There are many reasons a woman’s period may be late or her cycle may go off schedule. An obvious one is pregnancy. Others include poor nutrition, excessive exercise, and long-term illness. A less obvious reason for amenorrhea or missing a period, however, is depression.
The link between mental health and reproductive health makes sense when you consider that nature does everything it can to create favorable conditions for reproduction.
If a woman is chronically stressed, anxious, sad, or upset, she’s really not in a physical or emotional position to go through a pregnancy and then take care of and nurture a child. Under these less than ideal conditions, the female reproductive system can shut down.
How Depression Affects the Menstrual Cycle
The stress hormone cortisol is primarily responsible for changes in a woman’s cycle when she’s depressed. As cortisol levels rise in response to stress, the hypothalamus, an organ in the brain that plays an important part in regulating the reproductive system, stops sending signals to the ovaries to do their job.
Without this signal, ovulation (the monthly release of an egg from the ovary) is either delayed or stopped altogether. The result is a late period or sometimes no period at all.
The medical term for absent periods when there’s no pregnancy is amenorrhea, which also can be caused by health issues other than stress including problems with the hypothalamus, the pituitary glands, the ovaries, the uterus, or the vagina.
Pinpointing the Cause of a Missed Period
Of course, the first thing you should do if your period is late is to take a pregnancy test, which can be accurate as early as the first day of your missed period. If it’s negative and you don’t get your period in a few days or you completely skip it that cycle, or if you’re having chronic problems with menstruation, make an appointment to see your gynecologist.
She’ll likely do a repeat pregnancy test. If it’s negative, she’ll move on to some basic evaluations such as asking you about your medical history, doing a pelvic exam, and taking blood samples to check your hormone levels.
Depending on what these preliminary tests reveal, plus other basic factors such as your age, she may move on to more specific diagnostic methods, which may include:
Chromosome evaluation to look for chromosomal variations such as Turner syndrome
Genetic testing to see if you have fragile X syndrome
A hysteroscopy to examine the inside of your uterus
An MRI to check for a pituitary tumor
An ultrasound computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to make sure your reproductive organs are normal
Is Depression the Problem?
Amenorrhea caused by chronic stress and depression is called hypothalamic amenorrhea. If you tend to eat more or less than usual when you’re depressed and have gained or lost weight, that also could play a part in your menstrual irregularities.
If your doctor has determined that depression is behind your late or missed periods, getting back on track will be a matter of finding an effective way to reduce your stress and treat your depression.
There are many different ways to treat irregular or absent periods depending on your overall mental health and menstrual irregularities. This can include a wait and see approach (if it’s only happened a handful of times), stress management strategies, therapy, and/or prescription medication.
Consult with your gynecologist or mental health care professional to determine the type of treatment plan that’s best for your physical and mental health.
Making an effort to manage stress will reduce your risk of becoming depressed and missing your period. In addition to eating a well rounded diet and practicing good sleep hygiene, try to incorporate stress-lowering activities into your day.
While there isn’t a one size fits all option when it comes to stress relief, a few ideas to consider include:
Light exercise (such as walking)
Support groups (online or in-person)
An antidepressant, such as Prozac (fluoxetine) or Zoloft (sertraline), can be an effective way to relieve symptoms of depression—but it’s not right for everyone. In addition to possible side effects, some antidepressants can even cause your period to be late or delayed.
You may even be prescribed oral contraceptives to create a regular schedule of withdrawal bleeds, however, combination birth control pills have been linked to depression, so make sure to alert your doctor to your mental health history. It may take some trial and error, but it is possible to get back to feeling normal and your body back to functioning normally.