photo by greenchartreuse

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.

Dear Dr. Vanessa,

I haven’t had my period since August of 2008. I’m 21 and am not sexually active (I’ve never had sex) but I do “play” with myself every once in a while. Anyway, I was wondering what types of factors could be causing me to not have my periods?

— Grammatically Incorrect

Dear G.I.,

Many factors can cause amenorrhea — the medical term for the absence of menstruation. It’s helpful to know that you’re not sexually active so we can rule out pregnancy, the most common cause of missed periods. (You shouldn’t worry about masturbating — it has no role in whether or not a woman gets her period.)

Nearly every woman misses a few menstrual periods in her lifetime due to stress and illness. They can temporarily disrupt hormone levels, so one or two missed periods is usually nothing to worry about. When a woman becomes less stressed or recovers from an illness, her period usually returns to normal. Prolonged stress or illness can also lead to prolonged amenorrhea. The physical stress on the body from anorexia nervosa, strenuous exercise, or severe weight loss, for example, can keep a part of the brain called the hypothalamus from working properly. That can throw off your body’s levels of estrogen and progesterone, two hormones that are needed for normal menstrual cycles.

Polycystic ovary syndrome (PCOS) is another condition that can cause amenorrhea. Women who have polycystic ovary syndrome do not have normally fluctuating hormone levels, so they may not get their period regularly. Other possible causes of amenorrhea are low hormone production by the thyroid gland; structural abnormalities in the uterus or other reproductive organs; problems with the endometrium (the lining of the uterus), pituitary gland and other tumors; head trauma; shock following blood loss; menopause or premature menopause; and certain medications.

No matter what the cause is, prolonged amenorrhea should be evaluated and treated. Some of the causes of amenorrhea could also cause other health problems. Women who miss three or more periods should see a health care provider to determine the cause and prescribe treatment. You can be assured that there are very good treatments for amenorrhea. So, the best thing to do now is to make an appointment with your health care provider to figure out why you’ve not been having your period.

In the meantime, best wishes for your good sexual health,

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.