Generality
A delay in menstruation is an event that can occur in every woman's life, signaling simply episodic health conditions or something more important.
The causes of a delay in menstruation, excluding conception, are manifold and it could even happen that there is no specific reason; psycho-physical stress and a decrease in body weight for drastic diets are certainly the most frequent.
If the pregnancy test is negative and the situation persists, it is advisable to consult with your doctor or gynecologist, in order to carefully analyze the possible causes and the need for a possible therapy.
Regular cycle
What are menstruation?
Menstruation consists of the exfoliation of the mucosa covering the inner wall of the uterus (endometrium), accompanied by a variable blood loss through the vagina. This phenomenon is renewed cyclically every month and lasts, on average, from 3 to 7 days.
How often do they appear?
Menstruation occurs with a regular frequency and with fairly constant duration and quantity characteristics. In most women, the menstrual cycle, or the time between the beginning of a flow and the beginning of the next, occurs once a month with a frequency of 28-30 days. However, there may also be important differences between the individual subjects and not infrequently in the same person; this makes it difficult to define the characteristics of a "normal" menstrual cycle.
In general, a cycle lasting between 25 and 36 days is considered regular. It should therefore be noted that some women of childbearing age have longer or shorter menstrual cycles, but are equally regular in their periodicity.
What does having menstruation mean?
The first day of menstruation marks the beginning of a new menstrual cycle, which in most women lasts between 25 and 36 days. Regardless of the period of time between two flows, menstruation occurs 14 days after ovulation.
Menstruation allows the uterus to eliminate the inner lining built during the previous cycle (if conception has not occurred). By renewing the mucous layer of the endometrium, the uterus maintains, from a biological point of view, the "soil" that will welcome the possibly fertilized egg. These changes occur from puberty to menopause and are directly related to fertility. In other words, menstruation indicates the presence of an ovulation cycle, hence the ability to procreate.
How is a delay defined?
Once the regular periodicity with which menstruation occurs, a delay is defined on the basis of the lack of appearance of the flow compared to the day on which this would be expected.
Possible causes
The possible causes of a delay in the onset of menstruation are different. Once the pregnancy hypothesis is excluded, it is necessary to consider all the reasons why the menstrual flow may be delayed or not present .
The factors that cause menstrual delays are numerous and these include abrupt changes in weight, stress, climate changes and taking specific medications.
PREGNANCY
In case of delay in menstruation, it is always important to evaluate the possibility of a pregnancy. Even if the woman's body sends unequivocal signals (breast tension, nausea, widespread fatigue and a greater desire to sleep) and the cycle has a few days' delay, it is always good to do the pregnancy test (like those easily available) in the pharmacy), especially if you have unprotected sex.
The test must be performed at the missed appearance and if necessary 7 days later, trying to follow the instructions correctly.
STRESS
Stress is one of the most frequent causes of a menstrual delay. This factor can affect not only the daily life, but also the general state of health, affecting the hypothalamus (part of the brain that intervenes in the regulation of the menstrual cycle).
A daily life that is too hectic, a particular work pressure, personal and family anxieties, an emotional shock and fatigue can delay, therefore, the appearance of menstruation due to a transient imbalance of the hormonal structure determined precisely by psychological factors. In general, the reduction of the psycho-physical commitment induces a restoration of the menstrual flow.
POLYCHISTIC OVARIAN SYNDROME
Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by anovulation and hyperandrogenism. This condition involves 5-10% of the female population in reproductive age and represents one of the most common causes of menstrual irregularities and infertility in women.
On ultrasound examination, ovaries are slightly increased in volume, with many small cysts on the surface. Sometimes, this image can be associated with other symptoms, such as obesity, acne, an excess of hair and, precisely, irregularity of menstruation, in the sense of delays that can reach the absence of flow for months .
In the presence of polycystic ovary syndrome, therefore, there are very different situations, which can range from very nuanced pictures - which present only modest irregularities in the cycle - to others, much less frequent, which accompany the described symptoms.
Therapy depends, therefore, on the type of clinical manifestations and the desire of the pregnant woman: in many cases it is not necessary to do anything, other times the pill or other drugs that intervene correcting some clinical aspects, such as the lack of ovulation can be used, acne etc. Therefore, it is always important to talk to your doctor about it.
CHRONIC DISEASES
A disease, even a common flu, or the massive intake of drugs, can weaken the body, causing delays in the onset of menstruation.
Among the pathologies that are not strictly pertinent to gynecology, which can lead to alterations of the menstrual cycle, it is necessary to remember some endocrine problems, such as disorders affecting the thyroid, both in the sense of poor functioning and, on the contrary, of excessive activity. In fact, the thyroid is responsible for the metabolism and regulates the production of hormones that also influence the female reproductive system. The normalization of the thyroid function with a suitable therapy usually leads to the restoration of menstrual cyclicity, without the need for other therapies.
