Missed Period Concerns: When to Seek Further Medical Advice?

Missed menstruation?

After my period started on March 22, it did not come again.
I visited the doctor on May 20, had blood tests, and took progesterone.
On May 29, my period still hadn't arrived, so I returned for a follow-up and the test results were normal.
I switched to injectable progesterone, and the doctor said to come back if my period still didn't arrive.
I asked the doctor if this could be menopause, and he asked me what I thought.
Should I see the doctor again?

Xiao Xue, 40~49 year old female. Ask Date: 2014/06/04

Dr. Cai Yonglong reply Obstetrics and Gynecology

In Taiwan, individuals around the age of 45 enter menopause, with the average age of menopause being 49.8 years.
Blood tests for hormone levels should include estradiol and prolactin; if the former is too low or the latter is too high, menstruation may cease.
About 25% of individuals experience significant symptoms during menopause, while another 25% have no symptoms at all.
It is advisable to consult a gynecologist for accurate diagnosis and treatment.

Reply Date: 2014/06/04

More Info

When it comes to missed periods, especially if you've already consulted a doctor and undergone tests, it can be quite concerning. Based on your situation, where your last period was on March 22 and you have not had one since, it’s understandable to feel anxious about what might be happening with your body. You mentioned that you had blood tests and were prescribed progesterone (黄体素) to help induce menstruation, but your period still hasn't returned as of May 29.
Firstly, it’s important to recognize that missed periods can occur for a variety of reasons, including hormonal imbalances, stress, significant weight changes, excessive exercise, or underlying health conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders. Given that your doctor has already conducted tests and indicated that your results were normal, it may suggest that there isn't an immediate medical issue at hand. However, the fact that you are still experiencing amenorrhea (the absence of menstruation) warrants further attention.

You asked whether you should return to the doctor, especially considering the possibility of perimenopause or menopause. While menopause typically occurs in women between the ages of 45 and 55, perimenopause can start much earlier and is characterized by irregular menstrual cycles and other symptoms due to hormonal fluctuations. If you are in your 30s or early 40s, it is less common but not impossible for perimenopause to begin.
Here are a few reasons why you should consider seeking further medical advice:
1. Persistent Symptoms: If your period does not return after taking progesterone, it is essential to follow up with your healthcare provider. They may want to investigate further to rule out any underlying conditions that could be affecting your menstrual cycle.

2. Changes in Health: If you experience any other symptoms such as hot flashes, night sweats, mood swings, or changes in weight, these could be indicative of hormonal changes that need to be addressed.

3. Mental Health Considerations: The stress and anxiety surrounding missed periods can also impact your mental health. If you find that your concerns are affecting your daily life, discussing these feelings with your doctor can be beneficial. They may refer you to a specialist or suggest coping strategies.

4. Personal Health History: If you have a personal or family history of reproductive health issues, it’s crucial to keep your doctor informed. This information can guide them in making a more accurate diagnosis.

5. Regular Monitoring: Regular follow-ups can help track any changes in your menstrual cycle and overall health. This is particularly important if you are considering starting a family in the future or if you have other health concerns.

In conclusion, it is advisable to return to your healthcare provider for further evaluation. They may perform additional tests, such as hormone level assessments or imaging studies, to get a clearer picture of what might be causing your missed periods. Remember, your health is paramount, and it’s always better to err on the side of caution when it comes to changes in your menstrual cycle. Don’t hesitate to advocate for yourself and seek the answers you need for peace of mind.

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