No Period For 3 Months But Not Pregnant – What’s Wrong?

Once a female attains puberty, menstruation becomes an integral part of the normal functioning of their bodies. Menstrual cycles are not just a means of shedding the endometrium, but each menstrual cycle speaks a lot about the overall health of a female’s body.

That being said, although periods are an important part of a woman’s lifestyle, openly discussing and addressing menstrual problems is still considered shameful or a taboo. An additional problem faced women is the stigma related to not having periods for three months or more.

Reasons For No Period For 3 Months But Not Pregnant

This article is solely meant to understand the possible reasons behind having no periods for three months but not being pregnant.

Absence or cessation of menses is called amenorrhea. It can be primary or secondary. Absence of periods for at least 3 months is called secondary amenorrhea if the patient has previously had regular periods. Women experience absence of menses when they are pregnant, during breast feeding and after menopause. Apart from these three conditions, any reason for not having periods for 3 months or more without being pregnant needs to be evaluated.

A complete history and physical examination are done to understand the reason behind not having regular periods for 3 months without being pregnant. Your gynecologist may also run a set of tests to assess hormone function or an ultrasound to detect presence of any structural abnormality which may be causing amenorrhea.

Several hereditary, genetic, behavioral, hormonal and environmental causes are responsible for absence of periods for 3 months without pregnancy. Some of the commonest conditions responsible for the same are listed below.

Hypothalamic Dysfunction

Hypothalamic dysfunction account for nearly 35% cases of secondary amenorrhea. They all occur due to deficiency of estrogen.

1. Anorexia Nervosa

   Low energy results in reduced fat mass and alteration in secretion of gonadotropin-releasing hormone by the pituitary gland. Low GnRH leads to reduced bone mineral density and increases the risk of fractures.

2. Obesity

   Obese women have high levels of plasma androgens. This is also associated with high incidence of PCOS among obese women. Medications and weight reduction are proved to resume menses in these women

3. Strenuous Activity

   amenorrhea is common among athletes or women performing heavy labor work. This is because they have low gonadotropin hormone levels.

4. Drug Induced Amenorrhea

   Certain drugs can interrupt the normal menstrual cycle. These include anti-psychotic and anti-depressant medications, anti-allergic and anti-hypertensive medications. Chemotherapy and radiation also cause cessation of menses.

5. Post Pill Amenorrhea 

   This is common among women who consume contraceptive pills. The term post pill amenorrhea is used when a woman is unable to resume periods 3-6 months after discontinuing contraceptive pills.

6. Stress Induced Amenorrhea

   Undue emotional or mental stress can have a negative effect on the hypothalamus. Ovulation and menstruation are interrupted and resume as soon as the stressful period passes. This can be considered as the body’s natural response to excess of stress.

7. Chronic Illnesses

   The body reduces production of gonadotropic hormone in response to prolonged illness leading to amenorrhea.

Pituitary Dysfunction

1. Hyperprolactinemia

   It is a condition in which a person has abnormally high levels of the hormone prolactin in their blood. Prolactin is essential for normal reproductive development. Tumors called prolactinomas is the commonest cause for this condition. Certain medications like anti-hypertensive and anti-depressant drugs can also cause high levels of prolactin. They occur more frequently in women than in men. Irregular or absence of menses and vaginal dryness are the important signs and symptoms.

2. Sheehan Syndrome

   This syndrome is characterized by hypopitutarism because of necrosis of the pituitary gland which occurs as a result of massive hemorrhage during or after delivery. History of bleeding even after deliver (post-partum hemorrhage), failure to lactate and absence of menses are guiding symptoms. It can also cause hypothyroidism.

Ovarian Dysfunction

• Premature Ovarian Insufficiency

This is a condition in which there is loss of ovarian activity before the age of 40 years. In normal women, natural age for menopause is 40-60 years of age. There is absence of menses for more that 4 months in women below the age of 40 years. Young women rarely experience signs and symptoms. There is loss of fertility.

• Polycystic Ovarian Syndrome

It is the commonest endocrine abnormality in women condition characterized by menstrual irregularities due to presence of cysts in one or both ovaries. This syndrome is linked to obesity and insulin resistance. Women experience amenorrhea, excessive hair growth, obesity, acne and infertility.

Uterine Causes

• Asherman Syndrome

In this condition there is excessive scarring of the uterine wall due to previous surgical procedures or from repeated dilatation and curettage. This syndrome can be diagnosed only with the help of hysteroscopy. Thyroid dysfunction: both hypo and hyperthyroidism can result in menstrual irregularities or even absence of menses.

Other Causes

• Cushing’s Syndrome 

  This illness can occur due to a tumor of the adrenal gland or of the pituitary gland which results in excess secretion of the hormone cortisol.
  In women, menstrual irregularities or absence of menses may occur along with weight gain, high blood pressure, poor memory and concentration, excessive hair growth and irritability.

• Type 1 Diabetes

  Diabetic women with low BMI are likely to have menstrual irregularities because of reduced gonadotropins. It is certain from the list of causes above that the menstrual cycle clearly shows how healthy you are. A normal menstrual cycle is important for maintaining overall health. Out of all the possible causes mentioned above, polycystic ovarian syndrome (PCOS) and hypothyroidism have emerged as major health concerns for women having menstrual irregularities worldwide.

Two Major Complications of Not Having Regular Periods without being Pregnant

• Infertility

Because of abnormal and often lack of ovulation. You cannot get pregnant in absence of normal ovulation.

• Osteoporosis

Estrogen has a protective role in the body. In absence of estrogen, bone mineral density reduces, increasing the risk of fractures.
It is therefore important to consult a gynecologist if you have missed your period for more than three months but have a negative pregnancy test.

Dr. Himanshi Purohit

Dr. Himanshi is a Homoeopathic consultant and currently working as a lecturer in Post-graduate faculty of Homeopathy, Parul University, Vadodara. Completed BHMS and MD in Homeopathy in January 2018 and also has a clinical experience of about 6 years. Personal interests include reading, spending time with family and traveling.