home Audience 2 Why is there no reason for long periods? Delay and absence of menstruation (amenorrhea)

Why is there no reason for long periods? Delay and absence of menstruation (amenorrhea)

Normally, the menstrual cycle lasts from 21 to 35 days. For each woman, its duration is individual, but for most of them, the intervals between menstruation are equal or differ from each other by no more than 5 days. You should always mark the day your menstrual bleeding begins on your calendar so that you can spot cycle irregularities in time.

Often, after stress, illness, intense physical activity, or climate change, a woman experiences a slight delay in menstruation. In other cases, this sign indicates pregnancy or hormonal disorders. We will describe the main reasons for delayed periods and the mechanism of their development, and also talk about what to do in such a situation.

Why is there a delay?

Delayed periods may be the result physiological changes in the body, and also be a manifestation of functional failures or diseases of both the genital and other organs (“extragenital pathology”).

Normally, menstruation does not occur during pregnancy. After childbirth, the mother’s cycle is also not restored immediately; this largely depends on whether the woman is lactating. In women without pregnancy, an increase in cycle length may be a manifestation of perimenopause (menopause). Irregularity of the cycle in girls after the start of menstruation is also considered normal, if it is not accompanied by other disorders.

Functional disorders that can provoke a failure menstrual cycle, is stressful, intense exercise stress, rapid weight loss, previous infection or other acute illness, climate change.

Often, an irregular cycle with a delay in menstruation in patients suffering from gynecological diseases, first of all . In addition, such a symptom may accompany inflammatory diseases reproductive organs, occur after termination of pregnancy or diagnostic curettage, after . Ovarian dysfunction may be caused by pathology of the pituitary gland and other organs that regulate a woman’s hormonal levels.

Of the somatic diseases accompanied by possible violation menstrual cycle, it is worth noting obesity.

When is a delay in menstruation normal?

Puberty and the ovulatory cycle

Gradual puberty In girls, it leads to the appearance of their first menstruation - menarche, usually at the age of 12-13 years. However, in adolescence The reproductive system is not yet fully formed. Therefore, disruptions in the menstrual cycle are possible. Delayed menstruation in adolescents occurs during the first 2 years after menarche; after this period, it can serve as a sign of disease. If your period does not appear before the age of 15, this is a reason to visit a gynecologist. If the irregular cycle is accompanied by obesity, excess body hair growth, voice changes, and heavy menstruation, it is necessary to seek medical help earlier in order to begin correcting disorders in a timely manner.

Normally, by the age of 15, the cycle is already regular. Subsequently, menstruation occurs under the influence of cyclical changes in the concentration of hormones in the body. In the first half of the cycle, under the influence of estrogens produced by the ovaries, an egg begins to mature in one of them. Then the vesicle (follicle) in which it developed bursts, and the egg ends up in the abdominal cavity - ovulation occurs. During ovulation, short-term mucous white discharge appears from the genital tract, and there may be a slight pain on the left or right side of the lower abdomen.

The egg is captured by the fallopian tubes and travels through them to the uterus. At this time, the burst follicle is replaced by the so-called corpus luteum - a formation that synthesizes progesterone. Under the influence of this hormone, the layer lining the inside of the uterus - the endometrium - grows and prepares to receive the embryo when pregnancy occurs. If conception does not occur, progesterone production decreases and the endometrium is rejected - menstruation begins.

During fertilization and development of the embryo, the corpus luteum in the ovary continues to actively produce progesterone, under the influence of which the implantation of the egg, the formation of the placenta and the development of pregnancy occur. The endometrium does not undergo degradation and therefore is not rejected. In addition, progesterone suppresses the maturation of new eggs, so there is no ovulation and, accordingly, cyclic processes in the woman’s body stop.

If there is a delay

If menstruation is delayed by 3 days (and often on the first day), you can do a test at home to determine pregnancy. If it is negative, but the woman is still concerned about the delay, she should undergo ultrasonography uterus using a vaginal sensor, and also take a blood test that determines the level of human chorionic gonadotropin (hCG).

If the second phase of the cycle is determined, then menstruation will come soon; if there are no signs of the second phase, you need to think about ovarian dysfunction (we’ll talk about it below); during pregnancy in the uterus is determined ovum, and when it is located, for example, in fallopian tube(). In doubtful cases, the hCG test can be repeated after 2 days. An increase in its concentration by two or more times indicates the progress of intrauterine pregnancy.

Menstruation after childbirth

After childbirth, the menstrual cycle for many women does not immediately return, especially if the mother feeds the baby with her milk. Milk production occurs under the influence of the hormone prolactin, which simultaneously inhibits the synthesis of progesterone and ovulation. As a result, the egg does not mature, and the endometrium does not prepare to receive it, and then is not rejected.

Typically, menstruation returns within 8-12 months after childbirth due to breastfeeding baby and gradual introduction of complementary foods. A delay in menstruation during breastfeeding with a restored cycle in the first 2-3 months is usually the norm, and in the future it may indicate a new pregnancy.

Fading reproductive function

Finally, over time, women's reproductive function gradually begins to fade. At the age of 45-50 years, delays in menstruation, irregular cycles, and changes in the duration of discharge are normally possible. However, even at this time, ovulation is quite likely in some cycles, so if menstruation is delayed for more than 3-5 days, a woman needs to think about pregnancy. To exclude this possibility, you should consult a gynecologist in time and select contraceptives.

Intermittent cycle disorders

Delayed menstruation negative test often associated with the effect of unfavorable factors on the body. The most common reasons causing a short-term failure of the cycle duration:

emotional stress, such as a session or family troubles;
intense physical activity, including sports competitions;
rapid loss of body weight while following a diet;
climate and time zone changes when traveling on vacation or on a business trip.

Under the influence of any of these factors, an imbalance in the processes of excitation, inhibition and mutual influence develops in the brain nerve cells. As a result, a temporary disruption of the functioning of the cells of the hypothalamus and pituitary gland, the main regulatory centers in the body, may occur. Under the influence of substances secreted by the hypothalamus, the pituitary gland cyclically secretes follicle-stimulating and luteinizing hormones, under the influence of which estrogen and progesterone are synthesized in the ovaries. Therefore, when the functioning of the nervous system changes, the duration of the menstrual cycle may also change.

