Missed or Irregular Periods
Most women have between 11 and 13 menstrual periods each year. You may be different: You may have more or fewer. Missed or irregular periods must be looked at in terms of what is normal for you.
Menstrual periods also may be very irregular at the other end of the menstrual years. Many women realize that they are approaching perimenopause and menopause when their otherwise regular periods become irregular. Menopause occurs when it has been 12 months since you had a menstrual period.
Pregnancy is the most common cause of a missed period. If you might be pregnant, treat yourself as if you are pregnant until you know for sure. Use a home pregnancy test as the first step to finding out whether you are pregnant.
If you are not pregnant, other causes of missed or irregular periods include:
- Excessive weight loss or gain. Although low body weight is a common cause of missed or irregular periods, obesity also can cause menstrual problems.
- Eating disorders, such as anorexia or bulimia. For more information, see the topic Anorexia Nervosa or Bulimia Nervosa.
- Increased exercise. Missed periods are common in endurance athletes.
- Emotional stress.
- Medicines such as birth control methods, which may cause lighter, less frequent, more frequent, or skipped periods or no periods at all.
- Hormone problems. This may cause a change in the levels of the hormones that the body needs to support menstruation.
- Illegal drug use.
- Problems with the pelvic organs, such as imperforate hymen, polycystic ovary syndrome, or Asherman's syndrome.
- Breastfeeding. Many women do not resume regular periods until they have completed breastfeeding.
Remember, you can still become pregnant even though you are not menstruating. Practice birth control if you do not wish to become pregnant.
Other diseases such as irritable bowel syndrome, tuberculosis, liver disease, and diabetes can cause missed or irregular periods, although this is rare. But if any of these diseases are present, you will usually have other symptoms besides menstrual irregularities.
If you've skipped a period, try to relax. Restoring your life to emotional and physical balance can help. Many women miss periods now and then. Unless you are pregnant, chances are your cycle will return to normal next month.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Adults and older children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Many prescription and nonprescription medicines can affect the menstrual cycle. A few examples are:
- Aspirin and other medicines (called blood thinners) that prevent blood clots.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example, Advil or Motrin) and naproxen (for example, Aleve).
- Hormonal forms of birth control, such as birth control pills, Depo-Provera injections, Implanon or Nexplanon implants, and the levonorgestrel IUD (Mirena).
- Hormone therapy.
- Medicines used to treat cancer (chemotherapy).
- Thyroid medicines.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
There is no home treatment for missed or irregular periods. But the following information may help you find the cause of your missed or irregular periods:
- Eat a balanced diet. Being underweight or overweight can cause missed and irregular periods. For more information, see the topics Healthy Eating and Weight Management.
- If you are an endurance athlete, you may have to cut back on your training. Be sure to talk with your doctor about hormone and calcium supplements to protect against bone loss if you are missing periods. For more information, see the topic Fitness.
If you think you might be pregnant
Do a home pregnancy test if you have had sex since your last period. If the result is positive, practice the following good health habits until you see your doctor:
- Eat a balanced diet.
- Do not smoke or use other tobacco products.
- Do not use alcohol or drugs.
- Avoid caffeine, or limit your intake to about 1 cup of coffee or tea each day.
- Do not clean a cat litter box, to avoid the risk of toxoplasmosis.
- Avoid people who are ill.
- Take a vitamin supplement that contains folic acid or a prenatal vitamin.
If the home pregnancy test is negative but you continue to have pregnancy symptoms, it is a good idea to see your doctor to confirm the results. Practice good health habits until you see your doctor.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- You have early symptoms of pregnancy, such as:
- Missed periods.
- Increased urination.
- Breast tenderness or enlargement.
- Nausea and vomiting.
- You have missed more than two menstrual periods in a row.
Here are some steps you can take to help prevent missed or irregular periods.
- Avoid fad diets that greatly restrict calories and food variety, and avoid rapid weight loss. To maintain a healthy weight, focus on eating a variety of low-fat foods. For more information, see the topics Healthy Eating and Weight Management.
- Use contraception consistently, as directed by your doctor. For more information, see the topic Birth Control.
- Increase exercise gradually. For more information, see the topic Fitness.
- Learn and practice relaxation exercises to reduce and cope with stress. For more information, see the topic Stress Management.
If you participate in endurance sports, you may miss periods or stop menstruating. Eat a healthy, balanced diet, and keep track of your periods. Tell your doctor about any changes in your menstrual periods.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What was the date of your last menstrual period?
- When was your previous period? Was it normal?
- If you are a teen, do you have regular cycles, such as a period every 21 to 45 days?
- If you are an adult, do you have regular cycles, such as a period every 21 to 35 days?
- How old were you when your periods began?
- Are you sexually active?
- What type of birth control are you using? How long have you been using it?
- Have you missed any birth control pills or failed to have your hormonal injection according to schedule?
- Have you done a home pregnancy test? When did you do the test? What was the result?
- Have you been under increased physical or emotional stress?
- Have you recently changed your diet or exercise habits?
- Have you recently gained or lost weight?
- What prescription and nonprescription medicines are you taking? Are you using illegal drugs?
- Do you have any health risks?
Current as of: June 26, 2019
Author: Healthwise Staff
Medical Review: William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine