UCLA HealthMissed Your Period but Not Pregnant? 7 Possible Causes

This UCLA Health consumer education article addresses secondary amenorrhea evaluation, providing systematic differential diagnosis for missed periods excluding pregnancy. The content emphasizes pattern recognition in menstrual irregularities and highlights the connection between irregular cycles and early-onset menopause risk.

⚕️ Key Clinical Considerations ⚕️

• Age-related irregularities: Normal variations occur during menarche (up to 6 years) and perimenopause transition (ages 45-55), with primary ovarian insufficiency affecting 1% of women under 40.
• Hypothalamic amenorrhea assessment: Chronic stress disrupts hypothalamic-pituitary-ovarian axis through elevated cortisol, requiring evaluation of psychological stressors and coping mechanisms in reproductive-age women.
• PCOS diagnostic criteria: Hyperandrogenism presents with characteristic signs including hirsutism, acne, and metabolic dysfunction, necessitating comprehensive hormonal evaluation and insulin resistance screening.
• Weight-related menstrual dysfunction: Both low BMI with eating disorders and obesity create hormonal imbalances affecting estrogen and progesterone production, requiring nutritional assessment and metabolic evaluation.
• Medication-induced amenorrhea: Hormonal contraceptives, psychotropic medications, and chronic disease therapies can suppress ovulation, requiring careful medication history and potential alternative considerations.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Educate patients that amenorrhea represents a symptom requiring investigation rather than a benign condition, emphasizing the importance of establishing regular menstrual patterns for long-term reproductive health monitoring.
• Practice Integration: Implement systematic evaluation protocols including pregnancy testing, comprehensive history taking, physical examination for hyperandrogenism signs, and appropriate laboratory workup based on clinical presentation.
• Risk Management: Screen for underlying conditions including thyroid dysfunction, eating disorders, and chronic diseases that may require specialized management, while monitoring for potential ectopic pregnancy in IUD users.
• Action Items: Develop patient tracking systems for menstrual irregularities, establish referral pathways to reproductive endocrinology, and create patient education materials addressing lifestyle modifications and treatment expectations.

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