May they not start? Why don't I get my period? Sexual health is normal, but still no periods...
The delay is not always caused by pregnancy. There are at least 10 reasons why your period did not start on time.
The duration is different for each woman. Normally, this figure is in the range of 21-35 days. Sometimes your period comes 1-2 days earlier than the usual date, and sometimes it can be delayed by a couple of days. These phenomena are also within normal limits. But if menstruation does not start after 5 days, this is already considered a delay. The most common cause is pregnancy. But it happens that tests stubbornly show a negative result, but there are still no critical days. Or the delay occurred in a woman who theoretically and practically could not get pregnant. There are at least 10 reasons why your period did not start on time, and all of them are a reason to visit a doctor.
Pregnancy
The most common and most natural cause of delay in women of reproductive age. It may be accompanied by changes in taste and smell sensations, engorgement and soreness of the mammary glands.
An ectopic pregnancy can also cause delays. In this case, the fertilized egg is attached to the fallopian tube. This is a dangerous condition that threatens a woman's life. In the early stages, its symptoms are no different from normal pregnancy. Pregnancy tests show negative results, or the stripes are faint. Determination of the level of human chorionic gonadotropin, examination results and ultrasound will help determine the final diagnosis.
Ovulatory abnormality
The reason for the lengthening of the menstrual cycle may be acute inflammation, severe stress, lack of ovulation or late ovulation in this cycle. For example, if a woman took, ovulation could occur 10-15 days later than usual.
Taking oral contraceptives
Late ovulation can also be caused by taking or abruptly stopping birth control pills mid-cycle.
While taking oral medications or after stopping the drug for several cycles, menstruation may be absent. This is the so-called ovarian hyperinhibition syndrome. If the drugs cause the development of such a syndrome, their use is discontinued. Usually within 2-3 months (maximum 6 months) ovarian function is restored. Otherwise, the woman is prescribed medications to normalize the cycle.
Gynecological diseases
The most common diseases are ovarian cysts and polycystic ovaries.
Ovarian cysts are formed as a result of hormonal imbalance. The cells of these cysts produce the hormone progesterone, which leads to disruption of the second phase of the menstrual cycle. Since hormonal levels do not ensure timely rejection of the endometrium, menstruation is delayed.
Polycystic ovary syndrome is accompanied by a disruption in the production of hormones and interferes with ovulation.
In addition, the delay can be caused by inflammatory processes in the uterus, in the uterine appendages, and ovarian dysfunction.
Diseases of internal organs
Disruption of the adrenal glands, pancreas, pituitary gland, hypothalamus, thyroid disease, diabetes mellitus can lead to disruption of the hormonal cycle, and, as a result, to cycle disruption.
Abortion
Abortion (medical or voluntary) leads to hormonal imbalance. In addition, during instrumental curettage of the uterus, too much tissue may be removed, including part of the lining of the uterus, which normally grows during the cycle. This layer needs to be restored, so after an abortion, menstruation may begin 40 days or more later.
This is not normal and requires examination and treatment.
Perimenopause
After 40 years, ovarian function begins to fade - a woman’s reproductive age ends. Delays in menstruation at this age are explained by the fact that ovulation often does not occur or is delayed. However, there is still a chance of getting pregnant.
Sudden weight change
Being underweight, like obesity, can disrupt your cycle.
With rapid and severe weight loss, the body lacks vitamins, minerals and nutrients. The functions of many body systems are disrupted, which leads to failures.
Obesity is also often accompanied by hormonal imbalances and changes in cycle length.
Abrupt climate change
The reaction of the female body to a sudden change in climate is one of the 10 reasons why menstruation did not start on time. The more difficult acclimatization is for a woman, the higher the likelihood of cycle failure. On the other hand, the delay may be caused by emotional shock due to a change in place of residence/stay.
Excessive exercise
Regular intense sports activities and heavy lifting affect the cycle. This is due to the physical and psychological stress that such activities place on the female body, as well as the low percentage of body fat in female athletes.
Every woman’s body is designed to be able to perform a large number of functions, one of the most basic being childbearing. Consequently, it is the main difference between the fair sex and men. The female reproductive system is designed in such a way that it provides for such a monthly phenomenon as menstruation. Thus, every girl should know what to do if her period starts suddenly and what measures should be taken immediately.