Many women are interested in whether there can be a delay in menstruation after taking antibiotics? As a rule, antibacterial drugs themselves do not affect the length of the cycle and cannot cause a delay in menstruation. However, what can lead to it is infection, for which the patient was prescribed antimicrobials. The infection has a toxic (poisonous) effect on nervous system, and is also a stress factor that contributes to disruption hormonal regulation. This is possible, for example, with cystitis.

Normally, the next menstruation after a delay in the listed cases occurs on time. More permanent cycle disorders may occur when using certain medications:

, especially low-dose;
long-acting gestagens, used in some cases for the treatment of other diseases;
prednisolone and other glucocorticoids;
hormone releasing agonists;
chemotherapeutic agents and some others.

How to induce menstruation if there is a delay?

This possibility exists, but we need to clearly answer the question – why does a woman need menstrual bleeding as a fact? Most often, representatives of the fair sex answer this question - to restore the normal cycle. In this case, you need to understand that thoughtless self-medication with hormonal drugs can, of course, cause menstruation, but is even more likely to lead to dysfunction of the reproductive system and impaired ability to conceive.

Thus, a woman will receive a much larger set of problems than just a delay in menstruation. Besides, she might be pregnant. Therefore, if menstruation is delayed by more than 5 days, it is recommended to take a home test to determine pregnancy, and then consult a gynecologist.

To normalize the cycle, the patient can only get rid of external factors that contribute to the delay (stress, fasting, excess load) and follow the recommendations of her doctor.

Diseases that cause delayed periods

Regular delays in menstruation are most often a sign of diseases of the hypothalamic-pituitary system or ovaries, less often - the uterus or appendages. This sign can also be observed in extragenital pathology that is not directly related to diseases of the female reproductive system.

Damage to the hypothalamus or pituitary gland can occur due to a tumor of neighboring parts of the brain or these formations themselves, or hemorrhage into this part (in particular, as a result of childbirth). Common reasons other than pregnancy for which the regularity of the cycle is disrupted are ovarian diseases:

Emergency hormonal contraception. If irregularity persists during the next cycle after intrauterine manipulation, you need to contact a gynecologist.

Finally, a delay in menstruation occurs with some extragenital diseases:

epilepsy;
neuroses and other mental disorders;
diseases of the biliary tract and liver;
blood diseases;
breast tumor;
adrenal diseases and other conditions accompanied by hormonal imbalance.

The variety of reasons why menstruation may be delayed requires careful diagnosis and different approaches to treatment. It is clear that only a competent doctor can choose the right tactics after a general, gynecological and additional examination of the patient.

Regular menstruation is one of the main signs of the absence of pathologies and dysfunctions in a woman’s body. If menstruation is delayed, the first thing girls think about is conception, but there are other reasons for delayed menstruation besides pregnancy.

In this article we will look at what a “delay” is, and also study all the possible reasons for the lack of regulation.

What is delay in girls, its norms

Delayed menstruation is a failure of menstrual function, which is manifested by the absence of regular monthly bleeding for more than 35 days. The delay can be caused by both physiological reasons and various functional and organic disorders. Irregular menstruation may accompany different periods woman's life. So, at puberty and during menopause there is a delay critical days is the norm.

Let's consider the basic delay standards:

if the delay does not exceed 5-7 days, it should not be considered a pathology. Such a short absence of critical days is typical for the period of puberty and premenopause, as well as for some disorders menstrual cycle(oligomenorrhea, opsomenorrhea, amenorrhea);
if there are infections and diseases in the body, menstruation may be delayed for 10 or more days, in this case it is necessary to consult a doctor;
During pregnancy, menstruation does not occur throughout the entire period of gestation until the cessation of breastfeeding. In this case, menstruation is delayed by 1-3 years. If a woman is not pregnant, and her period does not occur for more than a year, this may indicate the arrival of menopause.

To know exactly why menstruation has not occurred, you should definitely visit a gynecologist.

When the absence of critical days is the norm

First, let's look at what can cause a delay in menstruation in women in good physical health. It is considered normal that if menstruation is delayed, their absence can only occur during certain periods of the life of the fair sex:

during puberty;
during pregnancy;
after childbirth;
with the decline of reproductive function.

Now let's look at why periods don't come, and this is the norm, in more detail.

Puberty

Starting from 8-10 years old, girls start puberty, during which the young lady’s reproductive system is formed. Usually, by the age of 12-13 years, the first menstruation or so-called menarche appears. Due to the fact that reproductive system and the hormonal background has not yet fully formed, during this period, disruptions in the menstrual cycle will be quite natural.

During puberty, delays may appear for 1-2 years after the first menstruation, but if two years have passed and the cycle has not become regular, you should definitely consult a doctor and be examined for diseases. Also health care is needed in cases where the girl is already 15 years old, but menarche has not occurred. You should definitely find out why there are no periods if, in addition to the delay, the girl has problems with overweight, excess hair growth on the face and body, and voice changes. All this may be a sign of hormonal disorders that require medical correction.

In adolescents, by the age of 15, the menstrual cycle is usually normalized, and then a cyclical change in the level of hormones in the body occurs every month, which causes new regulations.

Pregnancy

To understand why critical days are delayed during pregnancy, we will describe the main processes that take place in a woman’s body during the menstrual cycle.

In the first half of the cycle, the ovaries begin to intensively produce estrogens, which promote the maturation of a new egg, which until it is fully ready is located in a special vesicle, a follicle. When sex cell ripe, the follicle bursts, and it exits into the uterine cavity. Thus, ovulation occurs, accompanied by slight mucous discharge from the genital tract and mild pain on the right or left side of the abdomen.

