The normal average cycle time is from 21 to 35 days. It can be regular when menstruation begins like a clock, or it can walk for life all within a few days. In other words, everything is very individual: in order to understand what is normal for you, you need to keep a calendar. If, according to your calculations, the time has come, but there is no menstruation, think about the possible reasons for the delay.
1. Excitement and stress
Stress is a reaction of an organism to unusual situations, a condition in which forces are mobilized to deal with danger. The stress hormone cortisol affects the hypothalamus, the part of the brain that controls biological rhythms and also regulates hormone synthesis. Excess cortisol inhibits the production of sex hormones, therefore, with severe or prolonged stress, the menstrual cycle is sometimes disturbed.
The cause of stress can be both psychological experiences and excessive physical exertion (for example, exhausting preparation for a marathon or chronic lack of sleep). The cycle gets confused when changing time zones or after a severe infection, such as flu, is also stress for the body.
2. Sudden change in weight
Adipose tissue is a separate endocrine organ. It synthesizes hormones and other substances to regulate appetite, blood pressure and the menstrual cycle, and is also necessary for the production of sex hormones estrogen. Therefore, sudden changes in weight affect health.
Excessive volume of adipose tissue stimulates excessive synthesis of sex hormones, and a high level of estrogen, in turn, leads to an irregular cycle and increases the risk of developing polycystic ovary syndrome. Sudden weight loss, in contrast, creates estrogen deficiency and leads to delays or less profuse discharge.
3. The use of hormonal contraceptives
Discharge during menstruation consists of endometrial cells (the tissue that lines the uterine cavity) and an unfertilized egg. The endometrium is needed for implantation – the successful attachment of a fertilized egg to the uterine wall. Many hormonal contraceptives not only suppress ovulation, but also thin the endometrium to prevent implantation and pregnancy. When there is no ovulation, and the endometrium is thinned, menstrual bleeding becomes scarce, irregular, or may disappear altogether. Even after drug withdrawal, delays occur: the cycle is restored only after 3-6 months.
There is still insufficient scientific evidence on whether artificial menopause affects a woman’s health. If the absence or irregularity of spotting causes psychological or physical discomfort, it is better to consult a gynecologist.
During lactation, a lot of the hormone prolactin is produced, which reduces estrogen synthesis. A lack of estrogen causes lactational amenorrhea – the absence of menstruation during active breastfeeding. The cycle returns to normal in very different ways: menstruation may not return until the end of feeding.
5. Disruption of the hormonal background
Many endocrine diseases affect the regularity of the cycle: due to hormonal imbalance, either there are too few sex hormones, or other hormones inhibit their function.
Hormonal diseases can be suspected by characteristic manifestations. In case of thyroid dysfunction, this is increased fatigue, sweating, muscle pain and weight gain. With polycystic ovary syndrome – the appearance of acne, hair growth above the upper lip, on the chin, on the back and abdomen (male type hair) or, conversely, baldness. In diabetes mellitus, you constantly feel thirsty, you often have to go to the toilet, weight decreases, sometimes your arms and legs go numb, wounds and bruises do not heal for a long time.
Perimenopause is the period before menopause (the complete cessation of menstruation), when the hormonal background is rebuilt and the level of estrogen gradually decreases. Its deficiency leads to a delay in menstruation or to the absence of ovulation in the cycle (then the menstrual phase may not be at all).
The first symptoms appear several years before menopause – a violation of the cycle, dryness in the vagina, sleep problems, decreased libido. Sometimes – night tides, episodes of heat, bad mood.
7. Some medicines
Changing the menstrual cycle is a side effect of certain medications (this is usually prescribed in the instructions). If you are taking such medications and the cycle is broken, you need to consult the doctor who prescribed them. Antidepressants or antiepileptic drugs, for example, can cause amenorrhea (complete absence of menstruation).
Delay is not always an occasion for an urgent visit to the gynecologist. If menstruation is not only one cycle and you feel normal, it is enough to pass a pregnancy test.
Be sure to consult a doctor if:
- menstruation is not several cycles in a row;
- pregnancy test is positive;
- there were symptoms of hormonal diseases;
- weight has changed dramatically;
- you cannot handle stress.
Keep track of your cycle: mark the days of the beginning and end of menstruation, fix the nature of the discharge and any alarming features. Such a diary will help a specialist deal with the cause of the delay and, if necessary, choose a treatment.