Does it matter if I’m missing menstrual cycles?

You might be quite happy to miss a menstrual cycle for a few months and this is a very normal experience for newly menstruating teens and women in perimenopause.

For women outside of these phases, missing a menstrual cycle every once in a while is not really a big deal and can be a normal phenomenon if you’ve had a bad illness or a major stressor in life, but when you're having more chronic irregularities we need to dive deeper.

Why?

The menstrual cycle and ovulation that occurs within this cycle supports the production of estrogen and progesterone.  Estrogen and progesterone are SO important in terms of maintaining bone density over time and in terms of preventing cardiovascular disease.  While you may not care about bone density and cardiovascular disease in the menstruating years, these are REALLY significant causes of illness and death in women with age.  

Estrogen and progesterone are also very key in terms of supporting mood and sleep.  And of course, we need ovulatory menstrual cycles in order to get pregnant.  

Another reason we want to investigate if you’re missing menstrual cycles is because the underlying cause of that menstrual cycle irregularity might be from a condition that will have other side effects or future health risks.  

Irregular menstrual cycles might be the first symptom of hypothyroidism, or of PCOS, or of hypothalamic amenorrhea.  Each of these conditions can contribute to other health concerns and risks, so we want to understand them in order to put a plan in place to decrease those risks and manage your symptoms. 

We don’t need to have a menstrual cycle exactly every 28 days, and it’s normal to vary from one cycle to the next by up to 7 days.  

What we want is to have at least 9 cycles in a year to maintain bone density, preferably not more than 35 days apart (or 45 days apart for teens).

Where does the oral contraceptive pill (OCP) come into play?

The OCP shuts down ovulation by inducing a pregnancy-like hormonal state.  While this will lead to regular bleeding (assuming you’re taking the placebo pills), this is not ‘regulating’ your cycle, but shutting it down.  There’s definitely a time and place where this can be beneficial and can be a great option in terms of symptom management and pregnancy prevention, but it doesn’t tell us what’s happening to cause the irregularities and what else we need to eventually address.  This is great at certain stages of life, but eventually we want to understand more.  

If you’re having concerns with your cycles - let’s dive deeper and figure out what’s going on!