At the site of the ruptured follicle, the corpus luteum begins to rapidly develop, which synthesizes progesterone. Under the influence of this hormone, the inner mucous layer of the uterus begins to grow, increasing in size, and thus prepares to receive a fertilized egg in the event of conception. If fertilization does not occur, less progesterone is produced, and the endometrium, as unnecessary, begins to exfoliate and be removed from the uterus. This is how menstruation begins.

If the egg is fertilized, then the production of progesterone by the corpus luteum does not stop, but increases. Under the influence of this hormone, the zygote is implanted into the endometrium, the placenta begins to form and pregnancy develops. In this case, degradation and rejection of the endometrium does not occur, and progesterone suppresses the maturation of new eggs and the onset of subsequent ovulations. As a result, new periods do not occur. Thus, pregnancy is the main cause of delay for women who are active sex life and having no health problems.

Childbirth

Childbirth affects a woman’s body differently, so restoration of menstrual function occurs in every mother in individually. Most for duration recovery period influenced by the type of feeding of the newborn.

If a child immediately begins to eat artificial formula after birth, then the maximum delay in menstruation should not exceed 1 month. With combined feeding, critical days may be absent for 3-4 months. Regulae are delayed the longest for nursing mothers, since milk is produced under the influence of prolactin, which simultaneously inhibits the synthesis of progesterone and the onset of ovulation. Thus, prolactin prevents the maturation of the egg and the development of the endometrium, which means there is no germ cell for fertilization and a place for implantation of the zygote.

Against the background of breastfeeding with the gradual introduction of complementary foods (usually supplementing the baby’s diet with foods begins at six months of age), restoration of menstrual function occurs after 8-12 months. At the same time, for 2-3 months the cycle may be irregular, and it is quite possible that delays may occur; if critical days do not appear after this period, a pregnancy test should be taken.

Menopause

The number of eggs that mature in a woman’s body throughout her life is strictly limited, therefore, starting from the age of 40-45, reproductive function gradually fades away and menstruation becomes irregular. Their duration and nature also change. At this time, ovulation occurs periodically, so pregnancy should not be ruled out as a possible cause of delay. During menopause with an irregular cycle, it is better to use contraceptives to prevent pregnancy. Hormonal agents will help alleviate the symptoms of menopause and additionally protect against unwanted conception.

Why don't I get my period?

Most often, when menstruation is delayed, women who are sexually active suspect conception, but if there is no pregnancy and the test is negative, you should know what other reasons there are for the absence of menstruation besides the “interesting” position.

When a woman experiences a delay in menstruation, but is not pregnant, the lack of regulation can be caused by other physiological reasons besides pregnancy. First, you should rule them out, and only then suspect the presence of pathology and immediately seek help from a specialist.

Physiological reasons

During the menstrual cycle, normally all processes occur in a certain sequence, the main purpose of which is to prepare the woman’s body for conception and bearing offspring. Even a physically healthy woman sometimes experiences a delay in menstruation; such a failure is provoked by various external factors. Common causes of delay can be:

emotional overstrain. Even excessive anticipation of menstruation can provoke a delay; this happens when a woman has had unprotected sexual intercourse and is in a state of stress due to possible unwanted pregnancy. A similar reaction in the body can be caused by stressful situation at work or personal experiences;
excessive physical and mental stress, intense sports training and exercises involving heavy lifting;
change of place of residence, change of climate zone, also a delay in regulation may be associated with a change in daily routine and type of activity;
unbalanced diet, a large number of in the diet of unhealthy foods, strict diets, insufficient amounts of vitamins and nutrients, problems with excess weight;
colds, diseases of the digestive system and kidneys, diabetes;
reception antibacterial drugs and some other medications;
hormonal contraception, starting to take contraceptives, abrupt change in oral contraception or its cancellation;
body poisoning excessive doses alcohol, drugs and nicotine;
work in hazardous industries and on night shifts.

Physiological reasons for the absence of menstruation also include the factors discussed above: puberty, menopause and lactation. If after childbirth menstruation does not appear after a year, you should undergo a gynecological examination to rule out the presence of diseases due to birth injuries.

If you have ruled out all physiological causes, then your period is delayed due to pathology in the body. To identify it and prescribe adequate treatment, you should definitely seek help from a gynecologist.

Pathologies

The older a woman is, the more reasons can be found in her body that cause a delay in menstruation. If critical days do not occur, you first need to exclude pregnancy, and then suspect the presence of pathological conditions. Periodic delays in menstruation can cause diseases of the genital area and endocrine system. Let's consider the most common pathologies of each direction.

Disease affecting hormonal levels

Lead to violations hormonal levels and, as a consequence, diseases can lead to systematic and long delays of critical days thyroid gland, adrenal glands, ovaries and pituitary gland:

hypothyroidism A condition in which the thyroid gland produces insufficient amounts of thyroxine and triiodothyronine. These substances are directly involved in the synthesis of estrogens, progesterone and follicle-stimulating hormone in the ovaries. Without a sufficient amount of these hormones, the egg cannot mature, which means ovulation does not occur and menstruation does not begin. On initial stage disease, delay in the onset of menstrual periods is one of the symptoms of thyroid problems;
hyperprolactinemia - with this disease, the functions of the pituitary gland are affected. Intensive production of prolactin begins, which suppresses the secretion of estrogen, which prevents the timely maturation of the egg, ovulation does not occur, which explains the absence of menstruation;
oncological tumors in the brain or congenital hypoplasia of the pituitary gland;
benign neoplasm(adenoma) in the pituitary gland or adrenal gland. This tumor causes obesity, increased hair growth on the face and body, and menstrual irregularities;
improper functioning of the ovaries caused by hormonal imbalance, past inflammation;
If a girl’s period does not come on time, this may be caused by the installation of an IUD and the use of hormonal-based drugs.

Anorexia can cause a delay in menstrual periods. This mental illness, which is associated with digestive behavior disorders. Most often it affects young girls who strive to conform to the “glossy” canons. The desire to lose weight develops into an obsession, which is why food is not absorbed by the body, and it is completely depleted. Stopping menstrual function in this case is a defensive reaction female body, so when restored normal weight, menstruation resumes. For this disease, you may need to consult a psychotherapist and gastroenterologist.

