Why Am I Not Getting My Period? Causes of Amenorrhea

A doctor listening to a woman talk about her period while sitting at a round white table in a white office.

“Why am I not getting my period?” It’s not an uncommon question, and while we talk a lot about what to do when your periods aren’t ‘normal’, we haven’t touched on what happens if your period isn’t coming at all.

Amenorrhea, or the absence of a period, is further broken down into primary and secondary. Primary amenorrhea is periods that never came when you were a young girl. Secondary amenorrhea is when it just stops suddenly or doesn’t come back after being away for a known cause (pregnancy, birth control, etc.).

Secondary amenorrhea is what we want to focus on first. Keep reading for the most common causes for why you might not be getting your period.

Why Am I Not Getting My Period?

Have you been on oral contraceptives since you were a teen? Are you trying for the first time to get pregnant after being on the pill for years? Many girls and women who are on birth control from early teens until the time they want to start getting pregnant are sometimes surprised that when they stop contraceptives, their cycles don’t immediately jumpstart and become consistent like they were told. While not getting your period back within three months is rare, it’s still something I like to talk about because I’ve seen over a dozen cases in the last few years. 

Let’s break down the system and identify where things could possibly go wrong post birth control.

The Period-Brain Connection

Your brain communicates with your ovaries via the hormones LH & FSH. FSH is your “follicle stimulating hormone,” and it tells your ovaries to start maturing the egg. LH is “luteinizing hormone” and it spikes at ovulation to catapult the egg out and into the fallopian tube.

One area of disruption of these communications is in the brain itself. Whether that’s in the hypothalamus or the pituitary, things like hormone-secreting accumulation of tissue (specifically prolactin) can disrupt that LH & FSH secretory process. If the ovaries never get the message, they don’t know to ovulate. And without ovulation, you might not have a period.

If you also have lower estrogen values, we look to the hypothalamus to jumpstart that hormone process. Remember from our hormone 101 class, estrogen is the hormone that thickens that endometrial lining and gives you blood to shed every month. If that lining isn’t built up by enough estrogen, there can be nothing to shed.

The Ovaries + Hormone Imbalances

A very obvious source where the issue can arise is in the ovaries. If your LH & FSH are slightly elevated or even normal but you’re still wondering, “why am I not getting my period?,” we look to the ovaries. Conditions such as polycystic ovarian syndrome (PCOS) can show up in other lab values or even on an ultrasound, and can cause periods to be erratic.

If you’re not ovulating, we target the ovaries and provide nutritive, antioxidant and herbal support of ovulation and progesterone. Boosting those can help restart your period.

The Body Knows Best

As we all know, your body is an interconnected system, and if you’re not getting your period and your hormones appear balanced, something else could be amiss. Yes, ovulation is controlled by the brain and completed by the ovaries—but if your body is a train wreck, it will affect your cycle. Here are a few other things that seem unrelated, but could be causing your lack of periods:

  • Pregnancy (duh—but this is ALWAYS our first test!).
  • Not eating enough calories (as evidenced by performance athletes and disordered eating patterns).
  • Having high inflammation & low antioxidant status.
  • Having an abnormal thyroid (hypothyroid).
  • Having elevated or deficient cortisol (adrenal fatigue can increase FSH and LH).
  • Autoimmune disorders such as celiac disease & Type 1 Diabetes.

This is just the beginning of understanding how your body works in tandem with your brain and your ovaries to produce a healthy cycle that results in a period. We’ll talk more about treatment plans and labwork soon, but if you want more of a deep dive into periods, check out our hormone series, how stress can impact your cycle, the potential side effects of hormonal contraceptives, and a full guide to nontoxic period care.