Basic concept of menstruation
Menstruation is the result of a complex process that occurs as a result of puberty and the normal functioning of the female body. When puberty is reached, each woman can feel certain changes in the body that lead to pregnancy and, as a consequence, logical childbirth. The process is called the menstrual cycle, which occurs with a certain regularity and begins with menstruation.
The average duration of the period is from twenty-one to thirty-five calendar days. This indicator is individual for each woman. However, if a woman’s sexual health is normal, then despite the duration, the menstrual cycle is regular and repeats from month to month with the same frequency.
In some cases, menstruation may be delayed or a little rushed. This may be due to changes in the female body, stressful situations, climatic conditions and other negative factors. If we talk about pathologies that require consultation with a gynecologist and subsequent treatment, the following conditions can shift the menstrual cycle:
- inflammatory process of female genital organs;
- previous surgical interventions;
- hormonal imbalance and others.
Therefore, to summarize and understand what menstruation is, it is worth saying that menstruation is a monthly condition of the female body, which manifests itself in the form of bleeding as a result of the maturation of the egg and detachment of the upper lining of the uterus. The duration of the menstrual period is from three to six days. In gynecology, it is customary to consider the first day of menstruation as the first day of the menstrual cycle.
Basic actions if menstruation starts unexpectedly
What to do if your period begins, but you are not ready for such a process? This question is common today, since menstruation has a certain peculiarity of starting exactly at the moment when you do not expect it. This is especially true for teenage girls, when the menstrual cycle is not yet stable and bleeding may begin suddenly.
To understand how to act in the event of a sudden onset of menstruation, it is worth considering the most common cases when menstrual periods begin unexpectedly and how to act in this case.
Menstruation caught by surprise at sea
Of course, it is best not to plan a trip to the sea during your period, but menstruation does not always start on time and therefore can become the most unpleasant surprise. Therefore, you should clearly understand what to do during your period if you start having it during your vacation in the sea.
If you nevertheless decide that no menstruation can interfere with a full-fledged sea holiday, then you can breathe a sigh of relief, since you can choose tampons as a means of protection, which can be used while swimming in the water.
However, it is worth considering the fact that if a girl is a virgin and has not yet learned what sex life is, then as a means of protection it is worth choosing special tampons that are equipped with an applicator. During menstruation, such a tampon can be used. However, you should definitely ensure that its size is minimal or has a mark of two drops.
As for women who are sexually active, they may need such a thing as a special menstrual cup, which does not leak and is effectively used during a sea holiday. You can swim with it and it is reusable, which is also very convenient.
As for using a tampon, it is worth considering that it should be replaced strictly after each bath. This is very important, since this means of protection, in addition to menstrual fluid, is saturated with water, which can cause infectious inflammatory processes.
Salty sea water is a beneficial environment that stimulates the human immune system and helps fight many diseases, however, it is worth noting that this liquid can contain large amounts of dirt and other waste products. Consequently, as already mentioned, a tampon that is not replaced in time can become a source of pathogenic microorganisms inside a woman’s vagina. As for how to replace this protector, you can change it in a beach toilet or in a changing cabin.
To increase the level of hygiene, you should make sure that before going to the beach you have a bottle of clean water or special wet wipes with you. This is necessary so that after removing the used tampon during menstruation, you can rinse the external genitalia or wipe them with a damp sanitary napkin. This action is also aimed at making you feel as comfortable as possible if you have your period during a summer seaside holiday.
To prevent the appearance of menstruation from causing you discomfort during your summer holiday, you should take into account the rules for swimming during this period:
- The swimming mode should not exceed fifteen minutes. This is necessary to maximally prevent sea water from entering a woman’s body during menstruation;
- During the first three days of menstruation, it is necessary to limit yourself from intense solar ultraviolet radiation. This is due to the fact that during menstruation, melanin production does not occur as usual and the tan may lie unevenly on the surface of a woman’s skin. Consequently, you will tan either in spots, or be white in some places and burn in others. Sunbathing during menstruation is recommended either before 11.00 or after 16.00.
A teenage girl got her period at school
If a girl suddenly gets her period during school, what should she do in this case? This situation is definitely not as pleasant as it might seem, but you can easily find a way out of the situation. This is due to the fact that if menstruation occurs, they have such an unpleasant property of starting exactly at the moment when they are not expected.