If your periods are delayed due to the presence of endocrine pathologies, then in addition to visiting a gynecologist, you may need to consult an endocrinologist, but most often the delays are due to gynecological diseases.

Gynecological pathologies

Gynecological causes of delayed menstruation are diseases of the uterus and ovaries inflammatory in nature which lead to hormonal imbalances. At the same time, the concentration of hormones responsible for the maturation of the germ cell and the mucous layer of the uterus changes. As a result, there is a delay, the intensity and composition of monthly discharge changes, pain appears in the lower abdomen or lower back, and other pathological symptoms appear. In such a condition of the reproductive system, without proper treatment, tumors of both the genital organs and mammary glands can occur. Also, lack of proper therapy can lead to infertility. The cause of inflammatory processes can be an infection that has entered the genitals due to improper hygiene, unprotected sex, trauma to the uterus after childbirth, abortion and medical curettage.

If you don’t have your period, this may be due to gynecological pathologies that lead to delays:

What to do if you don't have your period

If menstruation is systematically delayed, this is not the norm for women of reproductive age. Such menstrual fluctuations can be harmful to a woman’s health, because the cause of a long delay can be not only pregnancy, but also a serious illness.

First thing to do if there is a delay menstruation is coming more than 10 days, buy a pregnancy test at the pharmacy; if it is negative, you should immediately go to the gynecologist.

Delay examination

If there is no period for a long time, and a woman wants to find out why there was a delay in a negative pregnancy test, she must undergo a gynecological examination. In case of absence of menstruation for a very long period, the doctor may additionally prescribe the following tests and examinations:

measurement and graphing of vibrations basal temperature, such a study will determine the presence or absence of ovulation;
blood test for hCG level, as well as tests for hormones of the ovaries, pituitary gland and other glands;
Ultrasound examination of the organs of the reproductive and excretory system. This method diagnostics allows you to determine uterine and ectopic pregnancy, the presence of benign and malignant tumors in the uterus, ovaries and signs of other diseases;
To exclude neoplasms in the ovaries or pituitary gland, CT and MRI of the brain may be prescribed.

If menstruation does not occur due to non-gynecological diseases, an additional visit to an endocrinologist, psychotherapist, nutritionist and other specialized specialists may be required.

Ways to provoke regulation

If your period is delayed, you can speed up its onset in several ways:

in order to restore menstruation, the delay of which is caused by stress, strict diet, vitamin deficiency, excess stress and other non-pathological factors, it is enough to eliminate external stimulus. The menstrual cycle will quickly return to normal if you rest well, eat well and do not subject the body to physical and emotional overload;
You can use emergency contraception such as Pastinor. This is a progesterone-acting drug, which after ovulation increases the level of progesterone in the body and can stimulate the rapid growth and detachment of the endometrium, thereby promoting speedy attack regul. Others have a similar effect hormonal drugs, such as Duphaston, Utrozhestan, Norkolut. But each of these drugs has a number of contraindications, so they can only be taken as prescribed by a doctor;
if your period comes late, your doctor may also prescribe injections that stimulate the muscle activity of the uterus. Increased tone the uterus can cause the onset of menstruation;
at home, you can provoke regulation with the help of herbal decoctions and chamomile infusions, bay leaf, tansy, parsley, blue cornflower, etc. Good efficiency with short delays, hot baths with iodine are indicated.

Despite the fact that there are a huge number of methods for dealing with delayed menstruation, each of them should be prescribed exclusively by a specialized specialist, since the reasons for the delay can be very different, which means that the method of dealing with the problem should be selected individually based on the results of tests and examinations.

Preventive measures

Preventing a disease is always easier than treating it later. To prevent the delay of critical days, it is better to maintain your health in normal condition in advance; for this, it is enough to follow several recommendations:

get rid of bad habits and lead healthy image life;
play sports, but do not allow severe overload of the body;
create a balanced diet, eliminating everything harmful products and drinks;
do not exhaust yourself with hunger and strict diets;
use medications only as prescribed by a doctor;
Go for preventive examinations to a gynecologist at least 2 times a year.

Every woman sometimes experiences delays, but if you follow the tips above, the likelihood of them occurring will be minimal.

What are the dangers of constant delays?

Absence of menstruation is not dangerous condition for a woman, the reasons for the delay may be much more serious, especially when it occurs monthly. The most positive reason that the regulations are late is pregnancy. Constant delays menstruation not only causes discomfort to a woman, confusing her plans, but can also indicate the presence of serious pathologies in the body.

If there is a delay, you should visit your doctor every month as soon as possible, because early diagnosis allows you to start treatment of diseases and neoplasms in a timely manner, prevent early menopause, prevent infertility or eliminate ectopic pregnancy, which is dangerous not only for a woman’s health, but also for her life.

Conclusion

First of all, if menstruation does not come on time, a woman should take a pregnancy test, and if the result is negative, seek help from a doctor, especially if there is a general deterioration in her condition, an increase in temperature and painful sensations in the lower abdomen. If the woman feels well and there are no pathological symptoms, then a visit to the gynecologist can be scheduled on the tenth day of the delay.

Delays in menstruation, especially when long absence are quite a serious disorder of the menstrual cycle, the elimination of which should be monitored by a gynecologist.

The menstrual cycle is an important indicator reproductive health women. If there are serious deviations in it, then it is very difficult to get pregnant. Therefore, you should pay special attention to any changes in the frequency and duration of your periods. And there are cases when menstruation is completely absent. In the medical community, this is called amenorrhea and seriously scares a woman, forcing her to think about the reasons similar phenomenon. But complete answers can be obtained from a doctor after undergoing an appropriate examination.

Physiology of menstruation

Cyclical changes in female body due to the coordinated operation of several systems. The central regulatory department consists of the cerebral cortex, hypothalamus and pituitary gland, which are responsible for the synthesis of liberins and gonadotropic hormones (follicle-stimulating, luteinizing). At the second level are the ovaries, which, under their influence, produce estradiol and progesterone. And they, in turn, support processes in the uterine mucosa.