Another gland located at the base of the skull, the pituitary gland, plays an important role in controlling the cycle and any injury or impaired function can lead to menstrual changes. Some pituitary alterations (adenomas, functional insufficiency, etc.) can sometimes be the causes of an oligomenorrhea, as well as hyperprolactinemia, ie the pathological increase in the hormone prolactin - produced precisely by the pituitary gland - can cause menstrual irregularities. In most cases, drugs are used which, by lowering the level of this hormone in the blood, return the cycle to normal.
DRUGS
- Certain drugs such as antidepressants, antiepileptics, antipsychotics and chronic cortisone-based therapies can induce alterations of the menstrual cycle with different mechanisms. Generally, with the drug withdrawal there is a normal resumption of menstrual function.
- Sometimes, after stopping the contraceptive pill, perhaps not gradually as recommended by gynecologists, a menstrual delay may occur. This problem most often affects girls with irregular flow, even before taking the pill. Usually, the recovery of the cycle takes place spontaneously, without performing therapeutic interventions, when the body regains its natural rhythm, but, if it delays for 2 months, it is advisable to consult the gynecologist.
FEEDING IMBALANCES
The relationship between lean muscle mass and body fat, and its distribution, are very important to determine the start of menstruation in girls, but also in the maintenance of normal menstrual flows.
Loss or weight gain are among the most common causes of menstrual delay in young women of childbearing age, especially if these changes are sudden or excessive .
Women who suffer from eating disorders (such as anorexia and bulimia) or who are strongly overweight often experience irregularities or lack of menstruation for long periods of time.
In fact, food imbalance affects the hypothalamic-pituitary-ovary system and the consequent production of hormones that regulate the menstrual cycle. Weight normalization is often sufficient to restore regularity.
MENOPAUSE
In some cases, a prolonged delay can portend an approach to the perimenopausal period, or that time (more or less long depending on the case) that elapses between the reproductive phase and the no longer fertile one. This situation can be diagnosed by the gynecologist with the help of specific blood tests.
Symptoms
The most obvious and obvious symptom of the menstrual delay is precisely the lack of appearance of the flow on the expected day .
In the case in which within a whole year a woman has few cycles compared to normal, we speak of oligomenorrhea, which has several causes. When a menstrual delay is prolonged, however, in a suspicious manner for at least three months, especially after a fairly regular history of the cycle, one speaks of secondary amenorrhea, which in cases of total disappearance of the menstrual cycle becomes amenorrhea . In these cases, more serious, we no longer speak of simple delay, but of real problems that must be addressed and eventually treated.
In addition to this, menstrual delay can be related to various manifestations, such as:
- Loss of white mucus : it is often a sentinel of both delay and pregnancy. This second hypothesis can be excluded immediately with a test.
- Brown losses : dark vaginal discharge, tending to brown, is due to the delay itself. The blood that settles tends to oxidize and take on this color and a more solid consistency.
- Poor flow: hypomenorrhea, which occurs after a delay, may be due to stressful situations, physical tiredness, debilitation and iron deficiency
When to worry
When the menstrual delay is sporadic and is not accompanied by particular symptoms, there is no need to worry.
If the delay, on the other hand, often presents itself, it is time to investigate to discover the extent of the causes that cause it. For this reason, it is important to refer to your gynecologist, in order to understand the situation together (just carry out a pregnancy test, a blood test and a pelvic ultrasound) and identify any remedies.
What to do
- First of all, the type of delay must be analyzed: some days fall within the "normality" and much depends on the regularity of one's menstrual cycle. If the situation persists, a clinical consultation with your doctor is advisable, so as to carefully analyze the possible causes and the need for a possible therapy. Findings that can be made in these cases include hormone dosages, blood tests and pelvic ultrasound.
- If menstruation causes discomfort (such as pain, premenstrual syndrome, excessively abundant flow, etc.), it is necessary to assess the situation with the attending physician who, if necessary, will help to find a therapy that allows regularizing menstruation and reducing the pain caused from the cycle.
- When the irregularity of the menstrual flows depends on a pathology, for example the "polycystic ovary syndrome", a targeted handling is necessary. Similarly, in cases where bleeding occurs outside the menstrual period and, above all, if these are associated with other symptoms such as pelvic pain, or if menstruation lasts more than 8 days or is particularly painful, it is worth consulting. the gynecologist.
Can menstruation be blocked and voluntarily delayed?
- There are drugs that can reduce the flow, but they are used only in particular cases, that is when menstruation occurs abundantly, assuming hemorrhagic characteristics. In normal conditions, therefore, medicines to intervene on the menstrual cycle should not be taken.
- If you are taking the contraceptive pill, it is possible to delay blood loss by suspension. Not taking a break between one box and another, in fact, the losses will not appear, but it is clear that they will recur at the end of the second package. The one just described is not a practice to be used lightly, since it still subjects the body to hormonal changes.