In order not to become the subject of ridicule, when the first signs of menstruation appear, you should immediately go to the toilet and make a sanitary pad using improvised materials.
You can easily improvise a gasket using available materials. It is worth highlighting some of them:
- toilet paper. It is worth rolling it up in several layers and placing it on the gusset of your swimming trunks. The product will help temporarily prevent bleeding from leaking onto the surface of clothing. However, do not forget that this gasket will not be able to retain unwanted liquid for a very long time;
- in case of sudden menstruation, you need to use an individual handkerchief, napkin or piece of any fabric. Like the first option, such a remedy will not control the flow for a very long time, therefore, you should hurry home;
- you can go to the medical center and ask for a small piece of cotton wool and a bandage. Then you should wrap the cotton wool in a bandage and place this pad on your panties. It will be able to temporarily slow down the unwanted course of menstruation.
These are the most common tips on how to avoid periodic periods that suddenly begin. If you are on good terms with your classmates, then you can borrow a pad from someone. Today, almost every teenage girl has a hygiene product in her purse in case her period starts suddenly.
If, however, a leak occurs during lessons, you should definitely cover it with a sweater, jacket, scarf or other means at hand and report it to the class teacher. After which you should definitely call your mother and wait for her to arrive or go home on your own. This is necessary to avoid ridicule from classmates, which can negatively affect the nervous system of a teenage girl.
Important points to consider when your period suddenly starts
To prevent menstruation from becoming a surprise, it is worth keeping a special calendar every month that will help calculate the onset of the next menstruation.
To ensure that this calendar is always at hand and you can accurately calculate the day of your next menstruation, you can download a special program to your phone or tablet that will notify you about changes in your body and help you decide what to do if your period should start very soon and not miss it given time.
If this is not very convenient for you, you can write down all your calculations in a special individual notebook or keep a simple pocket calendar. It's purely a matter of personal preference.
It is worth using panty liners, especially while waiting for your next period. This will help avoid an unpleasant surprise, since menstruation usually begins with spotting and only then does normal monthly bleeding occur.
If you are expecting your next menstruation, but it will not come in handy during this period, this situation can be corrected with the help of medications. However, the appointment must be given by a gynecologist. This is due to the fact that hormone-based products are used to delay menstruation. Consequently, their independent use is strictly prohibited, as this can be dangerous to a woman’s health.
As can be seen from all that has been said, if your period suddenly appears, you can make do with improvised means for the first time, but you should not panic during the sudden arrival of your period.
Every month, every woman of childbearing age begins to experience spotting - menstruation, indicating that her health is fine and she is able to conceive a child. However, there are often cases when menstruation does not come on time. There can be many reasons for this, besides pregnancy.
Reasons why your periods don't come
Diagram of the menstrual cycle.
Each woman's menstrual cycle is individual and can range from 21 to 35 days.
The cycle is counted from the first day of menstruation. If there is a prolonged absence or delay of menstruation, this condition is called amenorrhea .
Except pregnancy
It's no secret that a delay in menstruation in most cases is associated with pregnancy, but if it is excluded from the list of possible causes, then the following remain:
- Severe stressful situations
. One of the most common reasons for delayed menstruation is any mental shock, be it exams, troubles at work or chronic fatigue and lack of sleep. To normalize the situation, it is enough to have a good rest, try not to be nervous, and, if necessary, talk to a psychologist.
Stress can cause your period to be late.
- Sudden weight fluctuations . Fat cells take an active part in the regulation of complex biochemical processes in the female body. With a sharp increase in body weight, as well as with a critical decrease, a disruption occurs in the menstrual cycle. . Heavy physical work, as well as intense training in professional athletes, can cause a delay in menstruation.
- Diseases of the pancreas and thyroid gland , most diseases of the genital area in acute or chronic form, genitourinary infections, changes in the correct location of the intrauterine device.
- Complication of drug treatment
. Long-term use of certain medications (diuretics and psychotropic drugs, corticosteroids, etc.).
Taking medications in violation of instructions or bypassing doctor's orders can harm the body. And cause a delay in menstruation.
- Long-term poisoning of the body
. This could be anything: taking drugs or alcohol in large quantities, smoking or hazardous working conditions at work.
Long-term drinking of alcohol can cause poisoning and delay of menstruation.
