Many Conditions Can Cause Irregular Periods

Question 1: I am a 48-year-old woman and no longer get my periods. I had regular periods until age 46, when a family member suffered a terrible tragedy. I also lost 30 pounds quite quickly. Since then, I have only had a few periods in the past 2-1/2 years. I do not feel like I am in menopause, and I have no hot flashes. Could I have stopped menstruating due to an emotional state?

Dr. Julie Mitchell answers:
Menstrual periods can stop for a number of reasons. First on the list is pregnancy, but that’s obviously not likely in your case since you continue to have occasional periods.

You could be in menopause, since about 10% of American women have menopause before age 46 and as many as one-third of women do not get hot flashes. Other reasons include thyroid gland disorders, pituitary gland disorders and a condition called "hypothalamic amenorrhea."

Hypothalamic amenorrhea occurs when the body is under significant physical or emotional stress, when the total body fat is low (typically in women with eating disorders or in avid athletes) or with significant weight loss. However, menstrual periods usually resume when the stress is over or when body weight stabilizes at a normal weight.

Whatever the possible causes, bleeding after menopause should be checked out. Your doctor can do a few blood tests to find out the most probable reason your periods have stopped.

Question 2: I've been using hormone replacement therapy for several years during menopause, and haven't missed a single day taking it. Last July I got a full period and went right to my doctor. She examined me and found nothing. Now this year, I've had two periods. Should I be a little more concerned? I do get an exam once a year.

Dr. Julie Mitchell answers:
Most women have irregular bleeding around the time of menopause. It is a rare woman who has regular periods until menopause and then never bleeds again. However, once you have not had a period for 12 months, you are officially "menopausal" and any further bleeding is unexpected and concerning.

Additionally, if you are on cyclic postmenopausal hormone therapy, bleeding at an unexpected time in your medication cycle is also a cause for concern. Unexpected bleeding should be evaluated with either an endometrial biopsy or vaginal ultrasound to rule out endometrial cancer. Keep in mind, though, that this type of bleeding, thank goodness, is usually not cancer.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic – East. Her column also appears in the Milwaukee Journal-Sentinel.

For more information on this topic, see the HealthLink article Possible Causes of Irregular Menstruation.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.