What can you do about a missing period (especially after coming off the pill)?

It’s surprising how many people simply DON’T get their periods. If this is happening to you it’s because ovulation is missing, since a period is the result of ovulation. The only way to truly fix this issue is to get yourself ovulating!

Since this is a common issue when I got this question I knew I should touch on it here.

I’d love to know how to correct not ovulating after coming off the pill, (I’m guessing this has something to do with my body not having to have produced estrogen and ovulate for so long). I’d also like to know more about small follicle size (not PCOS related), what causes this, and how can we enlarge it?

In this case she knows it’s due to anovulation (not ovulating) and it’s not just a missing period. Yay! But WHY no ovulation? That’s what we really want to know here.

In regards to coming off of hormones, I want to reference something I wrote recently about how long you can expect things to be funky after hormonal birth control. If timing is no longer a factor, there is probably a deeper issue.

In this case, since your follicles are small and there is no PCOS, I am going to wager a guess that this is linked to low production of follicle stimulating hormone (FSH). That’s the hormone that actually makes your follicles, the sacs around your eggs that produce estrogen, mature. This could be due to either a problem with the pituitary or a problem with the hypothalamus (which signals the pituitary to produce follicle stimulating hormone).

When FSH is low, the follicles do not mature much and do not start to produce estrogen. Because there is not a sharp increase in estrogen, another hormone from the pituitary called luetinizing hormone (LH) is not signaled, either. LH is necessary for ovulation to actually occur.

So, as you can imagine, an issue with the hypothalamus or pituitary can easily make ovulation not happen and follicles can be small. Generally, if other causes of anovulation like PCOS are ruled out anovulation is considered hypothalamic amennorhea. Hypothalamic because it’s related to the hypothalamus, amenorrhea because that’s fancy speak for “no periods.”

So what can cause the dysregulation?

1. Stress
2. Low body fat
3. High prolactin (a hormone that is naturally high in those breastfeeding, which is why often women who are breastfeeding a baby frequently do not ovulate or have periods)
4. Low calorie and/or low carb diets
5. Pituitary tumor (kinda unlikely, but throwing it out there)
6. Recreational drug use

When I was listing the above I was thinking “Hmmm… how many ways can I say stress over and over again?” because many of these causes are stress, whether it’s mental/emotional or physical.

So let’s talk about what you can actually do about the above. You may have an idea from the list of what your current issue is and know that you need to focus there.

If you feel like your issue might be stress, obviously the number one thing to do is get enough sleep and do stress reducing activities like walk, read, meditate, yoga.. Whatever it is for you! Supplements that are good for stress and your hypothalmic/pituitary activity include magnesium (mineral) and ashwaganda (herb).

Low body fat can be a surprising one, especially because some people will feel they are at their ideal weight but their body does not feel like that at all and is in survival mode. Leptin is an important hormone that signals that you have enough body fat. A decrease in leptin can tell your hypothalamus you are not prepared to have a baby due to low fat stores, hence no ovulation. If you have even the slightest inkling this may be your issue you generally only need to put on a few pounds to start seeing a difference unless you are severely underweight.

High prolactin? This is pretty easy to get tested for, so you can ask your doctor if you think it might be a problem for you. Surprise surprise, high cortisol (one of the stress hormones) can raise levels of prolactin. If this is the reason for you, check out the above section on stress. Alcohol can cause increased prolactin production, so if you are a drinker you may want to cut back and see if that helps. If you want to take something, vitex is an herb that helps your pituitary not make as much prolactin. I recommend checking out the advice from Dr. Lara Briden and Nicole Jardim on vitex if you choose to take it, it is a powerful herb! Note: not all high prolactin is going to be helped by vitex. If you have high prolactin levels it could be due to a pituitary tumor, drug interactions, alcohol use, a thryoid issue, and more. 

Oh, geez, you are actually on a diet/low carb diet. This, again, can stress your body and cause low leptin levels. I don’t know a TON about this mechanism of action, but leptin is signaled to be released from your fat cells by insulin (another hormone, this one being produced to help clear glucose from the blood and into the cells for use), so if you do not have a lot of glucose going into your bloodstream I assume that is what can lower the leptin in this case. If anyone knows more about it (especially if you can link scientific research) let me know in the comments. Easy fix: up your carbs. Fruit is great. Starches like sweet potatoes and potatoes are great. Whole grains are great unless you have a reason you can’t eat them. Just. Eat. Carbs.

Recreational drug use is kind of an obvious fix. Stop using recreational drugs.

These are some ideas of what might be going on if your period is MIA and you have no idea why. This is not an extensive list and I definitely recommend working with a good doctor (basically a doctor that respects you and doesn’t just tell you to go on hormonal birth control instead of trying to help you regulate your cycles) to make sure you cover all of your bases. As always, learning how to chart your fertility signs is helpful in learning more about what is going on with your hormones and how to monitor them consistently.