- Emergency contraception . If a method of post-coital protection from unwanted pregnancy was chosen, applied immediately after unprotected intercourse, this can disrupt the hormonal balance in the female body and thereby lead to a delay in menstruation. This method of contraception has many side effects and contraindications, and should be used only in the most extreme cases.
- Stopping taking hormonal contraceptives . With prolonged use, the hormonal functioning of the female body eliminates the function of the ovaries, and even after taking synthetic hormones has been stopped, the body will need some time to readjust itself again.
- Genetic predisposition . In rare cases, a delay in menstruation can be caused by heredity, and can be passed down through the female line from mother to daughter.
- Abrupt change in climate zone . Changes in time zones, climate, and long-distance airplane flights lead to changes in the rhythm of life and, accordingly, to changes in the menstrual cycle.
- Menopause. After 45 years, most women experience a decline in reproductive function, resulting in a delay in menstruation. This is an absolutely natural process that should be treated calmly.
A woman experiences difficulties due to menopause. Menstruation stops.
How to control your menstrual cycle
Every woman should have a calendar in which to mark the beginning of each cycle. Thanks to this, you can easily control deviations, which normally amount to no more than three days.
If your period is late, you should take a pregnancy test. In the photo: a faint second line on a pregnancy test.
Otherwise, the first thing you should do is take a pregnancy test, which can be purchased at any pharmacy.
If the test shows a negative result and there is no general deterioration in health, you can wait about ten more days.
conclusions
If a delay in menstruation is accompanied by an increase in body temperature, the appearance of strange discharge, or pain in the abdominal area, you need to see a gynecologist as soon as possible.
– menstrual dysfunction, manifested by the absence of cyclic bleeding for more than 35 days. It may be due to physiological reasons (pregnancy, premenopause, etc.), as well as various organic or functional disorders. Delayed menstruation occurs at different periods of a woman’s life: during the formation of menstrual function, during the reproductive period and during premenopause. A delay of menstruation for more than five days is a reason to consult a doctor. Diagnosis of delayed menstruation is aimed at finding the main cause of this symptom, on which further treatment tactics depend.
General information
Delayed menstruation A disruption in the menstrual cycle is considered, in which menstrual bleeding does not occur at the expected time. A delay in menstruation not exceeding 5-7 days is not regarded as a pathology. Options for delaying menstruation are such menstrual cycle disorders as oligomenorrhea, opsomenorrhea and amenorrhea, manifested by a decrease in menstrual bleeding. A delay in menstruation can be observed at different age periods of a woman’s life: during puberty, during the reproductive phase, during premenopause and can be caused by physiological or pathological reasons.
Natural, physiological reasons for the delay of menstruation are explained in the puberty period during the formation of the menstrual cycle, when for 1-1.5 years menstruation can be irregular. In women of reproductive age, a delay in menstruation is natural during pregnancy and lactation. During the premenopausal period, menstrual function gradually fades away, changes occur in the rhythm and duration of menstruation, and delays in menstruation are replaced by their complete cessation.
All other options for delaying menstruation, exceeding 5-7 days, are not explained by natural phenomena; in such cases, urgent consultation with a gynecologist is required. A woman’s menstrual cycle is a subtle mechanism that maintains reproductive function and reflects any deviations in general health. Therefore, to better understand the causes and mechanisms of delayed menstruation, it is necessary to clearly understand what is normal and abnormal in the characteristics of the menstrual cycle.
Characteristics of the menstrual cycle
The functioning of the body of a woman of childbearing age has cyclical patterns. Menstrual bleeding is the final stage of the menstrual cycle. Menstrual discharge indicates that fertilization of the egg and pregnancy have not occurred. In addition, the regularity of menstruation indicates that a woman’s body is functioning smoothly. A delay in menstruation, on the contrary, indicates some failures that have occurred.
The onset of the first menstruation usually occurs between 11-15 years of age. At first, menstrual bleeding may occur irregularly; a delay in menstruation during this period is normal, but after 12-18 months the menstrual cycle should finally form. The onset of menstruation before 11 years of age and absence after 17 years of age is a pathology. A delay in the onset of menstruation up to 18-20 years of age indicates obvious pathological processes: a general lag in physical development, dysfunction of the pituitary gland, underdevelopment of the ovaries, uterine hypoplasia, etc.
