most of them, the intervals between menstruation are equal or differ from each other by no more than 5 days. You should always mark the day your menstrual bleeding begins on your calendar so that you can spot cycle irregularities in time.

Often, after stress, illness, intense physical activity, or climate change, a woman experiences a slight delay in menstruation. In other cases, this sign indicates pregnancy or hormonal disorders. We will describe the main reasons for delayed periods and the mechanism of their development, and also talk about what to do in such a situation.

Amenorrhea

In the medical world, a delay or absence of menstruation is called. It is divided into two categories:

Primary amenorrhea. This is a condition in which a girl has not started her period by the age of 16. Often primary amenorrhea is associated with the presence of congenital disorders that did not manifest themselves in any way until the onset of puberty. These are, for example, genetic or chromosomal abnormalities, problems with the organs of the reproductive system, etc. These may include being born without a uterus, or a uterus that does not develop normally.
Secondary amenorrhea. This is a condition in which periods suddenly stop and are absent for more than three months. Those. I used to have periods, but now they are absent. Secondary amenorrhea is the most common form of missed period. The most common causes of this condition are pregnancy, problems with the ovaries (for example, polycystic ovary syndrome or early menopause), pituitary tumors, stress, serious violations of normal body weight (both smaller and larger), and others.

In addition to amenorrhea, there is another medical term that I want to introduce you to - oligomenorrhea. This is a disorder in which the duration of the menstrual cycle significantly increases and the duration of menstruation itself decreases. It is generally accepted that a woman has oligomenorrhea if during the year she had periods less than 8 times and/or lasted up to 2 days or less.

Normal course of menstruation cycles

The normal menstrual cycle occurs at 10-15 years of age in a young woman, after which the body is considered to have entered a phase where it can perform full-fledged conception. This system works every month up to 46-52 years of age, but this is an average figure. (There are cases of later cessation of menstruation.)

Then there is a decrease in the duration of menstruation and the amount of blood released during this process. Eventually, menstruation stops completely.

Reasons for delayed menstruation other than pregnancy

A delay in menstruation can be the result of physiological changes in the body, as well as be a manifestation of functional failures or diseases of both the genital and other organs (“extragenital pathology”).

Normally, menstruation does not occur during pregnancy. After childbirth, the mother’s cycle is also not restored immediately; this largely depends on whether the woman is lactating. In women without pregnancy, an increase in cycle length may be a manifestation of perimenopause (menopause). Irregularity of the cycle in girls after the start of menstruation is also considered normal, if it is not accompanied by other disorders.

Functional disorders that can provoke disruption of the menstrual cycle are stress, intense physical activity, rapid weight loss, previous infection or other acute disease, climate change.

Often, an irregular cycle with a delay in menstruation occurs in patients suffering from gynecological diseases, primarily polycystic ovary syndrome. In addition, such a symptom can accompany inflammatory diseases of the reproductive organs, occur after termination of pregnancy or diagnostic curettage, after hysteroscopy. Ovarian dysfunction may be caused by pathology of the pituitary gland and other organs that regulate a woman’s hormonal levels.

Among the somatic diseases accompanied by possible menstrual irregularities, it is worth noting obesity.

List of reasons that may cause a delay in menstruation

A delay of 2 to 5 days in the “red days of the calendar” should not be a cause for concern, since this is considered a very real phenomenon for every woman. If pregnancy is excluded, then such disorders of the female body can be caused by many factors. Their careful analysis allows us to determine the cause of a gynecological or non-gynecological nature.

So, we list the top 15 reasons for missed periods:

Inflammatory diseases;
Hormonal contraceptives;
Diagnosis of the uterine cavity, abortion or miscarriage;
The period after childbirth;
Puberty;
Menopausal disorders;
Great physical activity;
Stressful conditions;
Environmental climatic conditions;
Body weight abnormalities;
Intoxication of the body;
Taking certain medications;
Hereditary predisposition.

As follows from all of the above, the reasons for regularly recurring delays of critical days are multifaceted. Biological clocks can go wrong even in nulliparous women, who often confuse the symptoms of menstrual irregularities with pregnancy. An inconsistent menstrual cycle should not be considered a particularly dangerous, serious illness, but it is still worth paying close attention to the frequency of your critical days.

