Why Am I Skipping Periods?

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• 0:02Introduction
• 0:24What a normal period is
• 2:42Causes of infrequent periods
• 4:13Stress, exercise and weight
• 5:21Ovary and hormone causes
• 6:30Uterine causes
• 7:36Testing and treatment

Full transcript

1. 0:02Introduction

   Hi, I'm Dr. Taz Varkey. Today I want to talk to you guys a little bit about irregular periods. One of the most common things I see patients for in my office is that their periods are not coming on time. Maybe they're happening too infrequently or they're too heavy. So I want to talk a little bit about why this might be happening.

2. 0:24What a normal period is

   And in particular, today I want to talk about periods that are not coming often enough, so maybe they're two or three months apart or six months apart. What does that mean if you miss a period? So first I need to review very quickly what a normal period is. A normal period is a period that comes approximately 21 to 35 days apart.

3. 0:47

   And if you watched my last video, I taught you a little bit about how you count the days between cycles. So the average cycle length is 28 days, and when I say 21 to 35, I mean that it's coming plus or minus seven days of that length. So that's about average and considered normal if it's in that range. In terms of the amount of bleeding, this is a hard one to judge.

4. 1:11

   Technically, the medical definition is less than 80 cc's of blood per day, but how in the world are you supposed to measure that? If you're a woman, you know that's very hard. So what we do as physicians is we try to guesstimate this by talking to a patient. For example, how often are you changing your protection, if you use a tampon or a pad?

5. 1:34

   If a woman is soaking through a pad every one to two hours or a tampon every one to two hours, that's too heavy. That's normally heavy. If you're in the range of three to four, well, then it's up to the patient whether she thinks it's heavy. Is this an acceptable amount of bleeding to you is what I ask her. And generally the patient's changing it every four hours or less, that's generally considered to be a normal amount of bleeding.

6. 1:56

   But again, if the patient herself thinks that's unacceptably heavy, then we have to have a discussion about that. But in terms of looking for medical problems, I've used that parameter of about every two hours or less in terms of changing your tampons. And then in terms of the duration of a period, how many days is it normal for it to last?

7. 2:20

   Generally we say three to seven days is the normal range. So if you're shorter than three days, it could be a sign of some medical issues, usually not, but it could be. And if it's longer than seven days, again, could be a sign of other medical issues, but not always. So maybe eight days, hey, that's still okay, but if you're nine, ten, twelve days, sometimes we gotta start asking why.

8. 2:42Causes of infrequent periods

   Okay, so what would cause a woman to have her periods occurring irregularly in terms of the timing, which is what I want to focus on today? So let's say a patient comes in and says, "Look, my period used to happen every month and now it's every three months or four months and I don't know why that is." The very first thing a doctor should do is a pregnancy test, right?

9. 3:06

   So anytime your period is changing, whether it's too much bleeding or too little bleeding, pregnancy test, pregnancy test, pregnancy test. You can do them at home. They're very accurate. The ones we do in the office is more accurate, but the ones that you do at home are most often helpful and predictable. If a woman's periods aren't coming regularly and she's not pregnant, then the way I like to explain what the cause could be is to start, I'm going to show you a diagram again, and I kind of categorize it by the anatomy.

10. 3:30

    Okay, so here we go. So I'm going to show you, this is the brain. Here we go, here's your abdomen, right, and then here you have your ovaries, your tubes, your uterus, and then the vagina is down here, and this is where the blood comes up.

11. 3:51

    Okay, so the brain is what sends the signals to the ovaries to tell you to make estrogen and progesterone. I talked about this last video. And the estrogen and progesterone goes to your uterus and causes the bleeding to occur.

12. 4:13Stress, exercise and weight

    So if things happen to keep this signal from being sent down to the ovary, then that can prevent you from getting your period. So what kind of things? If you've gained a lot of weight or lost a lot of weight, that will sometimes keep your body from sending the signal. Excessive stress, excessive exercising.

13. 4:37

    We've all heard about women who are athletes and exercising vigorously, and they will sometimes stop having their period because these signals aren't getting sent to the brain. The body thinks it needs to conserve, in an evolutionary sense. The body is thinking, "Oh, this woman is not ready to become pregnant, so we're not going to allow ovulation."

14. 4:59

    That's the way I think of this. So excessive stress, exercise, weight changes can cause you to stop getting your period. Other things are medications. So birth control pills actually can cause your lining to get so thin that you don't see it anymore. That's not abnormal, it's just kind of a side effect and, honestly, a good one of the birth control pill. It's not dangerous in any way.

15. 5:21Ovary and hormone causes

    Other medications that can stop or change a woman's period: steroids, sometimes thyroid meds, things like that. So that's something your doctor needs to kind of suss out with you individually. At the level of the ovaries here, what could happen here to keep you from getting your periods? Well, if your ovary stop making estrogen and progesterone because let's say you're in perimenopause or menopause, then that's another reason, that's another cause, right?

16. 5:45

    And generally that happens when a woman is in her mid 40s and later, but it can happen earlier. It can happen 40 to 45, sometimes even in a woman's 20s or 30s. And of course, if a woman's under 40 and she goes through menopause, that can be a sign of other medical problems. Definitely needs to be seen by a doctor.

17. 6:08

    We call that primary ovarian insufficiency, so that's premature menopause basically. That needs to be investigated. And then other hormonal abnormalities such as prolactin or thyroid changes. These are two hormones that are actually made initially by the brain or other areas like the thyroid gland, but if those levels get really high, it inhibits ovulation, it keeps you from dropping that egg, so you're not going to see it. So those are some simple tests that can be run.

18. 6:30Uterine causes

    Lastly, down at the level of the uterus. I already mentioned pregnancy as one cause of not seeing regular periods, but another one would be, let's say you've recently had a miscarriage, or a termination, and the doctor had to do a procedure to clean out the uterus.

19. 6:52

    Sometimes that can cause scarring. And if that's the case, if you've just had a procedure like that and suddenly your periods disappear, that's where we'd want to look to see if there's any scarring. The good news is that can be fixed pretty easily through a minor procedure, so don't panic if that's the case.

20. 7:14

    So these are the main reasons that a woman might not see her period coming regularly. There's many more, but these are the most common ones. Probably the last one I wouldn't want to mention at the level of the ovary is one called polycystic ovarian syndrome. It's probably one of the most common causes of irregular periods. It's a very fancy term for it, a hormonal imbalance.

21. 7:36Testing and treatment

    And to be honest, to teach you about it I'd have to do a whole nother video, so I can't cover all that today. But these are just things to get the conversation started with your doctor. In terms of testing, most of it's blood work, sometimes ultrasound. And in terms of treatments, it depends on what the cause is, right? So if it's a hormonal imbalance, we might want to do the birth control pill or other hormonal treatments.

22. 7:58

    But if it's thyroid imbalance, we'd give you thyroid meds. If it's scarring, we do a procedure. Okay, so that's it for today. I hope this was helpful. If you have any questions and you're my patient, please come in to see me or go see your own doctor. Thank you for tuning in, and don't forget to subscribe.