Young female feeling down

—Candace*, Fresno, California 

Stress could be one possible explanation. But first, let’s make sure it’s not something else, such as pregnancy. Sometimes women (especially younger women and teens) don’t know they’re pregnant because their cycles can be irregular. If you’ve been sexually active, take a home pregnancy test or visit your gynecologist or a health clinic and ask for one. (If a home test is positive, you’ll also want to see a health care provider for a more accurate blood test).

Once you can confirm that you’re not pregnant, visit your health care provider or gynecologist to be evaluated. The history of your cycles and any changes in your body are important clues to determining the root of the problem.

Tracking your periods

First, take note of how long it’s been since your last period. Have you had any spotting (very light bleeding or brownish discharge) during that time frame? Were your cycles very regular (e.g., approximately every 28 days) or have there been long gaps between periods in the past?

Bring a log of your menstrual cycles to your health care provider when you visit. They’ll want to know the date of the first day of your last period, as well as your previous periods, to figure out how many weeks is typical for you between periods (give your best approximation if you don’t know exactly). A normal range for most younger women and teens is three to six weeks between periods. Women under 18 can be especially irregular, which can be normal.

The balance of hormones in the body

Any issue that has to do with your menstrual cycle is based on where your hormones come from. Normally, you have hormones from the brain affecting hormones in the ovaries, which can also be affected by other hormones in the body, such as those from the thyroid gland. This hormonal axis can be disrupted by too much or too little of other hormones. When the hormones are in sync, it results in a menstrual cycle including ovulation. When hormones are out of sync, it can lead to irregularity.

What can affect your cycles

The brain is affected by stress and changes in the body. Strenuous exercise, diet changes, weight gain or loss, eating disorders, recently added medications, and travel all affect the brain’s hormone levels. Telling your health care provider about any of these things or any other life changes can give clues to where the issue may be stemming from. Also, note any changes in hair growth on the body, acne, any recent surgeries in the pelvic area, family history of thyroid, fertility, or menstrual problems, vaginal dryness, and hot flashes.

At your office visit, you may have an examination of your weight, skin, hair, breasts, and, sometimes, a pelvic examination. They may also do some blood work to check hormonal levels. Sometimes you may need further testing and treatment.

If stress is the cause

Once everything else has been ruled out, it could be that stress is to blame. How can you treat it? Look at your lifestyle, including diet and exercise. Getting your weight in the ideal range can help regulate your menstrual cycle. To work on managing your stress, try stress reduction techniques, such as mindfulness practices, and consider seeing a therapist or other mental health professional.

*Name changed