causes of delayed or missed menstruation.

A menstrual cycle is the period of time from day one of your menstrual period to day one of your next period. Menstrual cycles may occur at the same time each month or be irregular. Typically, a cycle occurs about once a month, but can be as short as 21 days or as long as 35 days and still be considered normal. Menstrual flow lasts about 3 to 7 days. 

A menstrual period is considered late if it is 5 or more days overdue according to your usual pattern of periods. A period is considered missed if there is no menstrual flow for 6 or more weeks.

CAUSES OF THE DELAY

A late or missed period could be caused by any of the following:

Pregnancy

This is the most common cause of missed periods in teenage girls. If you have had sex even once in the past several months, see your healthcare provider for a pregnancy test before you consider any of the other possible causes. Home test kits can be confusing and give misleading results. A positive pregnancy test is the only way to be certain of pregnancy. Breast swelling, weight gain, and nausea are also signs of pregnancy.

Stress

Stress is the second most common cause of late or missed periods in teenagers. It may be emotional stress or depression. Or it may be physical stress to the body, such as a severe illness, a sexually transmitted disease, rapid weight loss or gain, or strenuous exercise. Dieting or binging and purging may interrupt menstrual cycles. Changes in your usual routine (for example, going on vacation) may also cause your period to be late or missed.

Some stress is a normal part of daily life. Only you can know if you are under too much stress. Your periods should return when the activities or situations that are stressing you are eliminated or changed.

Normal development

During the first couple of years of menstruation many teenagers have irregular periods. During this time the body's hormones are not yet "fine-tuned," so the ovaries may not release an egg once every month. As a result, your cycles may be irregular, occurring as close together as 2 weeks or as far apart as 3 months.

If you've been having periods for 2 years or less and your physical exam is normal, your irregular periods may be part of your normal development. Remember, if you have had sex, go to your doctor's office for a pregnancy test when your period is late for you, even if you normally have irregular cycles. 

Most girls' menstrual cycles become fairly regular as their hormone levels mature and synchronize. A few women will continue to have irregular cycles as their normal pattern.

Hormone imbalance

Hormone imbalance is rarely the cause of missed periods. Though rare, polycystic ovary syndrome is the most common type of hormone imbalance that affects the menstrual cycle in teenagers. Polycystic ovary syndrome (PCOS) is caused when high levels of certain hormones stimulate your ovaries to produce lots of follicles. None of the follicles mature enough to release an egg. Because you haven't ovulated, you don't have a period either. Other signs of PCOS include excessive hair growth on your face, chest and lower abdomen, acne, and a tendency to put on weight around your middle.

Also If you produce prolactin at an abnormal level, you might miss one or more periods. A woman usually makes prolactin when she's breastfeeding, which is why her periods stop during this time. If you are not pregnant or breastfeeding but have a milky discharge from your nipples then prolactin could be the cause.

There are other reasons why your period may have become irregular or stopped. For example you could be suffering from the side-effects of a medicine you may be taking.

Sometimes when you stop taking birth control pills you may have a temporary hormone imbalance and loss of periods. If you are having sex, be sure to use another reliable method of birth control because you could still become pregnant.

If you have missed several periods without an explanation, your doctor can check your ovaries and look for any signs of hormone imbalance. Blood tests can be done to measure hormone levels. Most often a hormone imbalance can be treated.

TAKING CARE OF YOURSELF  

1. Mark on a calendar when your periods occur and how long they last. This information can help your doctor make a correct diagnosis. Take it to your appointment.
2. Eat healthy foods and keep your weight steady. If you are overweight, a balanced diet and regular exercise will help you lose weight slowly (no more than 2 pounds a week). Talk with your healthcare provider if you are not sure what your proper weight should be, or if others are worried about your weight.
3. If you follow a strenuous exercise program, consider cutting back until your periods come back.
4. If you have sex, always use birth control. Talk to your doctor about the available methods.
5. If you think you might be pregnant, get a pregnancy test if your period is 5 or more days late. Don't wait. You can get confidential testing and counseling in most doctors' offices and clinics. Take your first morning urine specimen with you for the test. Keep it refrigerated until you take it in.
6. Consider counseling if you are stressed out.

WHEN TO CALL YOUR HEALTHCARE PROVIDER?

Call during office hours if:

• You think you might be pregnant.
• Your period is at least 5 days late and you have had sex.
• Your period does not return within 6 weeks.
• You need help with gaining or losing weight.
• You need help for binging and purging or extreme dieting.
• You need help for stress or depression.
• You have an abnormal vaginal discharge or abdominal pains.
• You develop a lot of face or body hair, bad acne, trouble seeing, headaches that won’t go away, a deeper voice, coarse skin, or if you feel hot or cold when no one else does.
• Your period does not return within 6 months after stopping birth control pills and you aren't pregnant.
• You have other questions or concerns.

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