Menstruation represents the rejection (desquamation) of the functional layer of the endometrium. After their completion, the follicle matures in the ovary, and the concentration of estrogen in the blood gradually increases. This triggers proliferation processes that restore the uterine mucosa. In the middle of the cycle, the dominant follicle ruptures and an egg is released from it (ovulation). The corpus luteum then forms at this site, producing progesterone. And under the influence of the latter, the endometrium swells and enters the secretion phase, preparing the uterus for possible implantation of the embryo. If this does not happen, then your period comes again.

Causes and mechanisms

Based on the normal state of affairs, we can assume that the absence of menstruation indicates pregnancy. Indeed, for many women this option is the most preferable. Delayed discharge is a sure sign of conception and implantation of the fertilized egg. At this time, the corpus luteum of the ovary continues to function, secreting progesterone, and the endometrium nourishes the embryo. But besides pregnancy, there are other physiological causes of amenorrhea. These include:

Adolescence.
Breastfeeding a child.
Menopause.

These are situations in which amenorrhea is considered normal and does not require medical intervention. But the reasons for the absence of menstruation are by no means limited to them. Much more attention should be paid pathological conditions in the gynecological field or other body systems: functional, organic or congenital. Taking into account the level of damage, they are reflected in the table.

Thyroid hormones also play an important regulatory role. Therefore, hypothyroidism also contributes to the reduction and complete cessation of menstruation. It is also necessary to mention a pathology in which the cycle is not disrupted, but menstrual blood is not released. This occurs with atresia of the vagina or hymen, or cervical anomalies. But similar conditions are considered causes of false amenorrhea.

It is customary to talk about pathology when there is no menstruation for six months. That is, with amenorrhea they are quite absent long time. Therefore, risk factors must have a sustainable adverse effect on the body. And in addition to internal conditions, external reasons can contribute to disruption of the female cycle:

Thus, amenorrhea cannot be considered an independent disease. It is considered the result of endocrine, genetic, inflammatory, tumor pathology and traumatic damage to the organs responsible for regulating the female cycle. In the absence of menstruation, the reasons are so multifaceted that only a doctor can understand them. A woman should only notice the violations in time and immediately contact a specialist.

Menstruation may be absent for various reasons: physiological or pathological. But only a doctor will determine the source of the problem.

Classification

IN clinical practice There are several types of amenorrhea. It all depends on the origin of the pathology and the mechanisms involved in its development. Based on this, the absence of menstruation may be:

Primary and secondary.
True and false.
Physiological and pathological.

The primary nature of the disorders is spoken of in cases where girls aged 17–18 years have not started menstruation at all. If they were going as usual, but then suddenly stopped, then they diagnose secondary pathology. And pathological amenorrhea, depending on the level of damage, is divided into hypothalamic, pituitary, adrenal, ovarian and uterine (as mentioned above).

Symptoms

If menstruation was initially present, then before it stops altogether, other disturbances in the female cycle may occur. Sometimes they are perceived as transient (temporary) changes, and therefore diagnosis is delayed. More often we're talking about O various options hypomenstrual syndrome:

Brady- or opsomenorea (the intermenstrual interval is 1.5–2 months).
Oligomenorrhea (bleeding lasts no more than 2 days).
Hypomenorrhea (discharge volume less than 40 ml).

But most often these signs accompany each other. When this is observed in a woman aged 45–50, there is no need to worry, because this indicates a natural decline in fertility and the onset of menopause. But during reproductive age, this creates significant problems, primarily with conceiving and bearing a child (infertility).

Since the absence of menstruation is just a symptom, the doctor conducts a detailed examination of the patient in order to identify other signs of disorders in the body. We often encounter systemic disorders that complement the clinical picture and help in diagnosis.

Polycystic ovary syndrome

Among all forms of secondary ovarian amenorrhea, the first place is occupied by polycystic ovary syndrome (Stein-Leventhal). The disease is characterized by increased synthesis of androgens due to a defect in enzyme systems. The ovaries increase in size, and many cystic atretic follicles form in them. The clinical picture is characterized by the following signs:

Increased body weight.
Excessive hair growth (hirsutism and hypertrichosis).
Infertility.

In typical cases, menstrual irregularities appear in adolescence: in the form of a primary absence of discharge or as oligo-, opso- or hypomenorrhea. And the reproductive period is characterized by the absence of ovulation. Menstruation may be normal, but erratic. And pregnancy, if it occurs, is often complicated by miscarriage.

In women with polycystic ovary syndrome, regulatory processes in the hypothalamic-pituitary system are also disrupted, and lipid and carbohydrate metabolism disorders occur. Such patients have increased risk hypertension, atherosclerosis and coronary disease, gynecological tumors.

The clinical signs of Stein-Leventhal syndrome are varied, but the main symptom of the disease is considered to be menstrual and reproductive dysfunction.

Itsenko-Cushing's disease (syndrome)

Itsenko-Cushing's disease occurs against the background of a basophilic pituitary adenoma with signs of hypercortisolism, increased production of corticotropin and decreased levels of gonadotropic hormones. And with the syndrome of the same name, hyperplasia of the adrenal cortex is observed. The clinical picture consists of the following signs:

Disproportional obesity (upper type).
"Moon-shaped" face.
Purple stretch marks on the abdomen, buttocks, thighs.
Virilization.
Increased pressure.
Lack of menstruation.
Muscle weakness.
Dry skin, acne.

Hormonal disorders cause metabolic disorders in organism. Suffering the most carbohydrate metabolism: glucose tolerance decreases, signs of steroid diabetes appear.

Gonadal dysgenesis

Malformations of the gonads are observed with various genetic anomalies. Gonadal dysgenesis is not very common, but in the absence of menstruation in adolescence, it also requires exclusion. There are several forms of pathology:

Typical – Shereshevsky-Turner syndrome (karyotype 45X0).
Pure – Svaer syndrome (karyotype 46XX or 46XY).
Mixed – karyotype 45X0/46XY.

