- Stopped or missed periods
- Sudden weight loss
- Being overweight
- Doing too much exercise
- Contraceptive pill
- Polycystic ovary syndrome (PCOS)
- Referral to a consultant
- Treating underlying conditions
- Depression, amenorrhea, and why your periods have stopped
- What’s the link between depression and amenorrhea?
- Can antidepressants affect your menstrual cycle?
- How do you resolve amenorrhea linked to depression?
- Does amenorrhea have any long term effects?
- Can Anxiety Affect Your Period?
- Can Stress Cause Irregular Periods?
- How Long Can Stress Delay Your Period?
- How to Avoid Stress
- Take Care of Your Body
- Have a Regular Exercise Routine
- Get Plenty of Sleep
- Reduce (or Eliminate) Caffeine
- Talk to a counselor
- Problems With Your Period? Contact Us Today
Stopped or missed periods
There are many reasons why a woman may miss her period, or why periods might stop altogether.
Most women have a period every 28 days or so, but it's common to have a slightly shorter or longer cycle than this (from 21 to 40 days).
Some women do not always have a regular menstrual cycle. Their period may be early or late, and how long it lasts and how heavy it is may vary each time.
Read more about irregular periods and heavy periods.
There are a number of reasons why your periods can stop. The most common reasons are:
Periods can also sometimes stop as a result of a medical condition, such as heart disease, uncontrolled diabetes, an overactive thyroid, or premature menopause.
You might be pregnant if you're sexually active and your period is late. Pregnancy is a common reason why periods unexpectedly stop. It can sometimes happen if the contraception you're using fails.
It might be that your period is simply late, so you could wait a few days to see if it arrives. If it does not arrive, you can do a pregnancy test to confirm whether or not you're pregnant.
It's important to be aware that you can get pregnant in the days after your period is normally due. This can happen if the release of an egg (ovulation) is delayed – for example, as a result of illness or stress.
If you're stressed, your menstrual cycle can become longer or shorter, your periods may stop altogether, or they might become more painful.
Try to avoid becoming stressed by making sure you have time to relax. Regular exercise, such as running, swimming and yoga, can help you relax. Breathing exercises can also help.
If you're finding it hard to cope with stress, cognitive behavioural therapy (CBT) may be recommended. CBT is a talking therapy that can help you manage your problems by changing the way you think and act.
Sudden weight loss
Excessive or sudden weight loss can cause your periods to stop. Severely restricting the amount of calories you eat stops the production of hormones needed for ovulation.
Your GP may refer you to a dietitian if you're underweight, which is when you have a body mass index (BMI) of less than 18.5. A dietitian will be able to advise you about how to regain weight safely.
If your weight loss is caused by an eating disorder, such as anorexia, they may refer you to an eating disorder specialist or team of specialists.
Being overweight can also affect your menstrual cycle. If you're overweight, your body may produce an excess amount of oestrogen, one of the hormones that regulate the reproductive system in women.
Excess oestrogen can affect how often you have periods, and can also cause your periods to stop.
Your GP may refer you to a dietitian if you're overweight, with a BMI of 30 or more, and it's affecting your periods. The dietitian will be able to advise you about losing weight safely.
Doing too much exercise
The stress that intense physical activity places on your body can affect the hormones responsible for your periods. Losing too much body fat through intense exercise can also stop you ovulating.
You'll be advised to reduce your level of activity if excessive exercise has caused your periods to stop.
If you're a professional athlete, you may benefit from seeing a doctor who specialises in sports medicine. They'll be able to give you advice about how to maintain your performance without disrupting your periods.
You might miss a period every so often if you're taking the contraceptive pill. This is not usually a cause for concern.
Some types of contraception, such as the progestogen-only pill (POP), contraceptive injection and intrauterine system (IUS), particularly Mirena, can cause periods to stop altogether.
However, your periods should return when you stop using these types of contraception.
You may start missing periods as you approach the menopause. This is because oestrogen levels start to decrease, and ovulation becomes less regular. After the menopause, your periods stop completely.
