What If Your Period Is Late

Introduction

A healthy menstrual cycle is essential for the reproductive health of women. Most women have regular periods which aids them in keeping track of hormonal changes in the body.

But in some cases, your period can get off track by days which indicates some underlying change in the body. Keep reading to know more about late periods.

What are the causes of a late period?

Although a late period can cause significant anxiety in women, it is most often associated with no serious underlying diseases. The cause of a late period include:

Extremes of reproductive age

With the onset of menarche, the first few menstrual cycles are unpredictable, irregular, and sometimes painful. This should not cause any health concerns in teenagers if their periods are ‘missed’ or late by some days.

As the age advances, the monthly cycle becomes regular as the body adapts to hormonal changes.

In a similar manner, the perimenopausal age is also associated with irregular, ‘missed’, or late periods. As the antral follicle count (ovarian reserve of eggs) decreases, the ovarian production of hormones and the feedback control on menstrual cycle disrupts.

The decreasing estrogen levels in the body cause a myriad of symptoms, hot flushes, vaginal dryness, insomnia, menstrual irregularities, to name but a few.

Pregnancy

In the anticipation of pregnancy, a late period can overwhelm you with happiness or immense anxiety if you’re not expecting one. Pregnancy is one of the most common causes of no bleeding on due dates.

But you’ll have to wait a little longer and get a pregnancy test to confirm it. Urine stick tests become positive as early as the first day of a missed period in women with a regular cycle.

Lifestyle changes

Certain lifestyle modifications can throw off the normal menstrual cycle:

Exercise

Heavy exercise can cause a missed menstrual period or cause them to stop altogether. This can often happen to women who are not physically active for a long period of time and abruptly starting a vigorous exercise or workout.

Menstrual irregularities are common in athletic women and are of no serious concern.

Exercise is not directly linked to the period cessation but is a stimulus of energy misbalance in the body. Heavy exercise leads to an increased gap in energy demand and supply which culminates as less energy available for other bodily processes and can thus delay or completely halt the menstrual cycle.

This, in the long-term, can severely impact the health and reproductive life of women, contributing to infertility.

Stress

Psychological stress can also affect the reproductive cycle of women and can result in delayed or missed periods.

Hypothalamus is the central regulator of almost all bodily functions. Chronic stress can tip the feedback mechanisms of reproductive hormones resulting in menstrual irregularities

Obesity and Weight loss

The excess fat stored in the adipose tissue ramps up the production of estrogen in the body. The increasing circulating levels of estrogen in obese women are mainly responsible for delayed or irregular periods.

Weight reduction is the first piece of advice given to women with abnormal menstrual cycles.

Contrary to this, women who are thin, lean, taking a low-calorie diet, fasting, or are exercising heavily to lose weight also suffer from irregular and delayed periods.

A healthy diet is essential for the normal functioning of the reproductive cycle.

Polycystic Ovarian Syndrome (PCOS)

PCOS is a gynecological condition in which the hormonal imbalance affects the overall health of a woman. The excess estrogen production by the cystic ovaries is the hallmark of PCOS.

This excess estrogen makes it difficult for the ovaries to release eggs, as they would do every month, to keep up with a healthy menstrual cycle. This leads to menstrual irregularities along with a list of other signs and symptoms.

Chronic Diseases

The diseases that run a long course also affect the menstrual cycle. Diabetes, Fibroids, Pelvic inflammatory disease (PID), Celiac disease, Von Willebrand disease, and malignancies are a few most notable chronic diseases that can cause menstrual irregularities.

Both type 1 and 2 diabetes mellitus can produce hormonal disturbances with disrupted blood sugar levels. Thus, poorly controlled diabetes mellitus can lead to late periods.

Pelvic Inflammatory disease (PID) involves the inflammation of reproductive organs that can also lead to menstrual irregularities.

Celiac disease is an inflammatory bowel disease that is exaggerated with gluten intake and disrupts the villus architecture of the intestine. This leads to impaired intestinal absorption of nutrients which contributes to late or missed periods.

Malignancies can induce a cachexic change in the body. Cachexia is the excessive loss of weight in cancer patients due to high cell turnover consuming a lot of body energy and speeding up the catabolism.

Decreased body energy levels lead to delayed periods or amenorrhea in some cases.

Thyroid Problems

Thyroid hormones drive the body’s metabolic process and maintain homeostasis. Both hyper- and hypothyroidism can cause late or missed periods.

The other symptoms of thyroid diseases are usually present long before the menstrual irregularities and reproductive dysfunction. Most of the cases resolve with treatment.

Birth Control methods

Hormones containing contraceptives downregulate the body production of reproductive hormones and thus changes in the menstrual cycle are observed on starting and stopping such birth control methods.

It may take up to 6 months for women to start bleeding regularly after stopping the hormonal contraception. Changes in the menstrual cycle are also observed with injectable and implanted contraceptive devices.

How to remedy the late period?

The management of late periods depends on the root cause. Nothing needs to be done in teenagers going through the first few reproductive cycles as their monthly cycles would become regular with time.

Avoid stressing your body with heavy workouts if you’re having menstrual problems. Stay hydrated and energetic to keep your body in balance.

Mental stress should also be avoided. Maintaining good sleep and limiting caffeine intake can help overcome insomnia that can help cope with stress.

Healthy body weight is essential to homeostasis of hormones in the body. Losing excessive weight gradually can restore the hormonal balance in the body and remedy the abnormal menstrual cycles.

Likewise, nourishing the body with healthy nutrients and fulfilling the daily calorie requirement is essential to avoid the energy-deprived state in the body.

For chronic diseases, such as PCOS, thyroid disorder, malignancies, etc., consult your doctor for prompt diagnosis and initiation of treatment. Menstrual irregularities often resolve after the treatment of underlying pathology.

Women using contraceptive methods often face abnormal uterine bleeding. Consult your OB-GYN if you’re facing menstrual irregularities with your contraception method.

References

  1. Bae, J., Park, S., & Kwon, J. W. (2018). Factors associated with menstrual cycle irregularity and menopause. BMC women’s health, 18(1), 36. doi:10.1186/s12905-018-0528-x
  2. Boyle, J. A., & Teede, H. J. (2014). Irregular menstrual cycles in a young woman. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 186(11), 850–852. doi:10.1503/cmaj.130667
  3. Harlow, S. D., & Paramsothy, P. (2011). Menstruation and the menopausal transition. Obstetrics and gynecology clinics of North America, 38(3), 595–607. doi:10.1016/j.ogc.2011.05.010
  4. Hoyer, J., Burmann, I., Kieseler, M. L., Vollrath, F., Hellrung, L., Arelin, K., … Sacher, J. (2013). Menstrual cycle phase modulates emotional conflict processing in women with and without premenstrual syndrome (PMS)–a pilot study. PloS one, 8(4), e59780. doi:10.1371/journal.pone.0059780
  5. Nagma, S., Kapoor, G., Bharti, R., Batra, A., Batra, A., Aggarwal, A., & Sablok, A. (2015). To evaluate the effect of perceived stress on menstrual function. Journal of clinical and diagnostic research : JCDR, 9(3), QC01–QC3. doi:10.7860/JCDR/2015/6906.5611
  6. Sher N. (1946). Delayed Menstruation: Causes and Treatment. British medical journal, 1(4444), 347–349.
  7. Yavangi, M., Amirzargar, M. A., Amirzargar, N., & Dadashpour, M. (2013). Does Ramadan fasting has any effects on menstrual cycles?. Iranian journal of reproductive medicine, 11(2), 145–150.
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