Normally, menstruation begins and ends at certain time intervals. For 60% of women, the cycle length is 28 days, that is, 4 weeks, which corresponds to the lunar month. Approximately 30% of women have a cycle lasting 21 days, and about 10% of women have a menstrual cycle lasting 30-35 days. On average, menstrual bleeding lasts 3-7 days, and the permissible blood loss per menstruation is 50-150 ml. The complete cessation of menstruation occurs after 45-50 years and marks the onset of menopause.
Irregularity and fluctuations in the duration of the menstrual cycle, systematic delays of menstruation for more than 5-10 days, alternation of scanty and heavy menstrual bleeding indicate serious deviations in a woman’s health. In order to control the onset or delay of menstruation, every woman should keep a menstrual calendar, marking the day the next menstruation begins. In this case, the delay in menstruation will be immediately visible.
Delayed menstruation and pregnancy
Pregnancy is the most common cause of missed periods in women of childbearing age. In addition to a delay in menstruation, the probable occurrence of pregnancy is indicated by changes in taste and olfactory sensations, appetite, the appearance of nausea and vomiting in the morning, drowsiness, and painful sensations in the mammary glands. The possibility of pregnancy cannot be rejected even in cases where there has been interrupted sexual intercourse, sexual contact during menstruation, on “safe” days or using a condom, in the presence of an intrauterine device, taking oral contraceptives, etc., since neither One method of contraception does not provide 100% contraceptive effect.
If there is a delay in menstruation, and in the previous month the woman had sexual intercourse, then pregnancy can be determined using special tests. The principle of operation of all pregnancy tests (test strips, tablet or inkjet) is the same: they determine the presence of human chorionic gonadotropin hormone (hCG or hCG) in the urine, the production of which begins in the body 7 days after fertilization of the egg. The concentration of hCG in the urine increases gradually, and modern, even the most sensitive tests, are able to detect it only after a delay in menstruation and no earlier than 12-14 days after conception has occurred. It is necessary to “read” the test result in the first 5-10 minutes. The appearance of even a barely noticeable second stripe during this period of time indicates a positive result and the presence of pregnancy. If the second stripe appears later, then this result is not reliable. If your period is late, to obtain a reliable result, it is recommended to repeat the pregnancy test twice with an interval of 2-3 days.
It should be remembered that while being sexually active, a woman can always become pregnant, so it is necessary to closely monitor the menstrual cycle and pay attention to delays in menstruation. However, a delay in menstruation can be caused not only by pregnancy, but also by a number of very other, sometimes very serious and dangerous to health reasons.
Other reasons for missed periods
Gynecology conventionally divides all the reasons that cause a delay in menstruation into two large groups: physiological and pathological causes of a delay in menstruation. In some cases, a delay in menstruation is caused by special transitional, adaptive conditions for the body, and usually does not exceed 5-7 days. However, some of these conditions are borderline, and when they worsen, organic disorders may occur, leading to a delay in menstruation as a manifestation of one or another pathology. Caused by physiological reasons can be considered:
- delay in menstruation caused by strong emotional or physical stress: stress, increased sports, academic or work loads;
- delay in menstruation due to unusual changes in lifestyle: change in the nature of work, sudden climate change;
- delayed menstruation due to insufficient nutrition and adherence to strict diets;
- delay of menstruation during periods of hormonal changes: puberty or menopause;
- delayed menstruation as a condition after discontinuation of hormonal contraceptives, caused by temporary hyperinhibition of the ovaries after prolonged receipt of hormones from the outside. If your period is delayed by 2-3 cycles, you should visit a gynecologist.
- delay in menstruation after using emergency contraception containing a high dose of hormones;
- delay of menstruation in the postpartum period associated with the production of the pituitary hormone prolactin, which is responsible for the secretion of milk and suppresses the cyclic function of the ovaries. If a woman does not breastfeed, then menstruation should resume approximately 2 months after birth. When breastfeeding, menstruation resumes after the baby is weaned. However, if your period is delayed for more than a year after childbirth, you should consult a gynecologist.
- delay of menstruation caused by colds (ARVI, influenza), chronic diseases: gastritis, thyroid dysfunction, diabetes mellitus, kidney diseases and many others. etc., as well as taking certain medications.
In all cases (except for those when the delay in menstruation is caused by age-related hormonal changes or lactation), the period of delay should not exceed 5-7 days, otherwise it is necessary to visit a gynecologist in order to prevent the development of serious diseases.