The menopause is a natural part of ageing in women, which usually happens between the ages of 45 and 55. The average age for a woman to reach the menopause is 51 in the UK.
However, around 1 in 100 women go through the menopause before the age of 40. This is known as premature menopause or premature ovarian failure.
Polycystic ovary syndrome (PCOS)
Polycystic ovaries contain a large number of harmless follicles, which are underdeveloped sacs in which eggs develop. If you have PCOS, these sacs are often unable to release an egg, which means ovulation does not take place.
PCOS is thought to be very common, affecting about 1 in every 10 women in the UK. The condition is responsible for as many as 1 in 3 cases of stopped periods.
See your GP if you're not pregnant – you've had a negative pregnancy test – and you've missed more than 3 periods in a row.
If you're sexually active and you have not taken a pregnancy test, your GP may advise you to take one.
They may also ask you about:
- your medical history
- your family's medical history
- your sexual history
- any emotional issues you're having
- any recent changes in your weight
- the amount of exercise you do
Your GP may recommend waiting to see whether your periods return on their own. In some cases you may need treatment for your periods to return.
You should also see your GP if your periods stop before you're 45 or if you're still bleeding when you're over 55.
Referral to a consultant
If your GP thinks a medical condition might have caused your periods to stop, they may refer you to a consultant who specialises in the condition.
Depending on what your GP suspects is causing the problem, you may be referred to:
- a gynaecologist – a specialist in treating conditions that affect the female reproductive system
- an endocrinologist – a specialist in treating hormonal conditions
You may have a full gynaecological examination and various tests, including:
- blood tests – to see whether you have abnormal levels of certain hormones
- an ultrasound scan, CT scan or MRI scan – to identify any problems with your reproductive system or the pituitary gland in your brain
Treating underlying conditions
If test results show a medical condition has caused your periods to stop, you may be offered treatment for your condition.
For example, if the cause is PCOS, you may be advised to take the contraceptive pill or tablets containing a hormone called progesterone.
Read more about the treatment of PCOS.
If the cause is early menopause (premature ovarian failure), this means the ovaries no longer function normally. Hormone medicine is usually recommended. Treatments may include the contraceptive pill or hormone replacement therapy (HRT).
If you have an overactive thyroid gland, you may be given medication to stop your thyroid producing too many hormones.
Read more about treating an overactive thyroid gland.
This animation explains in detail how the menstrual cycle works.
Page last reviewed: 02 August 2019
Next review due: 02 August 2022
Depression, amenorrhea, and why your periods have stopped
Amenorrhea is a medical term for when your menstrual periods stop. There are, broadly speaking, two types of amenorrhea, primary and secondary. The former is when someone never starts their periods at all.
Most people should have started their periods by the age of 16, and primary amenorrhea may often be due to anatomical abnormalities in which the ovaries do not form properly, or due to chromosomal disorders such as Turner syndrome.1
Secondary amenorrhea is when you miss three or more periods in a row when your periods have previously been regular, or you have no periods for six months for people who have irregular periods, and when it is not down to pregnancy. Secondary amenorrhea can be caused by many things, including polycystic ovary syndrome (PCOS), high levels of male hormones in females, stress, anxiety, or depression.
Depression is where people have feelings of unhappiness and hopelessness lasting from several weeks, to months or more. It is a common condition, and affects about 10% of people during their lifetime.2
Symptoms include loss of interest in activities, feeling tearful for no reason, anxiety, feeling constantly tired, poor sleep, loss of appetite and sex drive, generalised aches and pains, and amenorrhea. Some people with severe depression may also have suicidal thoughts.
There may not be an obvious cause for depression and it can come on the blue. Sometimes it can occur after life events such as death in the family, losing a job, or even after giving birth.
People who have a family history or previous history of depression are more ly to have depression.
While it is absolutely normal to experience short periods of low mood from time to time, if it lasts longer than a couple of weeks, it is worth going to seek help from your GP.
What’s the link between depression and amenorrhea?
