Irregular Periods, PCOS and POF
Irregular periods are not uncommon in young girls who are just beginning their menstrual cycles. In fact, it can take up to three years for period cycles to become stable. Even after that time, menstruation periods can fluctuate. However, by keeping track of your periods, it is possible to know relatively accurately how many days there are between cycles. Some women have a 28 day cycle while others are 22 days or even as long as 35 days. Regardless, what is normal for one is not necessarily normal for another.
Missed Periods But Not Pregnant?
As time goes on, if your period cycle does not stabilize, or if it has been stable and then amenorrhea (missed periods for three months or more) occurs, it is wise to see your doctor. There are several reasons for missed periods and some of them are due to circumstances. For instance, it is possible to miss a period if you are under extreme stress, if you exercise too often and too hard, if you have an eating disorder or, of course, if you are pregnant. However, sometimes missed periods are due to disorders or conditions that are not provoked externally.
Polycystic Ovarian Syndrome
One such situation is polycystic ovarian syndrome (PCOS). PCOS is an imbalance of hormones between the brain and the ovaries. It essentially means that the ovaries are not getting the correct signals from the pituitary gland - where luteinizing hormone (LH) and follicle stimulating hormone (FSH) are made - without which you will not ovulate. The result will be either irregular periods or no period at all.
During a regular menstrual cycle the brain sends LH and FSH to the ovaries. The LH surge signals the ovaries to release an egg (ovulation). The egg makes its way down the fallopian tube and into the uterus where a lining awaits a fertilized egg. If the egg isn't fertilized, the uterus sloughs off the lining - your period arrives. Then the whole process begins again. If you have PCOS, your LH levels are usually quite high at the time menstruation is set to begin, and they are higher than FSH levels. Since LH levels are already high, there is no surge, without which there is release of an egg from the ovaries and irregular periods occur. This condition begins in young girls and continues through adulthood, affecting fertility and the ability to have children. Often women with PCOS have IVF in order to have children.
Premature Ovarian Failure
While irregular periods can be an indication of high levels of hormone release, as in PCOS, they can also signal hormonal shortage that could lead to osteoporosis in young women. A condition known as premature ovarian failure (POF) affects about one percent of American women who develop the condition by the time they reach the age of 40. Premature ovarian failure is a condition in which the ovaries stop producing eggs and the hormones necessary for reproduction well before the time of menopause - which usually begins in the late 40s and early 50s.
A study was done by the National Institute of Child Health and Human Development (NICHD) in which 48 women with POF were interviewed between September 2000 and June 2001. Most of the women who were in the study had experienced amenorrhea before the diagnosis of POF was given. The majority of those involved did not think that missing their periods for an extended time was a cause for concern. The fact that these women did not consider a change in their menstruation cycle an important health issue may contribute to the delay in being evaluated and diagnosed.
These results prompted Duane Alexander, M.D., Director of the NICHD, to comment, "These findings suggest that women and their physicians may want to err on the side of caution and evaluate menstrual irregularities early."
Don't Delay Diagnosis
Since missed periods are not out of the ordinary for women - many miss up to three periods a year - it is reasonable to see how you might downplay the issue. But, the delay in obtaining a diagnosis and treatment can increase the risk of developing osteoporosis later on. Because of the delay in diagnosis and the benefit of hormonal treatment, many women who have POF lose enough bone density to create a risk of fractures as well as developing osteopenia, the precursor to osteoporosis.
Osteoporosis occurs as a result of lost bone density which weakens the bones and makes them more susceptible to breakage. The hormones produced by the ovaries, estrogen and the other hormones needed for reproduction, help to maintain bone density. Menopause is a time when those hormones are reduced or production has ceased. However, for younger women with POF who lack sufficient hormonal production, the risk of developing the condition is significantly higher.