Pathological causes of delayed menstruation include, first of all, diseases of the genital area. This group of reasons includes:
- delay of menstruation caused by inflammatory (adnexitis, oophoritis) and tumor (uterine fibroids) diseases of the genital organs. Inflammatory processes in the genitals, in addition to delayed periods, can manifest as pathological discharge and pain in the lower abdomen. These conditions require emergency treatment as they can lead to serious complications and infertility;
- delayed menstruation due to polycystic ovary syndrome and associated hormonal disorders. Also, with polycystic ovary syndrome, in addition to delayed menstruation, there is an increase in body weight, the appearance
- delay of menstruation caused by health-critical weight gain or loss. For women suffering from anorexia, a delay in menstruation can result in their complete cessation.
Thus, regardless of the reasons, a delay in menstruation is the basis for an urgent visit to the gynecologist.
Examination for delayed menstruation
To determine the causes of delayed menstruation, examinations may be required in addition to a gynecological examination:
- measurement and graphical display of changes in basal temperature, allowing you to verify the presence or absence of ovulation;
- determination of the level of hCG, ovarian hormones, pituitary glands and other glands in the blood;
- ultrasound diagnostics of the pelvic organs to determine pregnancy (uterine, ectopic), tumor lesions of the uterus, ovaries and other reasons causing a delay in menstruation;
- CT and MRI of the brain to exclude tumors of the pituitary gland and ovaries.
If diseases accompanying a delay in menstruation are identified, consultations with other medical specialists are prescribed: endocrinologist, nutritionist, psychotherapist, etc.
To summarize the above, it should be noted that a delay in menstruation, no matter what circumstances it is caused by, should not go unnoticed by a woman. A delay in menstruation can be caused by a banal change in weather, or the joyful anticipation of motherhood, or by serious illnesses. If a delay in menstruation occurs, a timely consultation with a doctor will free you from unnecessary worries and worries that can significantly aggravate this condition. In families where girls are growing up, it is necessary to provide them with competent sex education, explaining, among other things, that a delay in menstruation is a problem that must be solved together with the mother and the doctor.
Almost every woman faces such a phenomenon as menstrual irregularities. However, girls are not always able to figure out on their own why they are not getting their periods if they are definitely not pregnant. Let's try to answer this question by naming the most common reasons that cause dysmenorrhea.
Ovarian dysfunction as the main cause of menstrual irregularities
Quite often, the answer to girls’ questions about why menstruation does not begin if there is no pregnancy is a disruption of the ovaries. It usually occurs due to a malfunction of the hormonal system. In turn, this can be caused by numerous factors, such as, for example, intake.
Stressful situations and experiences
Many girls, after long-term experiences associated, for example, with passing a test, noted the absence of menstrual flow on time. It is stress that gynecologists often put in one of the first places among the reasons explaining the fact why menstruation is delayed if a woman is not pregnant.
The thing is that the female body perceives a prolonged increase in the level of adrenaline in the blood as a difficult life situation in which the birth of children is simply impossible. Also, constant overexertion and lack of sleep should be considered as severe stress for the body.
How does changing climate conditions affect menstrual flow?
Another explanation for why a girl doesn’t get her period if she’s not pregnant could be a sudden change in climate. Many representatives of the fair sex have repeatedly observed a similar situation when traveling to warm countries, for example. In such cases, the situation resolves itself, and after just 1-2 cycles, your period comes on time.
Can changes in body weight affect the menstrual cycle?
Scientists have found that adipose tissue in the human body is directly involved in hormonal processes. That is why problems with menstruation can occur both when a girl’s weight increases and decreases.
When you are overweight, fatty tissue accumulates estrogen. In case of lack of weight and its reduction below 45 kg, the woman’s body perceives the current situation as extreme.
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What diseases can cause absence of menstruation?
Often the explanation for why periods are delayed but there is no pregnancy may be gynecological disorders. These include uterine fibroids, polycystic disease, cervical cancer, endometritis, adenomyosis, infectious and inflammatory processes in the reproductive system.
Thus, as can be seen from the article, in most cases it is quite difficult for a woman to determine on her own why there is no period when pregnancy is excluded. Only after a comprehensive examination can a doctor accurately determine the cause of the disorder.