Stress and physical activity

The most common causes of missed periods, besides pregnancy, are various nervous tensions, stress, and the like. Difficult work environment, exams, family problems - all this can cause a delay. A woman’s body perceives stress as a difficult life situation in which a woman should not give birth yet. It is worth taking care of changing the situation: contact a family psychologist, change jobs, or learn to relate to the situation more simply, and the like. Keep in mind that overwork and lack of sleep are also very stressful for the body.

Excessive exercise also does not contribute to the regularity of the menstrual cycle. It is known that professional athletes often experience problems with delayed periods and even with childbearing. The same problems plague women who take on physically demanding jobs. It's better left to men.

But don’t think that moderate exercise or morning jogging can affect the situation. An active lifestyle has never bothered anyone. We are talking specifically about excessive loads under which the body works for wear and tear.

Weight problems

Scientists have long found out that adipose tissue is directly involved in all hormonal processes. In this regard, it is easy to understand that the reasons for a delay in menstruation, in addition to pregnancy, may also lie in weight problems. Moreover, both excess and lack of weight can provoke a delay.

If you are overweight, the fat layer will accumulate estrogen, which negatively affects the regularity of your cycle. With underweight, everything is much more complicated. Prolonged fasting, as well as weight loss below 45 kg, is perceived by the body as an extreme situation. Survival mode turns on, and in this state pregnancy is highly undesirable. In this case, not only a delay in menstruation is possible, but also its complete absence - amenorrhea. Naturally, problems with menstruation disappear with normalization of weight.

That is, plump women need to lose weight, thin women need to gain weight. The main thing is that this must be done extremely carefully. A woman’s diet should be balanced: the food should contain proteins, fats, carbohydrates, as well as vitamins and microelements. Any diet should be moderate and not debilitating. It is better to combine them with moderate physical activity.

Inflammatory diseases of the uterus

Inflammatory diseases of the uterus and ovaries lead to disruption of the production of hormones that are responsible for the processes of maturation of eggs, follicles, and endometrium. As a result, they are often the cause of delay. At the same time, the volume and nature of the discharge changes, pain appears in the lower abdomen, lower back, and other symptoms.

Often, inflammatory processes are the cause of infertility, tumors of the reproductive system, and mammary glands. Inflammatory diseases occur due to infection due to improper hygienic care of the genitals, unprotected sexual intercourse, traumatic damage to the uterus during childbirth, abortion, and curettage.

Uterine fibroids

Menstruation with uterine leiomyoma can be irregular, with a delay ranging from several days to several months. Despite the fact that this pathology is in most cases considered a benign tumor, there are a number of negative consequences that it can lead to. And first of all, its degeneration into cancer is dangerous. Therefore, seeing a doctor at the slightest suspicion of fibroids is extremely necessary.

Polycystic ovary syndrome

One of the main reasons for menstruation to lag behind the usual schedule in this case is the lack of the required amount of hormones.

As a rule, the process is caused by the lack of ovulation, suppression of the endometrium, as well as existing hormonal disorders. The egg does not mature in this process, which gives the body a signal that there is no need to prepare for possible fertilization.

Endometriosis

This disease is a pathological proliferation of benign tissue, which is similar to the mucous membrane of the reproductive organ. The development of endometriosis can occur in various parts of the reproductive system, and it is also possible to go beyond it. Changes in hormonal levels can be both the cause of the disease and its consequence. Irregular periods are also one of the main symptoms of such abnormalities.

Birth control pills

If you are taking hormonal birth control pills, it is possible that your menstrual cycle will be significantly different from normal. Very often, the duration of cycles when taking birth control pills increases significantly. Some pills do not have this effect. Menstruation occurs as usual, but most often it is lighter and shorter. It is also worth noting that in very rare cases the pill may not prevent pregnancy, especially if it is missed. However, even if you took the pills accurately and correctly, if your period is late and you are worried about it, you can take a pregnancy test to calm down.

