Absence of menstruation

When menstruation fails to occur, this can have various causes. Especially at the beginning of menstruation in puberty, the cycle can still be very irregular, so that menstruation there does not initially start at regular intervals. This is no reason for concern, as the body must first learn to regulate the hormone balance.

Over time, the menstrual period then becomes more regular. During pregnancy, menstruation no longer takes place. The fertilised egg cell nests in the uterus and develops into an embryo.

Part of the placenta that supplies the growing child produces beta-hCG, a hormone that is essential for maintaining the pregnancy, already in the early stages of pregnancy. It stimulates the ovaries to produce progesterone, another hormone that suppresses ovulation in the subsequent period. Accordingly, it also prevents menstruation, which would otherwise result in the rejection of the fertilized egg by the lining of the uterus.

Especially at the beginning of pregnancy, however, so-called pseudo-strustrustrual bleeding can occur. These continue to follow the rhythm of the normal menstrual cycle, but are usually weaker than usual. Under certain circumstances, the pregnancy may only be recognized late.

After the end of the pregnancy, it may take some time for the body to return to the normal menstrual cycle. The hormone balance must first return to normal. Afterwards, the menstrual cycle will return to normal.

Some women nevertheless suffer from bleeding from time to time during pregnancy. Right at the beginning of pregnancy, the fertilized egg can implant itself in the uterus and cause a slight bleeding, the so-called implantation bleeding. This lasts for about one to two days and is not dangerous.

Even in later stages, certain processes in the child’s development can cause slight bleeding. These are usually harmless, but should be clarified gynecologically. As the cervix is very sensitive, it too can bleed slightly at the beginning of pregnancy.

Other causes of bleeding during pregnancy can also be infections in the genital area, as well as minor injuries caused by sexual intercourse. If the bleeding is heavy and accompanied by symptoms such as malaise, abdominal cramps and pain, a doctor should always be consulted. These signs could indicate an imminent miscarriage, ectopic pregnancy or damage to the child or placenta.

Psychological factors also play a major role in the regular onset of monthly menstruation. In the case of stress, illness, lack of sleep and psychological problems, fears and worries, the menstrual period can be delayed by a few days or even stop altogether. Another important factor is underweight.

In severely underweight women, it can cause the menstrual period to stop. The body then uses its remaining energy reserves for vital functions. Women who use hormonal contraceptives may have an irregular cycle at the beginning.

When taking the hormone preparations, the onset of bleeding does not correspond to normal menstrual periods. Nevertheless, many women are concerned if this so-called abortion bleeding does not start.After a few months of taking the pill the cycle under the pill should be regular. If the preparation is taken without interruption, there is no bleeding either.

After stopping the pill it may take some time for the normal cycle to settle down again. Missing or irregular bleeding in this phase is not a cause for concern at first, but occurs relatively frequently. When the menopause sets in, the woman loses her ability to conceive.

Correspondingly, the menstruation stops at some point. This is often initially indicated by irregular menstrual cycles until the body has finally adjusted its hormone balance to the new situation. The woman then no longer gets her period because she no longer ovulates every month.

Ultimately, the absence of menstruation can also be due to a hormonal imbalance. If there are regulatory disturbances in the hormone control circuits responsible for ovulation, the menstrual period may not occur. A doctor should therefore be consulted if there is no bleeding for a longer period of time for no apparent reason.

Ovarian diseases, such as an ovarian cyst or a malignant disease of the ovaries (ovarian carcinoma) can also cause menstruation to stop. A gynecological examination of irregular menstrual cycles is therefore advisable in any case. Impairments of the female cycle can have numerous causes, which should be clarified in any case.

Otherwise, complications such as infertility or the overlooking of serious underlying diseases can occur – not to mention the great suffering of many women. Abnormal changes can include the duration and intensity of bleeding as well as the time of bleeding. A weakening in all three criteria as well as inter-bleeding are the most likely indications of a hormonal disorder.

Depending on the indication, hormone therapy (e.g. the pill) is effectively used for almost all bleeding disorders. Especially dangerous are bleedings that occur again after the menopause. They can indicate a malignant process (cancer of the uterus).

Abnormal bleeding duration = longer than 6 or shorter than 3 days
Abnormal bleeding intensity = more than 5 pads or tampons per day or just spotting (up to 200 ml is normal)
Abnormal bleeding time = heavy bleeding outside the period or after menopause. Spotting around the period, before ovulation or in the middle of the cycle. Absence of the first menstrual period until the age of 15.
The causes are genetic defects, malformations, hermaphroditism, competitive sports and nutritional or eating disorders (anorexia, obesity, bulimia).
Bleeding without ovulation = despite the absence of ovulation (conspicuous by the absence of pregnancy or hormone tests by the doctor) menstruation occurs.
Abnormal bleeding frequency = (1) menstruation resumes after less than 25 days (counted from the 1st day of the last period). The cause here is usually a shortening of the 1st half of the cycle (follicular phase). (2) New menstruation after more than 31 days (calculated from the 1st day of the last period).
Here the cause is usually a lack of follicle maturation. Suspension of the period for more than 6 months. Possible causes are hormonal disorders due to malfunctioning of the ovaries or higher-level brain centers, psychological stress, competitive sports or problems with the sexual organs.