Ep. 98: Why don't I have a period?

Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started.

Welcome back to the Woven Well Podcast! 

I’ve been a little under the weather this week, friends, so please forgive me if my voice sounds a little bit different than usual. Hopefully, I’ll be back to normal next week. You know, it can be frustrating when you don’t feel good, or when you know something’s not right. I think about how often that comes up in women’s health. How often we just don’t feel great, but we don’t know if there’s anything we can do to improve it or not — is there a medicine to take? A herbal supplement to try? A surgery we need? Or is it just normal for this phase of the cycle we’re in or the phase of life, and we just don’t know. Knowledge is so powerful. 

There are lots of examples in how this plays out. Tons of underserved populations and conditions. But today we’re going to look at one in particular — women who are not having any periods. 

The technical term for this is amenorrhea. It just means - without menstruation. No periods. 

This is different than women who have sporadic periods, or long, or irregular cycles. (The fancy term for that one is oligomenorrhea.) There are lots of reasons for these types of cycles, too — PCOS and thyroid dysfunction are two common causes. But there’s also stress, which can delay a cycle by several weeks to even a couple months, if the stress level is high enough in that acute stress sort of situation. 

There are also very natural reasons to not regularly have a period. If a female is younger than 15 and has not yet had a menstrual period, that’s okay! It’s totally fine! If a woman is pregnant, then it’s very natural for her to not have periods, because she’s not having cycles of fertility, but instead her reproductive system is focused on developing and protecting the baby in the uterus. Even after delivery, breastfeeding will often delay ovulation to a degree and it can take several weeks to over a year to have the return to menstrual cycles. This is normal, too! Or, if a woman has already completed the reproductive years of her life and she’s in menopause, then it’s normal and natural to no longer be having periods. In fact, if she sees ANY bleeding after menopause, she needs to have it investigated immediately. 

So moving forward we’re going to be talking less on delayed cycles or natural reasons to not have periods, and instead more so on women who have either never had a period in their lives and are past the age of 15 (this is called primary amenorrhea) or those who used to have regular periods and are now not having any and it’s been at least 3 months — usually a lot longer — since they’ve had one (this is called secondary amenorrhea).

I realize I’ve thrown a few terms out there for us today, and they may not feel super important to know. But I’m giving them to you, because a lot of times, when we get into the doctor’s office and these terms start being thrown around — if we don’t know what they mean, that could be to our disadvantage. For instance, If they are investigating irregular periods (oligomenorrhea) when you’ve actually never had a period before (primary amenorrhea) - they actually may be looking in the wrong direction.  So, knowing the terms can be very helpful, especially when you’re looking to diagnosis and treatment.

And targeted diagnosis and treatment is critical here — well, in all areas of women’s health — but certainly here, as well. 

You may be surprised that I actually see this fairly often in my work. 

You may be wondering why women without periods would work with someone who teaches them how to chart their cycles! But remember, we’re not just charting cycles. Your cycle health — your reproductive hormones — it goes wayyyy beyond just your period. Yes, a period is important! But if all we were tracking was when your period started, then any ol’ app out there could do that for you. 

We’re looking at what’s going on inside your reproductive system. What reproductive hormones are you creating, and how strong do they look? Can we see signs of ovulation, or that the body is trying to ovulate, or does it seem like there’s no response? What about signs of response to medical treatments or lifestyle changes? Are they effective? Are they improving things? There is an INCREDIBLE amount of information that we can gather from charting with the Creighton Method, regardless of whether you’ve ever had a period. 

Now, if you’ve had periods before, but they’ve stopped — and not for any of the natural reasons we talked about earlier — then we’re going to look at causes of secondary amenorrhea. 

One of those is actually related to birth control. If you’ve been on any type of hormonal contraception and have recently come off of it, then it’s very likely that your lack of cycles is because your body is still recovering from being suppressed while you were on it. It takes time for the body to naturally produce those reproductive hormones again, and to a level that’s sufficient for ovulation. It could be 6 months before that first period comes back naturally, although I always encourage working with someone medically to help it return by that 3-month mark. So, if it’s not back by 3 months, that’s when I’m like, okay, let’s go ahead and start working with somebody because we really don’t want you to wait that long without having a cycle.

There are also other medications besides birth control that can make it difficult for cycles to continue. Although I’ve not seen this occur in my particular client population, there are some antipsychotics, some blood pressure medications, and certainly things like chemotherapy that can disrupt the reproductive cycle. I’d say these are not necessarily the most common cause for amenorrhea as a whole, but certainly inside this category, those who are taking very strong medications like chemotherapy would want to consider that as a primary reason for that to be occurring. 

What’s a lot more common for the population, in general, is something called hypothalamic amenorrhea. Now we’ve added two fancy words together to make a fancy term. 

