In the first five to seven years after the first menstrual period and the last ten years before menopause there can be variability in the cycles. Between the ages of 20 and 40 most women’s menstrual cycles fall into a familiar pattern of 28-day cycles. A pattern of very short (less than 21 days) or very long (greater than 35 days) time between menstrual periods or skipped periods indicates the woman is not ovulating. Extremely painful or heavy menstrual periods lasting longer than 7 days are also a cause for evaluation.
Sometimes young women with irregular cycles are incorrectly told “Well, that’s just normal for you!” It is very unfair to trivialize or dismiss these complaints in such patients. Signs and symptoms are your body’s way of telling you there’s a problem. It’s better to find the underlying cause of the menstrual disorder instead of masking it with birth control pills. In many instances birth control pills are prescribed without the woman ever undergoing a diagnostic evaluation. There are consequences to a young woman not having ovulatory cycles. These include bone loss, premenstrual syndrome (PMS), mood disorders, headaches, facial hair, acne, infertility, and a myriad of other symptoms. These symptoms can occur in polycystic ovaries syndrome, hypothyroidism, hyperprolactinemia, all of which are treatable endocrine conditions.
Secondary amenorrhea is the medical term that is used when a woman who was previously having regular or irregular periods, stops having them. When a woman younger than 40 stops having her periods, it is important to know that this condition is not likely to be menopause. Young women sometimes like the convenience of not having periods and may not seek medical attention. Women with elevations in prolactin and various other coexisting medical problems can have temporary cessation of periods. Women going through severe stress, marked weight loss or extreme exercise may stop having periods. If periods stop for three months or longer, be sure that you undergo a diagnostic evaluation and are not just started on birth control pills or oral contraceptives (OCs) which cause menstrual periods to resume in most women. Such treatment may give women a false sense of security that they are now “normal.” Nothing could be further from the truth. OCs in this instance let you know that you have a functioning uterus but nothing about the state of your ovaries. Proper diagnosis and treatment is especially important in younger women concerned about their future fertility.
Excerpt from “Outliving Your Ovaries” © 2012 by Marina Johnson MD. Dr. Johnson has no financial conflicts of interest or ties to any pharmaceutical company. Her only objective is determining the most effective, safest therapy for patients.