Absent periods can be worrying whatever your age – whether you’re a teenager whose periods haven’t started by the time you’re 15, or an adult whose periods have suddenly stopped for no reason.
At certain times of your life, it’s normal for your periods to stop, such as if you’re pregnant or breastfeeding, or if you’ve reached the menopause. It’s also not unusual to skip a period every now and again – due to stress, for example – then go back to your usual menstrual cycle the following month.
Missing 3 or more periods in a row, however, could mean something else is going on. If this happens to you, it’s understandable if you feel anxious. Not having periods can affect your self-esteem, and may lead you to worry about your fertility and general health.
But you’re not alone: research suggests that between 14% and 25% of women have abnormal menstrual cycles, and absent periods are 1 of the most common problems. And in many cases, there are treatments that can help. So read on to find out what causes absent periods, and what you can do about them.
What are absent periods?
Absent periods are known medically as ‘amenorrhoea’, and there are 2 types:
- primary amenorrhoea – this is when your periods don’t start by the time you’re 15. It’s rare, but can be caused by a genetic disorder, birth defect, or hormone problem. Eating disorders, extreme exercise or stress can also delay the start of your periods
- secondary amenorrhoea – this is much more common, and is when you’ve started your periods, but you miss 3 or more in a row. Pregnancy and breastfeeding are common reasons for missed periods, but secondary amenorrhoea can also be caused by lifestyle factors, certain medications or health conditions
Having absent periods is different from having irregular periods. This is when the length of your monthly menstrual cycle falls outside of the usual range of 21 to 35 days, or the gaps between your periods vary a lot from month to month.
What are the signs and symptoms of missed periods?
If your absent periods are caused by an underlying medical condition, you may also notice other symptoms, which can include:
- hair loss
- changes to your eyesight
- pelvic pain
- excess facial or body hair (hirsutism)
- more ‘masculine’ features, such as a deeper voice or muscle growth
- poor sense of smell
- milky discharge from your nipples
- delayed puberty – for example, you haven’t started getting breasts or pubic hair
What causes absent periods?
There are many possible reasons for not getting periods. Let’s look at the common causes.
Primary amenorrhoea can be passed on in the genes you get from your parents (hereditary). If late development runs in your family, your periods may simply start later than normal, and this is nothing to worry about.
A genetic disorder or birth defect can also stop your periods from starting, including:
- Turner syndrome – with this condition, your ovaries don’t make the hormones that trigger your menstrual cycle. It affects about 1 in 2,000 female births
- Kallmann syndrome – with this condition, the hormones that trigger sexual development are missing. It happens in less than 1 in 10,000 births, and is more common in males
- androgen insensitivity syndrome – with this condition, you’re born genetically male, but your genitals may look female. It’s thought to happen in around 1 in 20,000 births
- reproductive birth defects – these are problems in the development of your genitals or reproductive system that are present at birth, such as having no vagina or/and womb
It’s normal for your menstrual cycle to be interrupted and your periods to stop at certain times in your life, including during:
- pregnancy – you may have light bleeding in the first few weeks, called ‘implantation bleeding’, before your periods stop because your ovaries are longer releasing an egg (ovulation) every month
- breastfeeding – if you breastfeed your baby, your periods may only return once you reduce or stop breastfeeding
- menopause – this is when you stop having periods altogether, and usually happens between the ages of 45 and 55 (the average age in the UK is 51). In the time leading up to this, known as the perimenopause, your hormone levels start to change, and your periods may become irregular and less frequent before they stop. Some women have an early menopause before the age of 45
Your periods can become irregular or stop if you’re using a type of contraception that contains the hormone progesterone. These include the progesterone-only pill (mini pill), contraceptive implant, contraceptive injection and an intrauterine system (IUS) such as the Mirena coil.
Once you stop using them, your periods will usually return quickly – but this can depend on the method you’ve been using. Speak to a doctor if you’re concerned, or if your period hasn’t restarted after 3 months.