Hypothalamic refers to the hypothalamus — an area of the brain that determines a LOT about your reproductive health. Some of your reproductive hormones comes from the reproductive system itself, like estrogen and progesterone. But others, like FSH and LH, come from the brain. I’ll link one of our previous episodes that explain hormones in detail in the show notes, in case you want to learn more, but FSH has a lot to do with WHEN and IF periods start — both at puberty, and at the start of every menstrual cycle to follow. So if there’s something off with the brain’s ability to produce these important hormones, then it could definitely affect whether or not you’re cycling. 

So what are the things that can influence that? Here are the three main ones: under eating, over exercising, and stress

 So, I acknowledge this is where things can get a little bit tricky. We have a lot of thoughts and emotions that get tied into how much we’re eating, what we eat, how much we exercise, what we do to exercise. And just even without that, it can be difficult to know how much exercise is too much? How much and what type of food do you need to be consuming each day? We may not even realize that these really healthy diets, these really good choices we’re making, they may be GREAT! But maybe they’re just not ENOUGH. Maybe we’re not eating enough of those things. Or in our desire to be strong and healthy, or to improve our mental health, we may be working out or staying active more than we realize. When it comes to identifying anything with this topic, how much we eat, how much we exercise, my advice is to work with someone trained in this area to help you assess food and exercise. Find a trusted registered dietitian, someone who is very experienced in this area and who can give you really trustworthy advice as to what to do, how much to do—you don’t want somebody who’s going to be overly criticizing what you eat or encouraging a shame relationship there—and someone who’s going to be really supportive in the whole process.

 And we mentioned stress before.  Acute stress can delay a period for weeks or even a few months. But what about high levels of chronic stress? We’re not intended to live under such levels of continuous stress. And so, sort of in an effort to try to protect us, our body prevents ovulation and therefore prevents pregnancy. When we’re in super chronic stress, pregnancy is the last thing we need, mentally, emotionally, physically. At least that’s how we respond physically.

 These are all things to partner with a trusted medical provider on. They can give great guidance as to how to approach this and how to get your whole being - mind, body, spirit - into a place where it can naturally and safely menstruate again. We’ll be able to use your Creighton charting to see if things are improving or not, long before that first period returns. And this is super helpful to those providers who are looking to see how those lifestyle changes or medications, etc. are making a difference before that happens.

 But what about women who have never had a period? 

 I’ve actually worked with several ladies who fit into this category over the last few years, and the causes have been diverse. For me, a fertility nerd, it’s kind of fun, because everybody has had a different root cause to why their periods have not yet begun. Sometimes it’s been a lifestyle of overexercising — very health-conscious women who were shocked that all the decisions they made to help improve their health were actually a little more than what was necessary and were having some negative effects. I’ve had ladies whose bodies didn’t produce any reproductive hormones naturally — they were born that way, and previously told there wasn’t anything anyone could do. I’ve also heard of women who have a membrane or a wall at the point where the uterine opening should be, and so they are menstruating but it’s gathering inside the body until that membrane is removed, and they have horrible pelvic pain. It could be an issue like that, anatomical or biological, or hormonal! 

 But to me, with how diverse these causes are, what it comes down to is this — if you know that something is off with your body, then the key is to work with a health team that wants to help you get to the root of WHY. 

 The number one option every single one of these ladies was given was birth control. Even the ladies who weren’t having periods after coming off of birth control were told that that was their option! Last year I actually had a woman trying to CONCEIVE a pregnancy. She went off of birth control, did not have a cycle return within like five or six months. When she went to her doctor and told him that, he told her the best bet was to… can you believe it… to get BACK ON BIRTH CONTROL! Now how in the world is that supposed to help her naturally have a period and then conceive a pregnancy? It makes no sense whatsoever.

 So, instead of telling women how they can bleed without addressing the underlying issue, we want you to work with a medical team who is just as interested as you are in why these periods aren’t happening. So that when you find that root cause, then we can address that root cause directly and not only do you begin naturally cycling, but your overall quality of health is improved as well.

 Too often, women’s health issues are overlooked or undervalued. You know, if you aren’t cycling, IT MATTERS. Your body is designed to naturally ovulate and menstruate. I think it’s great that you care about that, that you know that, that you know something’s wrong. Not doing so may even cause issues down the line with bone strength or cancer risk. 

 Figuring out the root cause to why it’s not happening, it MATTERS. 

Finding a tailored approach to restoring your reproductive health, it MATTERS. 

 And if you’re not having a period, you deserve to know why. 

 When you DO have a supportive, restorative-focused team like that, you’ll be able to do what almost all of my clients with amenorrhea of various types have experienced — They’ve been able to have their problem respected, the cause investigated, and the treatment made specific to their needs. I’ll share one such story in the show notes, when I interviewed Anna last year about her journey of secondary amenorrhea. There are so many stories of this out there of this happening. If this is you, I want you to know there is hope out there. There is very, very likely a cause, because there’s always a cause, right? I would love to support you in getting that root cause of why you may not be having your periods.

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As always, thanks for listening as we continue to explore together what it means to be woven well.