Nowadays you can find a fairly large number of different birth control pills on sale. Some of them may differ significantly in their effects on the body. In addition, it is worth noting that each individual woman can react differently to the same pills.

Also, keep in mind that when you stop using birth control pills, you may not have a normal menstrual cycle right away. For most women, the recovery period takes from one to two months, and sometimes this period can last up to six months. Only then will you be able to conceive a child again. Accordingly, during the recovery period you may also have an irregular cycle, and this must be taken into account if you have a delay.

Delayed menstruation during pregnancy and after childbirth

During the entire period of pregnancy, a woman does not have periods. After childbirth, their resumption occurs in different ways - it all depends on the individual characteristics of the body. Elevated prolactin levels when breastfeeding can prevent eggs from starting to function. If a woman is breastfeeding, a delay in menstruation may last as long as milk is produced (this directly depends on the level of the hormone prolactin, which is responsible for lactation). Sometimes this can happen within 2-3 years.

If milk is not produced, another period will occur in about 6-8 weeks. But sometimes there are exceptions when the ovaries begin to work even before the baby stops feeding, the egg matures, and the woman can become pregnant again. If this does not happen, the new cycle ends with the appearance of menstruation.

Why are constant delays in menstruation dangerous?

Constant delays in menstruation indicate hormonal disorders, lack of ovulation, and abnormal changes in the structure of the endometrium. Pathology can arise due to serious, even dangerous diseases: tumors of the uterus, endocrine glands, polycystic ovaries. The cause of a missed period is an ectopic pregnancy.

It is necessary to establish a diagnosis as early as possible, to find out the degree of danger of the processes, since they lead, at a minimum, to infertility and early menopause. Diseases associated with delayed menstruation cause breast tumors, cardiovascular problems, diabetes, weakened immunity, premature aging, and changes in appearance. For example, if the delay occurs due to polycystic ovary syndrome, then the woman experiences a sharp increase in weight, up to obesity, hair appears on the face and chest (as in men), acne, and seborrhea.

Timely treatment of diseases that cause prolongation of the cycle often helps to avoid infertility, ectopic pregnancy, miscarriage, and prevent the appearance of cancer.

Examinations for delayed menstruation

To find out the reasons for the delay in menstruation, the following studies are prescribed:

Examination for sexually transmitted diseases (gonorrhea, chlamydia, trichomoniasis, mycoplasmosis, ureaplasmosis, etc.).
Ultrasound of the pelvic organs, thyroid gland and adrenal glands. This study is carried out to exclude pregnancy, tumors, gynecological and endocrine diseases.
Examination of the pituitary gland (radiography, magnetic resonance imaging, computed tomography, electroencephalography). Diseases of the pituitary gland are quite often the cause of delayed menstruation.
Hormonal studies. The levels of estrogen, progesterone, FSH, LH, PRL are determined, as well as thyroid and adrenal hormones.
Curettage of the inner layer of the uterus and its further histological examination. Curettage is performed from the cavity and canal of the cervix.

What to do if your period is late?

If you experience regularly recurring delays in menstruation or the period of delay exceeds the maximum permissible physiological limits of five days, you should consult a doctor. After determining the reasons, the woman will be prescribed appropriate treatment. Most often, therapy is carried out using hormonal pills. However, under no circumstances should they be taken independently, without medical advice. This is extremely dangerous for a woman’s health and can disrupt the entire hormonal system, which means it can lead to serious health problems.

Among the most common hormonal drugs, doctors prescribe the following:

Duphaston. Used if a delay in the menstrual cycle is caused by insufficient levels of progesterone in the body. Only a doctor should adjust the dose based on the research conducted. If there is no pregnancy and the delay does not exceed 7 days, then postinor is prescribed for a period of 5 days. After this time, menstruation should begin two or three days later.
Postinor. It is a drug used for emergency contraception. This remedy is used if it is necessary to induce a menstrual cycle as quickly as possible. However, it is recommended only for regular menstruation, since its use can cause cycle disorders, and if used very frequently, lead to infertility.
Pulsatilla. Another hormonal drug that can be prescribed for delayed menstruation. This is the safest remedy that does not lead to weight gain and does not affect the nervous system. However, it should not be taken by girls with irregular cycles.
Progesterone is an injectable hormone. Used to induce menstruation, dosage selection is carried out strictly individually. An increased intake of progesterone in the body can cause a lot of side effects, including excess hair growth, weight gain, and menstrual irregularities. More than 10 injections are never given. The effect is based on stimulating the work of the glands located in the mucous membrane of the uterus. The drug has a number of contraindications, including: uterine bleeding, liver failure, breast tumors, etc.
Non-ovlon, a drug that stimulates the onset of the menstrual cycle, is able to prevent acyclic bleeding. It contains estrogen and gestagen. Most often, if there is a delay, two tablets are prescribed every 12 hours. However, before using it, it is mandatory to consult a specialist, since the drug has side effects and can disrupt the functioning of the reproductive organs.
Utrozhestan. It is a drug that suppresses estrogen and stimulates the production of progesterone, which determines its therapeutic effect. In addition, it has a stimulating effect on the development of the endometrium. The drug can be administered vaginally, which is its undoubted advantage, however, this drug also has some contraindications.
Norkolut, causes menstruation, as it contains norethisterone, which in its action is similar to the action of gestagens. And their lack often provokes failures in cycles and their delay. The course of treatment should not exceed five days; it is not used during pregnancy, as it risks miscarriage and bleeding. It has a large number of contraindications and side effects, so a preliminary consultation with a doctor is necessary.

Naturally, the use of hormonal drugs to induce menstruation is not a safe method. They must be taken correctly, as they can cause irreparable harm to health.

Regular menstruation is a sign of the health of the female body, an indicator that a woman is ready and capable of conception, pregnancy, and childbirth. This is why the absence of menstruation is always a warning sign. Long-term (6 months or more) absence of menstruation. There are many reasons for its occurrence, so it is important to consult a doctor in a timely manner to determine the cause of amenorrhea and begin the necessary treatment.

All reasons for the absence of menstruation are divided into two groups: physiological (natural conditions of the reproductive system) and pathological (caused by any disease of the reproductive sphere or other organs).

Physiological reasons

The regulation of the menstrual cycle is based on a hierarchical process control system. The central link is the cerebral cortex, hypothalamus and pituitary gland, which receives signals from the peripheral link - the ovaries and other target organs for sex hormones (adrenal glands, thyroid gland, uterus, mammary glands).

Pregnancy

When pregnancy occurs, progesterone is actively released. It has a suppressive effect on the production of hormones that trigger the menstrual cycle.

Lactation

Prolactin and oxytocin are the two main lactation hormones. Prolactin promotes milk production and is secreted by the pituitary gland. It plays a major role in inhibiting ovulation. Some people experience a lack of regular periods for 2 months or a little more, and for some women the entire breastfeeding period.

Climax

Menopause occurs in the life of every woman. This is a normal, natural stage of aging. During this period, reproductive function declines and, as a result, the activity of the gonads gradually decreases until complete extinction. This process causes amenorrhea after menopause.

Pathological causes

There are many pathological causes of amenorrhea. They are divided into primary and secondary. Primary causes can be true or false.

Primary amenorrhea

Primary amenorrhea is considered when menstruation does not occur in girls 14 years of age who do not have secondary sexual characteristics: development of the mammary glands, body features and female-type hair growth. Or secondary signs are developed, but girls 16 years old do not have periods.

It is worth considering the fact that adolescents' cycles may be irregular.

In this case, for example, the following picture is observed: no menstruation 3 months after the onset of menarche (first menstruation). The described situation is not primary amenorrhea.

False amenorrhea

In this case, cyclic changes occur in the organs of the reproductive system, characteristic of a normal cycle, but there is no shedding of blood from the vagina. The reasons for this may include the following conditions:

infection or synechia of the vagina;
fusion of the cervical canal;
continuous hymen;
uterine obstruction.

Symptoms of false amenorrhea are as follows:

cyclical nagging pain in the lower abdomen caused by stretching of the uterus with blood;
absence of menstruation;
with large volumes of blood, a surgical emergency occurs - acute abdomen with severe pain;
normal development of secondary sexual characteristics;
characteristic visible features during a gynecological examination.

True amenorrhea

With true amenorrhea, cyclic changes in the reproductive system in the body do not occur. The regulatory connection between the brain, gonads and uterus is disrupted. The main reasons may be the following conditions and processes:

chromosomal abnormalities;
congenital adrenal hyperplasia;
delayed menarche;
abnormalities of the uterus and/or ovaries;
chemotherapy and/or radiation therapy in childhood;
removal of the uterus and/or ovaries in childhood (for example, due to trauma).

The main symptoms of true amenorrhea:

absence of secondary sexual characteristics;
short stature;
characteristic features for a specific chromosomal pathology syndrome;
infantile (children's) genitals;
dryness of the vaginal mucous membranes;
hair fragility.

Secondary amenorrhea

In this type, there is no menstrual flow for 6 months or more, but the woman previously had regular or irregular periods.

The main reasons provoking secondary amenorrhea may be the following conditions:

eating disorders;
discontinuation of oral contraceptives;
postpartum pathology of the pituitary gland;
endocrine pathology;
inflammatory diseases of the reproductive system.

Why have I not had my period for a long time?

Long-term absence of menstruation can be, as previously mentioned, primary or secondary.

Primary amenorrhea

Primary amenorrhea is difficult to correct, since it is most often caused by genetic changes.

Turner syndrome

Turner-Shershevsky syndrome refers to abnormalities of the chromosome set. There are three forms of the disease. In most cases, the second X chromosome is missing; in the mixed form, the Y chromosome may be present, and a mosaic type of pathology also occurs.

The characteristic features of the disease are the following:

underdevelopment of the genital organs;
short stature;
winged neck;
low hair growth;
never had a period;
secondary sexual characteristics are poorly expressed;
the ovaries are in the form of cords, the uterus is small, the endometrium is thin.

Anomalies of the uterus and ovaries

The most common developmental anomaly is uterine atresia in combination with the absence of the vagina. At the same time, there are ovaries, and, accordingly, secondary sexual characteristics develop according to age.

Delayed menarche

A delay in the onset of the first menstruation may occur in girls of northern peoples. This is a constitutional national feature. Development is not affected, and therefore prolonged absence of menstruation cannot be treated in this case. In addition, delayed onset of menarche may occur as a result of mental retardation in girls with organic brain pathology.

Congenital adrenal hyperplasia

With this pathology, there is a proliferation of adrenal tissue, excessive formation of glucocorticosteroids, which have a depressing effect on the hypothalamic-pituitary system. The disease is characterized by the following features:

absence of true menstruation;
obesity;
stretch marks on the hips, abdomen;
moon-shaped face;
excessive male pattern hair;
high blood pressure;
violation of water-salt metabolism.

Secondary amenorrhea

Much easier to deal with. It is necessary to find out the reason that caused the cessation of menstruation, eliminate it, and the cycle will be restored.

Stress

Various stressful conditions, be it a single impact (death of a loved one) or constant depression, disrupt the central link in the regulation of the menstrual cycle. The cerebral cortex stops sending impulses to the hypothalamus, and menstruation is delayed.

Drastic weight loss

When following a strict diet that causes sharp weight loss and a deficiency of various substances, the release of hormones by the hypothalamus is gradually inhibited. For this reason, the pituitary gland does not receive signals for the formation of follicle-stimulating hormone.

In addition, do not forget that the synthesis of sex hormones partially occurs in the cells of adipose tissue. A decrease in lipid levels can therefore result in hormonal imbalance.

Postpartum amenorrhea

Amenorrhea after childbirth can result from damage to the pituitary gland after a difficult birth accompanied by massive bleeding. Due to poor circulation, necrosis of the pituitary gland occurs. Depending on the degree of organ damage, patients experience not only a lack of menstruation, but also other symptoms:

hair loss;
weight loss;
memory loss;
weakness and chilliness;
hypotrophy of the mammary glands and genital organs.