In addition to primary true pathological amenorrhea, patients with gonadal dysgenesis are diagnosed short stature, hypoplasia of the external and internal genital organs, and often other anomalies: chest, kidneys, cardiovascular system.

Sheehan syndrome

Early postpartum period may be complicated by hypo- or atonic bleeding. Therefore, in women, hypoxia can occur, and then necrosis of the pituitary gland. This becomes the cause of hypopituitarism, which is manifested by hormonal deficiency and polymorphic neurovegetative symptoms. Most often we are talking about the following symptoms:

A woman cannot breastfeed her child, but she also does not have menstruation, because the cycle depends entirely on pituitary hormones. If its posterior lobe is affected, then a disease occurs called diabetes insipidus. It is characterized by excessive urine production and dehydration.

Sheehan syndrome is the second most common cause of hypopituitarism. This pathology can have serious and even dangerous manifestations.

Intrauterine synechiae

Causes related to the uterus include conditions such as synechiae or Asherman's syndrome. Connective tissue adhesions form in the organ cavity due to inflammatory processes or injury inner shell during abortion or other operations. More often clinical picture consists of signs of hypomenstrual syndrome, but more severe cases typical complete absence menstruation.

When synechiae close the exit from the uterus, even with a functionally active endometrium, blood cannot get out. This leads to the development of hematometra, which manifests itself:

Heaviness and cramping pain in the lower abdomen.
Increased heart rate.
Weakness.
Dizziness.
Increasing temperature.

Subsequently, a transformation into pyometra may occur - then the woman’s condition suffers even more, because there are phenomena of shock.

Additional diagnostics

Determining the origin of amenorrhea is not an easy task. The woman will have to undergo a whole set of diagnostic procedures, necessary for the doctor to confirm the diagnosis. The examination may include the following laboratory and instrumental techniques:

General blood and urine tests.
Blood biochemistry: hormonal spectrum (lutropin, follitropin, prolactin, corticotropin, thyrotropin, vasopressin, cortisol, estradiol, testosterone, human chorionic gonadotropin), electrolytes, glucose, coagulogram, inflammation indicators, etc.
Genetic research (karyotyping).
Ultrasound of the pelvic organs and adrenal glands.
X-ray of the sella turcica.
Tomography.

Each case requires differential diagnosis, because the symptoms can be very similar. And the gynecologist often requires consultation with an endocrinologist or geneticist. Qualified and experienced specialists will determine the cause of amenorrhea, and based on the examination results, they will provide treatment aimed at restoring the woman’s menstrual and reproductive function.

Why does a girl of reproductive age who is sexually active not have periods? First of all, you can suspect pregnancy, but not only it, but also many other circumstances and reasons can lead to delays in menstruation. Let's look at the most common situations.

Pregnancy

If you haven’t had your period for 1-2 weeks or more, even though you don’t exclude the possibility of pregnancy, you can certainly dispel your doubts in several ways. At this stage, the ultrasound can already show the fertilized egg (if it is in the uterus). According to a blood test, the hCG level is significantly higher than zero and corresponds to the stage of pregnancy. During a gynecological examination, the doctor diagnoses an enlarged uterus, acquiring a round shape (outside interesting situation it has the shape of a pear), cyanosis of the cervix and labia. There will be no periods throughout pregnancy and for some time after childbirth.

Lactation

The pregnancy period gradually gives way to the lactation period. Many young mothers never begin to have their periods... throughout the entire period of breastfeeding. For those who start, they come, most often, irregularly, and may be too scanty.

Young age

Why has a 13-15 year old girl not had her period for 2 months? There is nothing surprising here. In girls, the first two years after menarche (first menstruation) may experience delays of up to 2 months, and this does not at all indicate pathology. You just need to wait or visit pediatric gynecologist, which will dispel all doubts.

Menopause

Every woman at the age of 40-55 experiences a gradual decline in ovarian function, that is, reproductive function fades, ovulation becomes increasingly rare, as well as menstruation. If you are about 40 years old and you are experiencing menstrual irregularities that you haven’t had before, it is recommended that you go to a gynecologist and get examined. It is quite possible that she is competent hormone therapy will help prolong youth, since it is known that after menopause, a woman not only cannot get pregnant, but also the aging process begins to occur much faster.

Lifestyle change

Why is there no menstruation, and the test is negative in a woman who is not too young, who is not breastfeeding and has excellent health (no gynecological problems)? If this problem is not systematic, then the reasons must be sought in changing your lifestyle. Perhaps you started to adhere to some kind of strict diet or simply suddenly lost several kilograms, and these kilograms were not superfluous. Then you need to gain a little weight again, and your periods will return. Sometimes delays occur due to strong emotions, stress, during long trips, especially to places with unusual climatic conditions. In a word, periods can be delayed with any change in lifestyle. A one-time delay means nothing.

Hormonal shifts

Very often, when asked “why don’t I have periods,” doctors answer that it’s normal? hormonal disbalance. And if this is really a small “glitch”, then it’s okay. But the reasons may be more serious, such as, for example, increased level the hormone prolactin (by the way, due to which menstruation does not occur during lactation) due to microadenoma (tumor) of the pituitary gland; or hirsutism, which occurs due to high content"male" hormones in a woman. Hirsutism is manifested by hair growth male type(hair appears above the lips, on the chin, on the thighs, and very abundantly; acne appears on the skin, etc.). Both of these pathologies are detected through a blood test + doctor’s observation of the patient.

Diseases of the genital area

For example, a cyst corpus luteum. It is diagnosed using ultrasound. In addition to the delay of menstruation, nagging pain may be observed in the area of the ovary, where the cyst has formed, and in the lower back. If the cyst remains in the ovary for a long time, it may rupture and cause severe bleeding. If the cyst does not go away on its own, and the woman feels any discomfort due to its presence, surgery may be performed.

The menstrual cycle may also be disrupted with adnexitis - inflammation of the fallopian tubes and ovaries. The disease reveals itself primarily through pain. The most common causes are hypothermia and various infectious diseases.