If you are depressed, one of the symptoms you may experience is amenorrhea. When someone has depression they release a stress hormone called cortisol, which acts as a messenger that affects a part of the brain called the hypothalamus.
The hypothalamus is also the part of the brain that informs the ovaries to release an egg, by sending out a hormone called gonadotropin-releasing hormone.
However, as the cortisol has affected the hypothalamus, this signal is disturbed, meaning that ovulation is either delayed or stopped.3 This results in a later period, or no period at all (secondary amenorrhea).
When we are stressed or anxious, we may see the same thing happen, so it is ly that depression affects menstruation via this indirect method.
Depression can also affect appetite, meaning that those who are depressed may eat excessively, or not eat at all, leading to rapid weight loss or weight gain.
This fluctuation in weight can lead to amenorrhea as the ability of fat cells to produce extra oestrogen is affected.
When there is excessive oestrogen, or a lack of oestrogen, this affects the ovaries, causing irregular or missed periods.
Can antidepressants affect your menstrual cycle?
Antidepressants that are used to treat depression may also affect the menstrual cycle, leading to amenorrhea. Antidepressants that belong to a group known as selective serotonin reuptake inhibitors (SSRIs), such as sertraline and escitalopram, can cause high levels of a hormone called prolactin to be released.4
Prolactin works by affecting the nerves that are involved in the hormone release from the brain. High prolactin levels inhibit the release of follicular stimulating hormone (FSH) from the ovaries which stops the ovaries from releasing eggs, and menstruation does not occur.
Bupropion is another antidepressant which acts on a different set of biological targets in the brain, known as norepinephrine-dopamine reuptake inhibitors, and nicotinic receptor antagonists. This drug has been associated with shortened menstrual cycles, menstrual spotting, and amenorrhea, although the exact method of how it does this is unknown.
Selegiline is an enzyme inhibitor which is available as a skin patch to treat depression. There have been some reports of irregular periods with use of this drug, but the mechanism of this is not certain — it may be from the side effect of weight loss with the fat cells producing less oestrogen required for ovulation.
How do you resolve amenorrhea linked to depression?
If you do suffer from depression, and you have ruled out any other causes for disruption to your menstrual cycle, then the best treatment is to try to treat the depression. You may need help from your GP to be referred for talking therapy for depression such as counselling, or cognitive behavioural therapy (CBT).
Your GP may advise that you start taking antidepressants. There are many types available and many don’t affect the menstrual cycle.
If weight loss or weight gain is a problem, then having a look at whether eating more or losing weight would help, although understandably this is unly to be easy if the depression is not first treated.
Seeing a dietician may be useful when seeking advice on how to lose or gain weight healthily.
Does amenorrhea have any long term effects?
Amenorrhea does not necessarily mean infertility, and some women will experience amenorrhea for a while and then have their periods return completely back to normal. If your amenorrhea is due to depression, and your depression is treated, then regular period cycles can return, and fertility is not generally affected.
However, amenorrhea has many causes and could potentially be a sign of disease or a chronic condition associated with infertility. It is not always easy to attribute stopped periods to low mood alone, and it is extremely important to exclude other causes.
If you are sexually active and have missed more than three periods in a row, it may be worth taking a pregnancy test in the first instance. If you are aged over 45 years, and have symptoms such as hot flushes, vaginal dryness, palpitations, and mood swings, then menopause may be a possibility.
Hormonal disorders such as high prolactin can lead to amenorrhea, so if there are other symptoms, such as milky discharge from nipples, headache, and change in vision (partial loss or double vision) this may be a cause.
Similarly, an underactive thyroid can lead to low mood, weight gain, and amenorrhea. There may be other signs of underactive thyroid such as sluggishness and intolerance to the cold.
If amenorrhea is associated with sudden development of male features such as excessive body hair, a deepened voice, and increased muscle bulk then this may be caused by an excess of male hormones (androgens), that can occur if someone has a tumour or polycystic ovary syndrome.
Missing one period is rarely a sign of something serious.