Several things about your lifestyle can cause your periods to stop, including:
- stress or anxiety – severe stress brought on by things like job pressures, divorce or death of a loved one can increase your levels of the stress hormone cortisol. High levels of cortisol can then affect the production of other hormones, including oestrogen and progesterone, and this can lead to delayed or absent periods
- over-exercising – the stress that intense exercise puts on your body can also affect your levels of oestrogen and progesterone, and may stop you from ovulating
- losing too much weight, or sudden weight loss – a severe lack of calories can mean your body doesn’t have the energy it needs to make the hormones for ovulation
- being overweight or obese – if you’re overweight, your body may make too much oestrogen, which can also stop you from ovulating
Absent periods can also be a symptom of an underlying health condition or problem, including:
- polycystic ovary syndrome (PCOS) – this common hormonal condition affects about 1 in 10 women in the UK. If you have PCOS, you don’t always ovulate, so your periods may stop or become irregular. Other symptoms include weight gain, acne and excess body or facial hair
- thyroid problems – the thyroid gland in your neck makes thyroid hormones, which help control your menstrual cycle. If your thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism), it can cause your periods to change or stop altogether
- premature ovarian failure – this is when your ovaries stop working normally before you’re 40, so your periods stop or become irregular. It’s estimated to affect around 1 in 100 women. It’s different from early menopause, and in some cases your periods may return (read about early menopause)
- high prolactin levels – prolactin is a hormone made by the pituitary gland in your brain. It makes your breasts grow and produce milk during breastfeeding. But abnormally high levels can affect other hormones, including oestrogen, leading to absent periods. High prolactin can be caused by antipsychotic medication, a usually non-cancerous (benign) tumour on your pituitary gland, underactive thyroid or severe liver or kidney disease
- other long-term (chronic) health conditions – diabetes, heart disease and chronic kidney disease can all cause your periods to stop
- medication and medical treatments – cancer treatment such as radiotherapy or chemotherapy can stop your periods, as can certain medicines, including some types of strong painkillers called opiates. Ask your doctor for information about the possible side effects of any treatment you’re having
When to see your doctor about absent or missed periods
If you’re 15 years old and your periods haven’t started, see your doctor. They may ask about:
- any family history of period problems
- signs of puberty – such as breast development or pubic hair
- your lifestyle – such as your diet and what exercise you do
- any medication you’re taking
- any health conditions you have
You should also see a doctor if you usually have periods, but you’ve missed more than 3 in a row and you don’t know why. Your doctor may ask about:
- any family history of period problems or early menopause
- how old you were when your periods started
- how often you usually get your period, and your cycle length
- what symptoms you usually get with your period – such as sore breasts or mood swings
- when your periods stopped
- any other symptoms you have – such as excess body hair, acne or pelvic pain
- any lifestyle changes – such as extreme diets or exercise
- any medication you’re taking, including contraceptives
What you doctor will look for
Your doctor will check to see if you’re a healthy weight and look for signs of other possible causes of your absent periods. For example, excess body hair is linked to PCOS, while a lump in your neck suggests you may have a thyroid problem.
You may also be referred to a specialist in female reproductive health (gynaecologist) or hormonal conditions (endocrinologist).
Tests may include:
- pregnancy test – this is done from a pee (urine) sample. You can also do a test yourself at home (read about how to use a pregnancy test)
- blood tests – to check for abnormal levels of hormones, such as prolactin, thyroid-stimulating hormone, follicle-stimulating hormone or luteinising hormone
- scans – an ultrasound scan, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan may be done to look at the inside of your body, to check for problems with your reproductive system or pituitary gland
Treatment for absent periods
Treatment isn’t always necessary, especially if it’s thought that your periods will return by themselves. In some cases, absent periods can’t be treated – if you have a genetic disorder or reproductive birth defect, for example.
If you do need treatment, you may be treated by your doctor or referred to a specialist, depending on what’s causing your period problems.
If your absent periods are caused by lifestyle factors and/or mental health issues, treatment may include:
- advice from a dietitian – if you need help to lose or gain weight safely
- psychological therapy – if you have a mood or eating disorder that’s affecting your periods (read more about treating anorexia nervosa)
- cognitive behavioural therapy – if you’re struggling with stress. This talking therapy can help you to manage your problems by changing how you think and act
- advice from a doctor who specialises in sports medicine – if you’re an athlete and you need help maintaining your fitness without causing period problems
If your absent periods are caused by a health condition, you’ll be offered appropriate treatment, such as:
- treatment for PCOS – hormonal contraception can be used to restore your periods. You may be prescribed a contraceptive pill or progesterone tablets. Read more about PCOS treatment
- treatment for overactive thyroid – the main options are anti-thyroid medications such as carbimazole and PTU, or a type of radiotherapy called radioiodine treatment, both of which reduce the amount of hormones your thyroid gland makes. Medications to slow your heart rate, such as beta-blockers, are also sometimes used. In some cases, surgery is needed. Read more about overactive thyroid treatment
- treatment for underactive thyroid – this usually involves levothyroxine medication, which replaces the thyroxine hormone your body can’t make enough of. Read more about underactive thyroid treatment
- treatment for premature ovarian failure – you may be given hormone medication, such as the contraceptive pill or hormone replacement therapy (HRT). These treatments can help reduce your risk of complications associated with premature ovarian failure, such as weak bones (osteoporosis), but won’t necessarily restore your periods
- treatment for high prolactin levels – your doctor will usually try to find out what’s causing this. If it’s a side effect of medication, they may recommend you continue to take it (if it’s a medication you really need), or suggest a different medication. Other causes, such as a pituitary gland tumour, will need specialist treatment such as surgery
If you’re concerned about any symptoms, try our Smart Symptom Checker to get an online assessment to help you work out what to do next.
Your health questions answered
Can I still get pregnant if I don’t have periods?
Answered by: The Healthily Medical team
“Absent periods mean you may not be releasing an egg (ovulating) regularly. If you don’t ovulate at all, you won’t be able to get pregnant naturally. But often, it's not possible to know for sure that you’re not ovulating – so pregnancy could still be a possibility. If you’ve missed 3 periods in a row, see your doctor, who can find the cause and treat it if necessary. If you’re trying to get pregnant and it’s been 12 months (or 6 months if you’re over 35), or you’re struggling to get pregnant and you don’t have regular periods, see your doctor. You may need to have some fertility investigations, or be referred to a fertility specialist. Read more about infertility treatment.”