There are multiple questions to ask if there’s a change in menstrual cycle

I haven’t had my period in months, should I be worried?

This is a frequent question and often causes a patient to see her OB/Gyn. The menstrual cycle is a fragile axis that is dependent on multiple factors and as such can be thrown off balance by any number of changes in one’s life or health: Exercise, nutrition, weight loss, stress, exogenous hormones, tumors, medications, and finally and most common – pregnancy. Once pregnancy has been ruled out (or ruled in for some), there are a number of questions that need to be addressed to determine the possible cause of Amenorrhea (or the lack of menses).

How long has it been since you last had a period? The menstrual cycle can be momentarily nudged in and out of balance but after 3 to 6 months without menses, one should be seen by their OB/Gyn to determine what may be the cause.

Have you recently lost weight, had changes in your diet, or started a new exercise routine? These can all lead to changes in hormones that signal the Uterus to shed its lining each month and are a common cause for a lack of menses.

Have you had any type of gynecologic procedure performed such as a dilation and curettage? This procedure can sometimes cause scarring that may affect the lining of the Uterus and the natural outflow tract of menstrual blood flow.

Are you breast-feeding or have you recently stopped breastfeeding? Breast-feeding or nipple stimulation is known to increase Prolactin which can cause suppression of the Hypothalamic, Pituitary, ovarian axis which is responsible for regulating the menstrual cycle.

Are you taking any new medications? The most common culprits are hormonal contraceptives, antipsychotic medications, and any medication that may affect the thyroid. Be sure to speak with your doctor before stopping any medications.

Have you had any new or unexplained headaches or vision changes? These may be a sign/symptom of a Pituitary tumor such as a Prolactinoma, which can suppress menstruation and should be addressed immediately as tumors affecting vision can obviously be dangerous.

Do you have any new coarse hair growth, deepening of the voice, or acne? These can be signs of PCOS (polycystic ovarian syndrome) which is a common cause of Amenorrhea (and infertility). This is important to address as it is also commonly associated with insulin resistance and Diabetes, which can have long-term implications for one’s health.

Have you been experiencing hot flashes/flushes, vaginal dryness, sleep disturbances, or changes in mood? This could be a sign of ovarian insufficiency/failure or menopause.

In addition to these questions, a detailed physical exam should be performed and from this, your doctor may recommend additional laboratory or imaging studies to help determine and guide the best course of management for you.