You can talk for a long time about why there is no menstruation due to this or that disease. But why guess? The diagnosis must be made by a doctor. And in conclusion, we will talk about the tests and examinations that you will most likely have to undergo if you are affected by the problem of an irregular menstrual cycle.

Survey

If you think several times a year about why you don’t have your period, but the test is negative, then it’s time to get properly examined. After all, the absence of menstruation indicates some kind of problem in the body. At a minimum, it will be difficult to get pregnant, and at maximum, an irregular menstrual cycle may be one of the symptoms of serious diseases - endocrine, for example.

First, the doctor must make sure that the patient is not pregnant (either uterine or ectopic). To do this, the woman is given a referral for a blood test for human chorionic gonadotropin. If there is no pregnancy, and there are no complaints other than irregular menstruation, the gynecologist recommends that the woman measure her basal temperature for at least 3 months and make charts. Based on them, it will be possible to judge the presence of ovulation and how the cycle proceeds as a whole. Next, an ultrasound of the uterus and hormone tests are prescribed. Based on their results, the doctor may refer the woman for consultation to other specialists - for example, to an endocrinologist. If it is clear that a girl is underweight (which may be the cause of amenorrhea), then she is recommended to visit a nutritionist. Additional examinations not related to gynecology may also be prescribed if various pathologies are identified. For example, if prolactin is elevated, magnetic resonance imaging may be prescribed in order to exclude the presence of a benign pituitary tumor, which is often the cause of hyperprolactinemia.

In a word, don’t let the situation get worse. If your body gives you signals that something is wrong with it (delayed menstruation), you need to respond to them. Be healthy!

When consulting women, an obstetrician-gynecologist often encounters the complaint of “delayed menstruation.” In this case, the patient has concerns and natural questions: “Is everything okay? What if I’m pregnant? Does this happen to others? Am I healthy?” Let's talk about the reasons for this condition, which can be different.

A little physiology

The menstrual cycle is the monthly changes in the female body that occur under the influence of sex hormones. The main sign of a normal cycle (its duration is 21-35 days) is considered to be regular menstruation - bloody discharge from the genitals, the normal duration of which is 3-7 days. Normal blood loss during menstruation does not exceed 50-100 ml.

Menstrual function is regulated through the joint activity of a complex complex of nervous and humoral structures (cerebral cortex; hypothalamus and pituitary glands internal secretion located in the brain), as well as the genital organs (ovaries, uterus). Since all levels of this system are interconnected, the delay next menstruation may be associated with a malfunction of any of the listed links. Therefore, the cause of delayed menstruation can be a “breakdown” at any level of regulation of the menstrual cycle.

Causes of delayed menstruation

Delayed periods may be caused by various gynecological diseases, such as inflammation of the uterine appendages (salpingoophoritis), uterine fibroids ( benign tumor uterus) and others. However, it should be noted that with these diseases bleeding from the uterus is more often observed.

Periodic delays in menstruation are characteristic of a disease such as polycystic ovary syndrome (PCOS). This concept combines a number of pathological processes, in which the production of hormones is disrupted. In this case, ovulation (the release of an egg from the ovary) does not occur in the body and infertility occurs.

PCOS is observed when the function is impaired various organs: hypothalamus, pituitary gland, adrenal glands, thyroid gland and the ovaries themselves. Therefore, the disease can manifest itself differently depending on the causes of its occurrence, and to establish a diagnosis it is not enough to use any one diagnostic sign or method.

With polycystic ovary syndrome, the most common problems are menstrual irregularities (more often - delays from several days to several months), excessive growth of body hair, an increase in the size of the ovaries (but not always), and in half of the patients - obesity. When measuring basal temperature (in the rectum), it remains approximately constant throughout the cycle, and does not increase in the second half, as is normal. In the most severe (primary) form of the disease, these signs appear already in adolescence after the onset of menstruation.

To treat this condition, various hormonal drugs are prescribed, drugs are used that reduce the level of male sex hormones (the formation of which increases with this disease), regulate metabolic processes in the structures of the brain, etc. In the presence of obesity, it is absolutely necessary to reduce body weight. When preparing for a planned pregnancy, an important stage of treatment is to stimulate ovulation - the release of an egg from the ovary. For this purpose, medications are used, and if they are ineffective, they are used surgical methods treatment. Currently, it is performed by laparoscopy: in the anterior abdominal wall small holes are made through which optical instruments for examining the abdominal cavity and surgical instruments are inserted.

Delayed menstruation may also occur after termination of pregnancy. The reason is a violation hormonal balance, as well as the fact that during instrumental curettage of the uterus, an excessive amount of tissue can be removed, including that part of the inner lining of the uterus, which normally grows during the menstrual cycle and is released in the form menstrual blood. To restore this functional layer sometimes takes a little longer than during a normal cycle. That is, after an abortion, menstruation may occur not after 28-32 days, but after 40 days or more. This delay is not normal: the woman requires examination and treatment.

The cause of delayed menstruation may be taking oral contraceptives. While taking the drug or after its withdrawal, absence of menstruation may occur for several menstrual cycles: this is the so-called ovarian hyperinhibition syndrome.

If ovarian hyperinhibition syndrome develops, oral contraceptives are discontinued. As a rule, within 2-3 months, maximum within 6 months after the end of their use, ovarian function is spontaneously restored. If the absence of menstruation persists for a longer period, drugs that stimulate the pituitary gland (CLOMIPHENE) or drugs that stimulate the maturation of the egg and its release from the ovary (PERGONAL, CHORIONIC GONADOTROPIN) are prescribed. Until normal menstrual function is restored, it is necessary to use other methods of contraception.

Stress- long-term or strong short-term - is the cause of a malfunction of the central structures (cerebral cortex, hypothalamus) that regulate the functioning of the ovaries and uterus. An example of such disorders is the so-called wartime amenorrhea, when women stopped menstruating under conditions of stress.

Another reason for a significant delay in menstruation can be significant and rapid weight loss. So, doctors have such a concept as critical menstrual weight - this is the weight at which teenage girls, as a rule, begin to menstruate. However, we are more interested in the fact that when strong desire to lose weight, having reached this critical menstrual mass (45-47 kg), a woman can gain not only desired result, but also a long delay in menstruation.