Cancellation of oral contraceptives

After discontinuation of second generation oral contraceptives, ovarian hyperinhibition syndrome occurs. Moreover, against the background of long-term use of COCs, persistent inhibition of the hypothalamic-pituitary structure and gonads develops. After a few months, menstruation returns on its own.

Endocrine pathology

With an excess or deficiency of thyroid hormones, the main cause of amenorrhea lies in the suppression of the pituitary gland and, as a consequence, a decrease in hormone production. In diabetes mellitus, excess blood insulin has a suppressive effect on the ovaries.

Inflammatory diseases of the reproductive system

With salpingitis, oophoritis, meningitis and encephalitis, the hormone-producing function of the affected organs decreases due to the pronounced inflammation process. Amenorrhea can last for a long period until the pathological process completely subsides.

Resistant ovarian syndrome

In this case, the ovarian tissue becomes insensitive to pituitary hormones. The cause may be a genetic abnormality. Women's first menstruation comes on time, gradually they come less often, and by the age of 35 they stop completely. Pregnancies occur very rarely. Unlike early menopause (up to 40 years), with resistance there will be no hot flashes and other manifestations of the menopause.

Risk factors

Risk factors for the development of amenorrhea may include the following conditions:

stress;
excessive physical activity (especially among professional athletes);
eating disorders (both starvation and overeating);
frequent inflammatory diseases of the genital organs;
micro- and macroadenomas of the pituitary gland (in which hyperprolactinemia is observed, which inhibits ovulation);
frequent trauma to the mucous membrane of the genital tract during abortions and diagnostic curettages.

Diagnostics

Due to the fact that the reasons for the absence of menstruation are diverse, their diagnostic search is quite extensive. When a patient contacts a gynecologist, a thorough questioning is first carried out to identify the provoking factor. Then a general examination and examination on a gynecological chair are shown. Additionally, other diagnostic methods are used.

Pregnancy test

If your period is more than a week late, you should take a simple pregnancy test. During pregnancy, the hormone hCG (human chorionic gonadotropin) is produced, which is determined by dipping a test strip into a container of urine. The test is informative and sensitive.

Prolactin

As is known, increased levels of prolactin have a depressing effect on the ovulatory function of the ovaries. To determine its level, venous blood is taken in the morning. Normally, prolactin levels should not exceed 23 ng/ml.

Progesterone test

To carry it out, a gestagen (progesterone) is used. Using this test, the hormonal activity of the gonads and the possibility of blood outflow are determined. The test is positive for bleeding that occurs within a week while taking progesterone. This confirms the presence of the uterus, ovaries and free flow of blood.

Ultrasound of the pelvic organs

It can be performed either abdominally (through the abdomen) or transvaginally (by inserting a special sensor into the vagina). Ultrasound allows you to visualize the internal genital organs and assess their condition, size, determine whether pathological changes are absent or present.

X-ray of the sella turcica

A survey X-ray of the skull is performed, and the sella turcica, where the pituitary gland is located, is clearly visible. Changes in this structure may indicate pathology of the pituitary gland.

Assessing the condition of the endometrium

This is done using ultrasound or hysteroscopy. Its presence, structure, thickness are assessed depending on the phase of the menstrual cycle.

Computed and magnetic resonance imaging

This diagnostic method allows you to visualize with great accuracy the structure of the genital organs and brain, including the hypothalamus and pituitary gland.

Treatment

Aimed at restoring a woman’s reproductive ability or the appearance and regulation of the menstrual cycle. Depending on the cause, therapy can be of the following types:

hormone replacement therapy (use of estrogen);
stabilization of body weight;
surgical correction for developmental anomalies;
the use of drugs that reduce the level of prolactin in the blood;
surgery for pituitary tumors;
stabilization of thyroid hormones, blood sugar levels;
antimicrobial therapy for inflammatory processes.

A gynecologist will help you answer the question: why have you not had your period for a long time? Only a competent examination and adequate timely treatment will help a woman or girl restore reproductive function.

httpss://youtu.be/WfFQ7JucrX8?t=9s