However, it would be advisable to seek help from your GP if you are not pregnant and not taking a form of hormonal contraception which means you don’t get periods, and you miss three menstrual periods or experience a sudden change in your pattern of periods — all the more so if you are experiencing any associated symptoms.
Featured image is of a person standing with their back to the camera, with their head looking down over their left shoulder. They have a thick dark-brown afro and wear a loose white blouse
Last updated June 2019
Next update due 2022
Can Anxiety Affect Your Period?
Anxiety affects every aspect of your body.
It raises your blood pressure.
It increases your blood sugar.
Can anxiety affect your period?
We’ll take a closer look at stress and your period, how they interact, and help you find solutions to some common problems.
Can Stress Cause Irregular Periods?
Yes, particularly if you’ve been under a high level of stress for an extended period of time. To fully understand why, we have to look to the “fight or flight” response.
Stress causes your body to go into fight or flight mode—it’s just the way we’re wired. When you’re in this mode, it affects your hormones, which in turn affect your ovulation and, of course, your period.
This means you may have periods that are late or even stop completely for several months.
If you are having these irregular periods and you aren’t pregnant, you should schedule an appointment with us as soon as possible. While stress can be a culprit, there could also be several other causes.
How Long Can Stress Delay Your Period?
It can delay your period by a month or two, but it shouldn’t stop completely. The absence of a period is called amenorrhea, and it could indicate a potentially serious condition. Hormonal imbalances, thyroid problems and even tumors on your pituitary gland can all trigger amenorrhea
The bottom line is if your period has stopped and you’re not pregnant, we need to see you. Please contact us. Often, we can schedule your appointment within the next week.
How to Avoid Stress
We’ve got some bad news for you—it’s impossible to avoid stress completely. It’s part of our world.
In some cases, stress can actually be a good thing. It alerts us to danger and may give us the motivation to accomplish tasks.
But too much stress is devastating to your health.
We want to be clear: We care about much more than your gynecological health. We care about every aspect of your wellness, from how you’re sleeping to your cholesterol and blood sugar levels. We know that stress can offset any of those.
This is why we will address issues of anxiety that you’ve been having. In the meantime, the following are some stress relief methods we’ve found that help our patients. We encourage you to try them and then schedule an appointment with us to let us know how you’re doing.
Take Care of Your Body
There’s a reason you reach for chocolates and ice cream when you’re feeling stressed. However, these “comfort foods” can actually compound your problem. Although it’s tempting to eat fast food and unhealthy meals, by keeping your nutritional schedule, you can help your body deal with stress more effectively.
Have a Regular Exercise Routine
Burning calories can go a long way toward relieving stress. It also lowers your blood pressure, cholesterol, and helps prevent heart disease and strokes.
Guided meditation is a wonderful way to calm your anxiety and help alleviate stress. Not sure where to start? Take a look at this handy guide from the Mayo Clinic. All you need is a quiet setting, a comfortable position and an open mind.
Get Plenty of Sleep
Sleep usually goes out the window at the first sign of stress, and that’s a shame because rest gives your body a chance to “reboot.” Be sure you get enough sleep by avoiding caffeine later in the day, eliminating “screen time” a few hours before sleeping, and keeping bedtime at the same time each night.
Reduce (or Eliminate) Caffeine
We’re not saying you have to give up that morning cup of Joe. What we are saying is that too much caffeine can make you anxious and jittery. Back off of coffee and sodas for a while. Try decaffeinated varieties or even a relaxing cup of decaffeinated tea instead.
Talk to a counselor
Sometimes, anxiety can be so overwhelming that it interferes with your day-to-day life. If that’s the case, we encourage you to talk to a licensed counselor who can help you adjust and adapt new coping skills to help you.
Problems With Your Period? Contact Us Today
Your period tells us a lot about your gynecological health. If you have severe cramps or unusually heavy periods we want to know. Sometimes these are an indicator of another health problem.
Most importantly, we want you to know we’re on your side. Our doctors are women who have been providing care for women for decades. Our compassion and dedication set us apart, and we consider it a privilege to care for you.
Schedule your appointment today.