Most often this effect occurs when anorexia nervosa- eating disorder, characterized by refusal to eat and/or its rejection. This is accompanied by a disorder in the functioning of such regulatory systems of the body as the nervous and endocrine ones. Anorexia nervosa characterized by a sharp decrease in the production of pituitary hormones, which also regulate the functioning of the ovaries. In this case, reproductive dysfunction should be considered as defensive reaction under conditions of nutritional deficiency and mental stress. Therefore, to restore age-related hormone secretion, it is necessary to achieve ideal body weight and eliminate mental stress.

Anorexia nervosa in 50% of cases can occur with episodes bulimia(gluttony), after which the patient shows particularly obvious signs of anxiety, remorse and depression, and successful attempts to induce vomiting.

For this reason, when preparing for pregnancy, do not try to achieve the ideal “90 - 60 - 90”. If you are planning to lose weight, treat it wisely, or better yet, consult a nutritionist.

Pregnancy- this, fortunately, is the most common and most physiological cause of delayed menstruation in women of reproductive age. In this case, a delay in menstruation may be accompanied by such signs as changes in taste and olfactory sensations, engorgement, and soreness of the mammary glands. As a rule, a pregnancy test in this case gives positive result. Delayed menstruation also occurs during ectopic pregnancy, when the fertilized egg attaches to the fallopian tube. In this case, all subjective sensations characteristic of pregnancy may also be present.

What can the doctor do?

In case of menstrual irregularities, you should immediately consult a doctor. An examination by an obstetrician-gynecologist will help rule out conditions that require immediate surgical intervention. This could be an ectopic pregnancy, frozen pregnancy, tumor diseases, etc.

To understand the cause of menstrual irregularities, the doctor may prescribe additional examinations:

measuring basal temperature and charting its changes- these measurements, along with other methods, make it possible to judge the presence or absence of such an event as ovulation - the release of an egg from the ovary;
Ultrasound of the pelvic organs- uterus, ovaries;
blood test for hormones- with its help, the level of hormones of the pituitary gland, ovaries, and, if necessary, other endocrine glands is determined;
computed or magnetic resonance imaging- methods that can be used to obtain layer-by-layer images of brain structures to exclude pituitary tumors.

If there are associated endocrine diseases The gynecologist will prescribe a consultation with other doctors - an endocrinologist, a psychotherapist, a nutritionist.

Ildar Zainullin
obstetrician-gynecologist, Ufa

Discussion

I have a delay of 8 days, pain in the lower abdomen, as if it will start soon, but there is none (
Strong white discharge
There are no signs of pregnancy, no nausea, no changes in taste, the chest does not hurt, there is nothing, what could it be?

Hello. I’m already 7 days late and why is this or pregnancy?

02/08/2018 10:50:30, Tursyn

Good article, thanks. In my life I have experienced delays due to stress. And more than once. The most important thing in this situation is not to be nervous. And, since I myself cannot counterattack it, I took and continue to take courses of Theanine from Evalar, good drug Helps with stress, calm down, relax.

my sister was delayed for a month due to hormonal imbalance and also had dysbacteriosis - she was injected with progesterone then and was prescribed a drug to restore the microflora, after that there were no problems

For me, the article is also quite tolerable, some points and subtleties may not be revealed, but in general it is well written.
By the way, I also didn’t attach any importance to this cycle before, until I started thinking about the baby, and then it started, then one point needs to be taken into account, then treated here, corrected there (They also prescribed a time factor to stabilize the cycle. I have a problem only after half a year I made up my mind a year ago, and now I’m almost a mommy.

I don't agree that the article is weak. Everything is described very clearly. I like it. I also had a problem with my cycle, at first I didn’t go to the doctor, it didn’t really interfere with my life. And then, when I decided to give birth, it was not there. I couldn’t get pregnant right away. Until the doctor prescribed me treatment, my cycle did not even out, I did not get pregnant. I took Time Factor for three months and voila)))) My baby is already with me, we are almost a month old!!!

give me internet ****

06/04/2007 15:49:19, Boba

05/30/2005 18:11:42, Listik

extremely weak article...:(((((

Comment on the article "Delayed menstruation - why does this happen?"

Before the exams I didn’t have my period for 2 months. In general, everything depends on nutrition. There are functional cysts ovaries, which lead to delays.

Delayed menstruation - why does this happen? Causes of delayed menstruation. A delay in menstruation can be caused by various periods. Menstruation has become much heavier.

Discussion

This phenomenon happens to me after a sudden change in climate, physical activity and diets. Only a gynecologist can tell for sure.

I don’t want to upset you, but it’s very similar. Perhaps there will be such an uncertain period for a long time

Delayed menstruation - why does this happen? Causes of delayed menstruation. Delayed menstruation can be caused by various gynecological diseases, such as...

Discussion

With a longing, I received “Novinet”, after the change, the first menstruation came after being postponed for 10 days on the 12th of Wednesday, there are no others (
DUFASTON and SPIRONOLACTONE were prescribed. The ultrasound did not clearly write “echo signs of PCOS, paraovarian cyst?” under a question mark
I don’t understand at all, other than from the conclusion it is read that the IA is 36*29mm, and the LA is 48*30mm

It is necessary to examine not only a gynecologist, but also an endocrinologist. Duphaston is an excellent remedy for solving such problems, but maybe the doctor will also advise you to connect OK.

Delayed menstruation - why does this happen? Causes of delayed menstruation. Delayed menstruation can be caused by various gynecological diseases...

Discussion

Oh, Nastenka, of course I’m hoping for a miracle, so I’m waiting for the test result, and it needs to be repeated in a couple of days, even if it’s negative tomorrow. Did your chest hurt before after stopping duphaston? In general, I heard that after cancellation you can wait a week for months.

You can wait 10 days, in general there is a corpus luteum cyst on duphaston, you can do an ultrasound and see if it is there. If there is, this is not at all scary and even good - it means that the ovaries are working, it’s just that there may be a delay due to the cyst.